The news of the Scott sisters' pardon from lifetime prison sentences in Mississippi is first and foremost a story of cruel (though, arguably, not-so-unusual) punishment, belatedly rectified. But what made the headlines, of course, was the condition Gov. Haley Barbour set for their release: Gladys (age 36) must "donate" a kidney to her older sister Jamie, whose own kidneys have been destroyed by poorly controlled diabetes and hypertension. (By coincidence, no doubt, Gladys' release will also rid the state of the very expensive obligation to treat her for end-stage renal failure.)
This deal, with its taint of coercion, will no doubt reinforce the view of many people that material incentives shouldn't be used to create a market for organs from living persons, or even from cadavers. If money changes hands, who's to stop authoritarian governments from executing prisoners in order to harvest their body parts? Who's to stop an entrepreneur in Mumbai or Lagos from buying kidneys and the occasional resected liver from people struggling to earn enough to feed their families?
But, to my mind, these dark scenarios shouldn't be the only considerations in regulating the exchange of human organs. Don't forget that the quantity of compatible organs available for transplant in the United States is only a small fraction of the number that could be used to extend lives. Moreover, as the technology for organ transplants continues to improve, one would expect the gap between supply and demand to grow.
Are we stuck, then, with the ugly reality that tens of thousands of patients on transplant waiting lists must die unnecessarily each year?
The least controversial possible fix - one in the spirit of "Nudge" the remarkable book by Cass Sunstein and Richard Thaler - would be to require people to declare whether they wish to be organ donors when they get their driver's licenses. Sounds great, and is probably worth trying. Or rather, trying again: Texas and Colorado both abandoned this approach, apparently because drivers found the requirement to make a choice offensive.
So, there doesn't seem to be an obvious way to finesse the big question: How about paying people to do the right thing? I would certainly favor an offer of government cash (or tax credits) to the families of brain-dead patients. And (unlike a lot of other people) I would go much further, allowing competent adults to sell their own organs in a highly regulated environment - one in which the transaction would be permitted only if the risks to the donor were judged to be modest and consent was well-informed.
Are you offended by the notion? Then maybe you should also be offended by the fact that employers pay premium wages to induce people to do dangerous jobs, or by the government's policy of paying soldiers extra when they are stationed in combat zones.
At very least, we ought to be discussing new ways to increase the supply of organs. The current system isn't working nearly well enough.