Book Review by Lily P (U6th) - Who Gets What and Why


This book investigates the capitalist world we inhabit, it explores how finite resources are allocated using the example of kidney exchange. Alvin E Roth is a Nobel Prize winning economist who used game theory to save thousands of lives by improving allocative efficiency in the market for kidney exchange.  In the USA in the early noughties, two-way kidney was pioneered; this occurs when two donor/recipient pairs trade organs for a better compatibility match. The system was long and slow with donor/recipient pairs having to wait long time to find a compatible matching pair; this was inefficient as many matching markets are.

Alvin E Roth realised that if the correct algorithm was designed matches of up to 12 parties could occur; meaning the donor from pair 1 gives the kidney to the receiver from pair 2 and then the donor from pair 2 gives the kidney to receiver 3 and so on, all the way along the chain until the receiver from Pair 1 receives a kidney from the Pair 12 donor. This hugely shortened the average waiting time for kidneys, vastly improving the lives of all effected. This book raised many ethical questions in an economic environment; kidney exchange is a controlled market therefore, meaning that individuals cannot sell their kidneys and the government decides who gets which kidney. This leads to great shortages in the market, resulting in millions of people worldwide living on dialysis; allowing people to sell kidneys would result in a market equilibrium in which demand would equal supply and therefore, the kidney shortage would be eradicated. There are strong arguments for and against; would this would lead to the exploitation of the less well-off where those with lower incomes may feel forced to sell their kidney? Would this mean that the rich would benefit, being able to pay higher prices for the all-important good? Or is there a way in which the market for selling kidneys can be regulated to prevent exploitation but still shorter the fatally long waiting list. I ask you the question, should we be allowed to sell our kidneys?  

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