An Economist’s Case for Selling a Kidney

*Felix Salmon for Bloomberg News*

You almost certainly have two kidneys. There’s a smallish number of people to whom you might donate one of your kidneys, if it would save their life. Likewise, there’s a smallish number of people who would donate one of their kidneys to you, were you to need one. The problem is that there’s a high probability that none of those potential donors are compatible with you. To put it another way: Your spare kidney can save a life, but it probably can’t directly save the life of any of the individuals you care about the most.

Stanford University economist Alvin Roth won a Nobel Prize for his contributions to the most common solution to this problem, the donation chain. The insight is that if you’re willing to give up a kidney to save my life, maybe you don’t need to donate that kidney *to me*. Your kidney can go to someone compatible, while my replacement kidney comes from someone else’s loved one. By kick-starting a chain, a single altruistic donor can end up saving dozens of lives.

Roth tells this story in his most recent book, *Moral Economics* (Basic Venture, May 12), which, at least in part, is an attempt to apply the empiricism of economics to domains that are often resistant to such analysis. The opposition to the 2015 kidney chain, for instance, comes from nephrologists who have no problem with chains but who draw the line at international chains, or at least chains linking poor and rich countries. Such objections turn out to be almost impossible to express in terms an economist can understand: Even if there’s an economic component to them, at heart they’re just not economic arguments.

[Read the full review here.](https://www.bloomberg.com/news/articles/2026-05-08/why-decriminalizing-sex-work-surrogacy-and-kidney-sales-makes-economic-sense?accessToken=eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJzb3VyY2UiOiJTdWJzY3JpYmVyR2lmdGVkQXJ0aWNsZSIsImlhdCI6MTc3ODI1ODgyOCwiZXhwIjoxNzc4ODYzNjI4LCJhcnRpY2xlSWQiOiJURVBKSURLSVAzSkQwMCIsImJjb25uZWN0SWQiOiJEMzU0MUJFQjhBQUY0QkUwQkFBOUQzNkI3QjlCRjI4OCJ9.yH6coIfdJ9JSIwuJYXc_gVJTzbD19ZCNLElVtG3PCc4)