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When the Patina of Empirical Respectability Wears off: Motivational Crowding and Kidney Sales

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Abstract

An increasingly common objection to kidney sales holds that the introduction of monetary incentives may undermine potential donors’ altruism, discourage donation, and possibly result in a net reduction in the supply of kidneys. To explain why incentives might be counterproductive in this way market opponents marshal evidence from behavioral economics. In particular, they claim that the context of kidney sales is ripe for motivational crowding. This reasoning, if sound, would have a profound influence on the debate over kidney sales. What’s perhaps the principal reason to favor a market – the increase in supply it would bring – would be called into doubt. However, on inspection it becomes apparent that the evidence touted by market opponents not only lends no credence to their claims, but also provides some positive reason to doubt them. The near-ubiquitous references to motivational crowding in the literature on kidney sales are fundamentally misplaced.

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Notes

  1. For example, Davis and Crowe (2009) hold that a market would compromise the ends of medicine. Hughes (1998) opposes sales with reference to a Marxian conception of exploitation. Cohen (2002) takes them to be incompatible with the political ideals of liberalism. On the other side, Cherry (2005) argues from a conception of the state’s legitimate authority to the permissibility of kidney sales. What’s common to these views is that facts about the market’s productivity are beside the point.

  2. See, for example, Rippon (2014), Malmqvist (2014), and Koplin (2014).

  3. See, for example, Stephen Wilkinson (2003), Hippen (2005), Taylor (2005), T.M. Wilkinson (2011).

  4. This term and its cognates are often used in a colloquial sense to indicate that one group has become so successful so as to replace alternatives. By contrast, notice that this term essentially involves the influence of explicit incentives on intrinsic motivation.

  5. Part or all of this exchange, in more or less the same form, appears often in the literature. See, for example, Capron (2014), Danovitch and Leichtman (2006), Capron, Danovitch, and Delmonico (2014), Rippon (2014), Koplin (2017a, 2017b), Rothman and Rothman (2006), and Delmonico et al. (2015).

  6. This is the response offered in, for example, Taylor (2005), Hippen and Satel (2008), Epstein (2008), and TM Wilkinson (2011).

  7. Here I follow Frey and Jegen (2001). See that work for more of the distinction between Motivational Crowding and non-theoretical notions.

  8. This name is borrowed from Frey (1997) who’s referencing Hume. It also appears in Bowles (2008).

  9. For a survey of the evidence on the significance of pro-social behavior see Meier (2007).

  10. For a frequently-cited survey of the evidence for Motivational Crowding, including discussion of the various contexts in which it occurs, see Frey and Jegen (2001). For a more recent and comprehensive survey of work related to the failure of the Separability Assumption, see Bowels and Polanía-Reyes (2012).

  11. They are Rothman and Rothman (2006), Danovitch and Leichtman (2006), Sandel (2012), Capron (2014), and Koplin (2015b) which is presumably supposed to be Koplin (2015a).

  12. For a survey of donors’ motives, and discussion of what influences them, see Dew et al. (2007).

  13. For discussion of these harms, see Gordon (2001); Kranenburg et al., (2007); Scheper-Hughes (2007). Costs borne by donors are non-trivial (Klarenbach et al., 2014). Recent estimates suggest $10,000 (McCormick et al. 2018).

  14. It has been estimated that a transplant from a single living unrelated donor saves about $100,000 relative to the cost of dialysis (Matas and Schnitzler 2003). More recently, it has been shown that compensation as high as $375,000 per kidney would cut costs (Held et al. 2016).

  15. For example, Koplin cites Sandel (2013) and Gneezy, Meier, and Rey-Biel (2011).

  16. A noteworthy exception is Rippon (2014), who cites a more recent paper on blood procurement (Mellström and Johannesson 2008). That study is interesting, not because it supports the Appeal to Crowding – it does not – but because it suggests that the effects of Motivational Crowding may be mitigated or eliminated by including a charity option alongside the option for payment. This points to the significance of market design, an issue conspicuously absent from Pessimists’ discussion.

  17. See Semrau (2014) for discussion.

  18. See Koplin (2017a; 2015a), Capron, Danovitch, and Delmonico (2014), and Delmonico et al. (2015).

  19. See, for example, Danovitch and Leichtman (2006), Koplin (2017a), and Delmonico et al. (2015).

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Acknowledgments

For constructive feedback I thank Andrew T. Forcehimes, Peter Jaworski, Magdi Semrau, participants of the workshop at the Georgetown Institute for the Study of Markets and Ethics, and two anonymous reviewers for this journal.

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  1. McDonough School of Business, Georgetown University, Rafik B. Hariri Building, 3700 O St NW, Washington, DC, 20057, USA

    Luke Semrau

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Semrau, L. When the Patina of Empirical Respectability Wears off: Motivational Crowding and Kidney Sales. Ethic Theory Moral Prac 22, 1055–1071 (2019). https://doi.org/10.1007/s10677-019-10034-6

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