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The Economic Solution to Kidney Shortages

By Walter Block

February 25, 2026

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We all know what kidney failure is. It is the inability of this organ to function properly. When this occurs the only present long-term, adequate solution is transplantation of a healthy kidney from someone else. Dialysis is a palliative; it can keep people alive, postponing the eventual death that is the fate of those with this dreaded disease. Here, a machine does the work of this human organ. Patients are hooked up to it for many hours each day, in great discomfort. Transplantation from other animals, such as the pig, might well be a solution, but only as a possibility, and only in the future.

Donating one of them requires major surgery; thus, such transfers are to a great degree limited to relatives and close friends.

Right now, there are some 80,000 Americans suffering on dialysis machines for lack of a transplant. Why is there a shortage of kidneys for donation? Healthy people have two functioning kidneys; only one of them is needed for full functioning. But donating one of them requires major surgery; thus, such transfers are to a great degree limited to relatives and close friends. It is heroic to donate to a total stranger; it occurs too few times, at present, to constitute a satisfactory solution. Moreover, potential donors worry that if their one remaining healthy kidney fails, will someone else step up to the plate on their behalf?

Why are organs such as kidneys for transplant in short supply? This is due to the fact that we as a society are mobilizing only one motive that enables us to solve such problems: benevolence. But this, sadly, is also in short supply. Why does this problem arise in this context and in virtually no others? Because with regard to other life-saving products, such as food and clothing, we marshal one other, often far-stronger motivation: self-interest. Said the father of economics Adam Smith on this matter: “It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own self-interest. We address ourselves not to their humanity but to their self-love, and never talk to them of our own necessities, but of their advantages.” It is time, it is way past time, that we utilize some of these market incentives to stop all these needless deaths, and suffering on dialysis machines.

Whenever there is a shortage of anything, college students are taught in courses of Introductory Microeconomics 101, that price controls are to blame. A price ceiling, set below the equilibrium level, the price that would otherwise obtain, leads to a situation where demand is greater than supply. In other words, a shortage.

Is there such a regulation now in operation in this small but important part of the economy? Unfortunately, there certainly is: There is a price control of zero on the law-books. That is, donors may freely donate these parts of their bodies for free (with minor exceptions for the cost of a stay in the hospital, transportation, compensation for salary loss, etc.). However, it is illegal for them to charge anyone a significant fee for this life-saving offer.

Eliminate this one pernicious law, and the entire problem disappears, in one fell swoop.

Do we have waiting lists for other life-supporting items? For food? No. Do we have waiting lists for clothing? No.

Do we have waiting lists for other life-supporting items? For food? No. Do we have waiting lists for clothing? No. Are people forced to do without? Of course not. This applies, even, for relative luxuries such as cars, clocks or coloring books. The very idea is silly; preposterous. Why not, pray tell? Because we have free markets in operation regarding these items. There are no price controls of zero on any of these products. They are allowed to be bought and sold. They are commodified.

Why do we not unleash the powers of free enterprise in this organ transplant sector of the economy?

Why do we not unleash the powers of free enterprise in this organ transplant sector of the economy? Our present laws do not allow it. Why, in turn, does this occur? It is due to philosophers and legal theorists such as Elizabeth Anderson, Francis Delmonico, David Rothman, Michael Sandel, Debra Satz, Nancy Scheper-Hughes, who have perpetrated, promoted and promulgated the idea that ordinary motivations cannot be allowed to come to the rescue of the thousands of people who are now on waiting lists to receive these vital organs. These people, in addition to those who actively uphold these laws, judges, policemen, legislators, are responsible for the deaths of many innocent people. It is difficult to dismiss the view that they are in effect murderers.

Cadaverous organs would also be forthcoming in far greater numbers given incentives operational under a regime of free enterprise. Have you yet signed that form donating your organs after death? No? Would you do so if the economic incentives were vastly increased? Many more would indeed do so. Supply curves slope in an upward direction, students of Econ 101 are taught: ‘tis true!

The problem, now, with supply from this source is that the parents, guardians, relatives of those suddenly overtaken by death (such as those who perish from motor vehicle accidents) are asked to donate to the needy the organs of their kinsmen. All too often they are so engaged in grieving, they do not give permission. But if contracts were already signed, and paid for, then this source of organ donation would go a long way in the direction of solving this challenge.

Cadaverous organs would also be forthcoming in far greater numbers given incentives operational under a regime of free enterprise.

Apart from the revulsion felt by some socialists at the purchase and sale of kidneys, are there any objections to this “modest proposal”?

There are two. First, the poor would be donors. The sale of a kidney for transplant might range in the tens of thousands of dollars, and this would be unfair to them. But it is unclear as to why this would be so. Should not the impoverished be legally allowed to take advantage of the “human capital” they own? Why should poor people be prohibited from earnings from this source? In any case, it is likely that cadaveric organs might take up virtually all of the present slack.

Second, the organ pirate! If there were a market in this human commodity, criminals would seize the organs of innocent people, killing them, in order to make a profit. But to say this is to reckon in the absence of supply-and-demand analysis. At present, there is a black market for kidneys; there always is, whenever government is unwise enough to institute price controls. Nowadays, the voluntary supply of these organs is relatively low, due to these laws. But with a low quantity available, prices will be relatively high. Under free enterprise, the supply will increase. Thus, its price will fall. The point is, there is now a greater danger of organ piracy than under free market institutional arrangements. The temptation of piracy will decrease, not increase, with the elimination of these laws.

 

 

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