The Big Donor Show

I have to admit that I'm entirely disgusted by this TV show, The Big Donor Show, coming out of Holland.

The Dutch broadcasters of a reality show in which chronically ill contestants battle to win a life-saving kidney from a terminally ill cancer patient have faced international condemnation.

The producers say the programme will help to raise awareness of the ordeal of waiting for an organ donor.

The Big Donor Show, made by the same company behind Big Brother, has provoked calls in the Dutch Parliament for it to be banned from being broadcast on Friday.

No, it's not the unease that such a thing is either made or shown on TV, the depths to which people will plumb for ratings doesn't surprise me. It's this:

The Dutch government and medical professionals say the programme is "unethical".

What is unethical are the current arrangements for organizing (sorry) the whole process of garnering kidneys for transplant. You see, under the guise of "ethics", many thousands of people are condemned to lengthy and painful dialysis treatment, many of whom die before they receive a new kidney. And yet we know how to solve this:

Which brings us to an interesting piece in The Economist this week on kidney transplants. Just over 4,000 people died while waiting for a kidney in the US last year so we would of course like to increase the supply. Theory would suggest that allowing healthy people to sell a kidney would help and the risk to them of doing so is small:

What's more, having a kidney removed is as safe as common elective surgeries and even beauty treatments (it is no more dangerous than liposuction, for example), which sets it apart from other types of living-organ donation. America already lets people buy babies from surrogate mothers, and the risk of dying from renting out your womb is six times higher than from selling your kidney.

How does that theoretical answer stack up against the real world results?

That's what Iran has done. An officially approved patients' organisation oversees the transactions. Donors get $2,000-4,000. The waiting list has been eliminated.

Interesting don't you think? Theoretical and real world results coincide, we can solve the shortage of a scarce resource by instituting a market in it. Said market also producing better results than appeals to altruism.

Yes, Iran (!!) is the only place in the world without a waiting list (OK, only place with a functioning health care system without one) and is the only place in the world with a financial market for kidneys.

We don't adopt that policy because there are people who get the vapours over the idea of markets and money being involved in health care. That is, the ethics of some lead to a profoundly unethical result, that people die as a result of the desire for financial purity.

As Milton Friedman pointed out, it's outcomes that matter, not intentions.

What's worse is that this is not news to those who decide our policies on such matters. But they condemn those thousands to death rather than allowing icky things like markets to solve the problem.

Now that is unethical.