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A place to hash out the things that we’re not really supposed to talk about, but want to anyway. Equal parts naughty and enlightening, and always worth discussing for days.

Operating table with surgical tools on table and kidney being ready for surgery
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Source: Brendan Smialowski/Getty

Provocative Daily Topic

Here's One Way to End the Kidney Shortage: Eminent Domain

Why you should care

Isn’t it better for the government to take your kidneys when you’re dead than to take your house while you’re alive? 

There is a serious kidney shortage in the U.S. Donation-only may be a nice way to handle kidney transplants, but it is also deadly deficient.

According to the National Kidney Foundation, 16,812 kidney transplants took place in 2012 (with 11,043 kidneys coming from deceased donors and 5,769 from living ones), and 4,903 patients died while on a wait list. As of June 2013, there are 96,645 people on that list, and nearly 3,000 new patients are added each month. 

Eminent domain is commonly used to take property to make room for building roads, airports and so on.

To make up for the excess demand, what if kidneys were made part of eminent domain? What if, when we died, our bodies became property of the state, allowing the government to take ownership of our organs for public use? 

x-ray film in black and white showing kidneys being highlighted in orange

Source: Corbis

Economists have long been known to champion market solutions for these types of issues. Because people have two kidneys but need only one to live, we all have a spare. Nobel Laureate Gary Becker calculated that if kidneys were salable, the price would likely be around $15,000 per kidney (in 2005 dollars). But economics is about more than market solutions; it’s about moving resources to their highest-valued use. Markets are one way to do that, but they don’t always work well, and they are sometimes deemed unacceptable even when they do work well. Here’s another approach that can be supported by economic reasoning: Let the government use its power of eminent domain to take kidneys from every recently deceased person. 

Eminent domain is commonly used to take property to make room for building roads, airports and so on. But the system has inherent problems. First, because property is seized without negotiation (compensation is mandated but not bargained over), it may move a resource to a lower-valued use. Second, it may encourage people not to care for property that may be taken. Third, it may encourage people to devote wasteful resources toward protecting their property from being taken. Finally, it is upsetting to people that their property can be seized at any time.  

Some may find the proposal disturbing, but isn’t it disturbing that so many die waiting for a transplant?

When we look at kidney transplants, is it not most likely that the recipient will value the kidney more than the deceased? People are unlikely to purposely degrade their kidneys with the specific intention of preventing them from being taken — and just as unlikely to devote resources to dying in seclusion so their kidneys can’t be harvested in time. 

Will most people find eminent domain objectionable when it comes to organ harvesting? Most probably yes. 

But if repugnance is the main criticism, keep this in mind: Kidneys would not be taken simply at the whim of the medical profession but for the sole purpose of saving lives. Also, repugnance is a two-way street: Some may find the proposal disturbing, but isn’t it disturbing that so many die waiting for a transplant?

Surgeon holding live kidney during operation with body below kidney showing

Source: Corbis

Surgeon James Guarrera prepares a donated harvested kidney for transplant, New York, August 1, 2012.

It comes down to simple economics: supply and demand. The substantial benefit of eminent domain is that it maximizes the number of kidneys available for transplant from the deceased, thereby addressing the excess need. Furthermore, it can be a short-term solution used to reduce the current shortage, just as military conscription is sometimes used in times of war. 

Opponents of eminent domain, regardless of the setting, will find this proposal abhorrent. But if you believe eminent domain is a valid way to reallocate resources in certain settings, as many economists do, why not use it to alleviate the kidney shortage? Wouldn’t you prefer to have the government take your kidneys when you’re dead than to take your house while you’re alive? 

Will this proposal be taken seriously by anyone in a position to change things? Of course not. But extreme solutions to extreme problems are perfectly valid. Most importantly, we need to address the kidney shortage. It’s time to stop being nice and start saving lives.

Harold Winter is a professor in the Department of Economics, Ohio University, and author of a number of books on the economics of public policy, including ”Trade-Offs: An Introduction to Economic Reasoning and Social Issues” (Second edition, 2013, University of Chicago Press) and ”The Economics of Excess: Addiction, Indulgence, and Social Policy” (2011, Stanford University Press).

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