The Good Fight Al Roth on Why People Should Be Free to Sell Their Kidneys
May 12, 2026
Alvin E. Roth, Nobel Prize–winning economist and market designer, explains how market design can fix broken exchanges. He discusses kidney shortages and the debate over paid donation. He explores kidney exchanges, moral disgust around buying organs, and pragmatic experiments on payments. He also compares organ markets to plasma, drugs, and sex work to show how norms shape economic outcomes.
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Kidney Exchange Multiplies Living Donor Transplants
- Kidney exchange increases transplants by swapping incompatible living donors so patients get compatible kidneys.
- Alvin Roth explains chains of exchanges let donors give to different recipients, enabling thousands more living-donor transplants each year.
Illicit Organ Markets Are Dangerous Because They Bypass Medicine
- Illegal markets for kidneys create low-quality, dangerous surgeries because they operate outside medical establishments.
- Roth argues legal, well-regulated payments would reduce black markets and improve safety for donors and recipients.
Payments Usually Increase Supply Despite Crowding Out Gifts
- Paying donors may crowd out altruistic donations but economic history shows payments increase total supply enough to compensate.
- Roth uses blood plasma: paid US donors supply ~70% of world plasma, eliminating shortages elsewhere.
