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December 30, 2010, 12:30 PM

Freakonomics Radio: You Say Repugnant, I Say … Let’s Do It!

By STEPHEN J. DUBNER

Photo: Magnus D

PODCAST

Freakonomics Radio

You Say Repugnant, I Say … Let’s Do It!: What’s wrong with paying for human organs?

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Some ideas are downright repugnant. Like …paying for human organs.

On the other hand, is it any less repugnant to let thousands of people die every year for want of a kidney that a lot of people might be willing to give up if they were able to be compensated?

Our new podcast ventures into the realm of repugnant ideas. (You can download/subscribe at iTunes, get the RSS feed or listen live via the link in box at right.) The fact is that the repugnance border shifts over time. Selling eggs or sperm, “renting” a womb — not long ago, all of this was considered way out of bounds. So was birth control and adoption. Go back a bit further in history: currency speculation, charging interest on loans, even selling life insurance — these practices, too, were almost universally felt to be repugnant.

Will the border shift for human organs as well? Should there be a legal market for organs? (At the moment, only Iran has one.) And if not, what should we be doing to help alleviate the massive world demand for transplantable organs, especially as the increase in diseases like diabetes continue to drive kidney failure?

Steve Levitt kicks off our journey through the repugnant by describing why economists can be useful in such conversations:

Economists are pretty much immune to repugnance. Either by birth or by training, economists have their mind open, or skewed in just such a way that instead of thinking about something in terms whether something it’s right or wrong, they think about it in terms of whether it’s efficient whether it makes sense…and many times the things that are most repugnant are the things that are quite efficient — but for other reasons, subtle reasons sometimes, are completely and utterly unacceptable.

The star of the podcast is Harvard economist Al Roth (the dean ofrepugnant ideas), who has thought a great deal about the organ problem. But more than that, he has actually done his part to help, helping to found theNew England Program for Kidney Exchange. Here, from SuperFreakonomics Illustrated, is a look at how it works:

The Harvard economist Alvin E. Roth, a specialist in market design, helped invent a “paired donation” organ exchange that finds matches for compatible organ donors. Here’s how it works: A willing donor enters the exchange along with a person she wants to give an organ to (her husband, for instance) but with whom she is biologically incompatible. This pair is matched with a similar pair of people so that each pair’s donor is compatible with the other pair’s recipient. Although this organ-for-organ transaction is in fact a sort of market, it doesn’t provoke the repugnance of a cash exchange.

But Roth knows that, given the scope of the problem, a program like his doesn’t help all that much. Here’s how he puts it in the podcast:

There’s an enormous social cost that people pay personally when they’re ill, that we pay as a society to have them ill and dying, and that cost weighs very heavily on me as I see it. When I started thinking about kidney exchange, the waiting list was on the order of 50,000 people and now it’s getting near 90,000 people. So kidney exchange is a small but fast growing source of live donors, but it’s like trying to hold back the tide with a broom.

You’ll also hear from two doctors — one an Israeli transplant surgeon, the other a New York emergency-medicine specialist — who stare the existing organ-donor protocols in the face and spit on them. Because sometimes the best way to fight repugnance is with a little repugnance of your own.

In Israel, Jacob Lavee was so outraged by the low organ-donor rates that he pushed for a law that gives medical preference to people who sign up to be organ donors. It’s called Give Life, Get Life.

And in New York, we spoke with Lewis Goldfrank, the driving force behind a new Organ Preservation Unit — whose goal is to increase organ donation by making house calls.

Brilliant? Repugnant? Maybe … both?

Hope you enjoy the program.

FDNYNew York’s new Organ Preservation Unit, making house calls.

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Stephen J. Dubner is an author and journalist who lives in New York City.