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Repugnant transactions Al Roth Harvard University. Kahneman Lecture IAREP/SABE World Meeting 2008 at LUISS, Rome September 4, 2008. Plan of the talk. Introduce what I mean by repugnant transactions and try to convince you that there are a lot of them around.

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repugnant transactions al roth harvard university

Repugnant transactionsAl Roth Harvard University

Kahneman Lecture

IAREP/SABE World Meeting 2008 at LUISS, Rome

September 4, 2008

plan of the talk
Plan of the talk
  • Introduce what I mean by repugnant transactionsand try to convince you that there are a lot of them around.
  • Survey repugnance more systematically and try to convince you that it may be important in the economy.
  • Consider some reasons why adding money to a transaction sometimes makes it repugnant (with special attention to kidney sales)
  • Outline some research directions.
slide3

Section 301 of the National Organ Transplant Act

(NOTA), 42 U.S.C. 274e 1984 states:

“it shall be unlawful for any person

to knowingly acquire, receive or otherwise transfer any human organ for valuable consideration for use in human transplantation”.

slide4

Article 21 of the Council of Europe’s (2002) Additional Protocol to the Convention on Human Rights and Biomedicine, on Transplantation of Organs and Tissues of Human Origin:

“The human body and its parts shall not, as such, give rise to financial gain”

you can t eat horse or dog meat in a restaurant in california
You can’t eat horse or dog meat in a restaurant in California.
  • It’s against the law.
    • California Penal Code Section 598 states in part “…horsemeat may not be offered for sale for human consumption.”
  • Many Californians find it repugnant that anyone should eat a horse
    • and this repugnance was enacted into law, by popular referendum (Prop. 6 in 1998)
note there aren t laws against eating cockroaches
Note: there aren’t laws against eating cockroaches
  • A big part of behavioral economics focuses on regularities in peoples’ tastes that were unmodeled in classical models.
    • Strong tastes for avoiding losses, for fairness, for immediate as opposed to delayed rewards…
  • These are largely tastes revealed in choices that people make for themselves.
  • My talk today is about tastes that people have concerning choices that other people might make—I’m going to argue that these have big consequences in what markets we see.
    • This is something I see as a market designer, even for markets and allocation mechanisms more usual than kidney exchange.
slide7
The law against eating horses is different from laws that seek to protect consumers by governing the slaughter, sale, preparation and labeling of animals used for food.
  • And it is different from the laws that seek to prohibit the inhumane treatment of animals, including animals that are routinely slaughtered for food
    • E.g. different from the recently established and then abandoned ban on foie gras in Chicago restaurants (and different from e.g. bans on fox hunts and cock fights).
    • It is not illegal in California to kill horses or dogs, although the California law outlaws such killing “if that person knows or should have known that any part of that horse will be used for human consumption.”
it s not just americans
It’s not just Americans
  • Genetically Modified (GM) crops in Europe
  • Prince Charles warns GM crops risk causing the biggest-ever environmental disaster (Telegraph, Aug. 12, 2008)
    • Relying on "gigantic corporations" for food, he said, would result in "absolute disaster".
slide10

Swiss to ban cat fur trade

after pets vanish

(Telegraph, March 7, 2008)

Switzerland is to ban the trade in cat fur following an outcry in France over the disappearance of hundreds of domestic cats allegedly poached for their soft coats.

Under Swiss law, it is permitted to kill stray cats and sell their fur for £3 a piece to tanneries.

Cat fur products in clothes and belts are believed to ease rheumatism.

However, the Swiss have come under intense pressure to end the practice after hundreds of domestic cats vanished over the French border.

slide11

EU to ban cat and dog fur trade

(BBC, March 31, 2008)

The European Parliament has backed a ban on cat and dog fur imports, in a move to curb the slaughter of millions of cats and dogs in China.

MEPs have agreed with EU member states on the text of the law, which will come into effect from 31 December 2008.

a different view
A different view
  • Saudi Arabia bans sale of dogs, cats in capital (NY Times, July 31, 2008)
  • Saudi men arrested for 'flirting' (BBC, Feb. 23, 2008)
  • Saudis ban red roses for Valentine's Day (Telegraph, Feb. 12, 2008)
  • Saudi Women Can Now Stay in Hotels Alone (NY Times, Jan. 21, 2008)
  • Saudi Arabia to lift ban on women drivers (Telegraph, Jan. 21, 2008) (??)
miscellaneous developments july 2008
Miscellaneous developments, July 2008
  • Germany Recoils at the Assisted Suicide of a Healthy, 79-Year-Old Woman (NY Times, July 3, 2008)
  • Declaration of Istanbul Sees Organ Transplantation Worldwide Threatened by Organ Trafficking and Transplant Tourism and Commercialism (Lancet, July 5, 2008)
  • SKorea to end ban on revealing sex of babies (NY Times, July 31, 2008)
    • “…neighborhood clinics …offered gender information in various ways, including telling parents whether the baby is ''cute'' or ''energetic'' -- allusions to girls or boys.”
repugnant transactions somewhere or when
Repugnant transactions (somewhere, or when)
  • Bodies and body parts
    • Cadavers for anatomical study, deceased-donor organs, blood and tissue
      • Grave robbers
      • Museum exhibits
    • Live donor organs (kidneys, livers)
  • Reproduction and sex
    • Adoption (children may not be purchased from the birth mother)
    • Surrogate mothers, egg and sperm donation, abortion, birth control (all other reproductive services may be purchased)
      • Egg donation for research (may not be compensated in MA)
    • Prostitution, pornography
    • Marriage with bride price, dowry, polygamy, gay marriage
      • E.g. India’s Dowry Prohibition Act, 1961
  • Labor
    • Indentured servitude, slavery
    • Volunteer army, mercenary soldiers
    • Discrimination on race, gender, handicap, marital status, etc
slide15
Words and ideas
    • obscenity and profanity (FCC broadcast regulations, movie ratings, 1959 Post Office ban on Lady Chatterley’s Lover)
    • blasphemy (e.g. ban on sale of Rushdie’s “Satanic Verses”)
  • Risk
    • Life insurance (“insurable interest”)
      • for adults
      • For children?
      • Stranger (or Investor) Owned Life Insurance (SOLI) and “Viatical settlements”—third party markets and funds. ( “dead pools”)
    • Gambling,
    • prediction markets (“terrorism futures market”)
slide16
Finance
    • Short selling, currency speculation
    • Interest on loans (state usury laws, Islamic banks)
  • Pollution markets:
    • Title IV of the 1990 CleanAirActAmendments (tradeable emissions entitlements)
    • Summers’ 1991 World Bank memo on dirty industries in LDC’s
  • Price gouging
    • After disasters (e.g. Hurricane Katrina)
    • Ticket scalping (ticket auctions)
  • Religion/Sports (amateur/professional)
    • Sale of indulgences, sale of religious offices (“simony”)
    • Endorsements/payments for amateur versus pro athletes
    • Drugs and sports
  • Food, drink, and drugs
    • Horse, dog meat (illegal in CA, but legal in Europe, Asia…)
    • Alcohol (Prohibition)
    • Marijuana and narcotics
  • Vote selling, bribery (not ok, but how about frequent flier miles?)
  • Dwarf tossing
the arrow of time points in both directions on repugnance of markets
The arrow of time points in both directions on repugnance of markets
  • There are markets that are repugnant today that once were not (or not sufficiently to serve as a binding constraint)
  • And there are markets that were once repugnant but no longer are.
slavery and indentured servitude
Slavery and indentured servitude
  • Once both kinds of markets were common in the U.S.
  • Indentured servitude was once one of the common ways for Europeans to buy passage across the Atlantic to America.
  • Outlawed by 13th Amendment, US Constitution, 1865.
  • You can’t even sell yourself into slavery or indentured servitude.
lending money for interest
Lending money for interest
  • Once widely repugnant, now not (with the important exception of Islamic law).
  • Albert Hirschman paraphrases Max Weber’s question in “The Spirit of Capitalism”:
    • “How did commercial, banking, and similar money-making pursuits become honorable at some point in the modern age after having stood condemned or despised as greed, love of lucre, and avarice for centuries past?”
slide20

Credit. Man’s Confidence in Man. “Commercial credit is the creation of modern times and belongs in its highest perfection only to the most enlightened and best governed nations. Credit is the vital air of the system of modern commerce. It has done more — a thousand times more — to enrich nations than all the mines of the world.” Daniel Webster, March 18, 1834.

changing repugnancies can interact
Changing repugnancies can interact
  • Bankruptcy law
    • In colonial America and in the early years of the Republic, insolvent debtors could be imprisoned, or sentenced to indentured servitude
    • As debt became less repugnant, and involuntary servitude more repugnant, bankruptcy law has come to provide protection to the debtor as well as to the creditor
repugnance is often confounded with other objections
Repugnance is often confounded with other objections
  • E.g., while hiring mercenaries (Condottieri) was once an accepted way of dealing with military affairs, it has largely fallen out of favor since the rise of states with standing armies.
  • This is not only because of repugnance towards the fact that mercenaries kill for pay rather than for state-sanctioned duty or patriotism.
  • But such repugnance plays a role: e.g. the Geneva Conventions: “A mercenary shall not have the right to be a combatant or a prisoner of war.”
repugnance negative externalities
Repugnance + negative externalities
  • Prostitution
    • Repugnance at commercializing sex, but also neighborhood externalities (crime, public health, etc.)
  • Pornography
  • Obscenity
    • FCC broadcast regulations (externalities—doesn’t apply to subscription radio…)
    • E.g. 1959 Post Office ban on Lady Chatterley’s Lover (private consumption)
    • (cf. Fairman, Christopher M., "Fuck" (http://ssrn.com/abstract=896790 , Cardozo Law Review, 28, 2007, forthcoming.)
  • Profanity (externalities)
  • Blasphemy
    • E.g. bans on Rushdie’s “Satanic Verses” seem primarily aimed at limiting privateconsumption (not to mention production…)
blasphemy article 40 6 1 irish consititution
Blasphemy: Article 40, 6, 1, Irish consititution
  • The State guarantees liberty for the exercise of the following rights, subject to public order and morality:
  • i.  The right of the citizens to express freely their convictions and opinions.
  • The education of public opinion being, however, a matter of such grave import to the common good, the State shall endeavour to ensure that organs of public opinion, such as the radio, the press, the cinema, while preserving their rightful liberty of expression, including criticism of Government policy, shall not be used to undermine public order or morality or the authority of the State.
  • The publication or utterance of blasphemous, seditious, or indecent matter is an offence which shall be punishable in accordance with law.
repugnance addiction coercion
Repugnance + addiction/coercion
  • Alcohol
    • E.g. Prohibition (in a number of countries)
      • 18th amendment U.S. Const. 1917 (prohibition)
      • 21st amendment 1933 (repeal of 18th amendment)
  • Narcotics
    • Strenuous bans both on national markets and international trade
  • Gambling
    • also negative externalities like bankruptcy and crime?
  • Prostitution/human trafficking
  • Child pornography
repugnance incentives
Repugnance + incentives
  • Life insurance (“insurable interest”)
  • for adults
    • Justice Oliver Wendell Holmes, Jr. in a 1911 case involving insurable interest: “A contract of insurance upon a life in which the insured has no interest is a pure wager that gives the insured a sinister counter interest in having the life come to an end.
    • Justice Holmes’ opinion continues: “On the other hand, life insurance has become in our days one of the best recognized forms of investment and self-compelled saving. So far as reasonable safety permits, it is desirable to give to life policies the ordinary characteristics of property.”
  • For children?
  • Stranger (or Investor) Owned Life Insurance (SOLI) and “Viatical settlements”—third party markets and funds. (“dead pools”)
uncomplicated cases of repugnance as a constraint on markets may help clarify what s going on
“Uncomplicated” cases of repugnance as a constraint on markets may help clarify what’s going on
ontario dwarf tossing ban act 2003
Ontario Dwarf Tossing Ban Act, 2003
  • Bill 97 2003 An Act to ban dwarf tossing
  • Her Majesty, by and with the advice and consent of the Legislative Assembly of the Province of Ontario, enacts as follows:
  • Dwarf tossing banned
  • 1.  (1)  No person shall organize a dwarf tossing event or engage in dwarf tossing.
  • Offence
  • (2)  A person who contravenes subsection (1) is guilty of an offence and on conviction is liable to a fine of not more than $5,000 or to imprisonment for a term of not more than six months, or to both.
  • Commencement
  • 2.  This Act comes into force on the day it receives Royal Assent.
  • Short title
  • 3.  The short title of this Act is the Dwarf Tossing Ban Act, 2003.
dwarf tossing30
Dwarf tossing

U.N. backs 'dwarf-tossing' ban

Friday, September 27, 2002: CNN

GENEVA, Switzerland --A French ban on the controversial practice of "dwarf-tossing" has been upheld by the U.N. Human Rights Committee.

  • Manuel Wackenheim began his fight in 1995 after the French ban meant he could no longer earn a living being thrown around discotheques and nightclubs by burly men. But on Friday, Wackenheim -- who measures 1.14 metres (3 feet 10 inches) -- lost his case when the U.N. human rights body ruled the need to protect human dignity was paramount. In a statement, the U.N. Human Rights Committee said it was satisfied "the ban on dwarf-tossing was not abusive but necessary in order to protect public order, including considerations of human dignity.“ The committee also said the ban "did not amount to prohibited discrimination.“ The pastime, imported from the United States and Australia in the 1980s, consists of people throwing tiny stuntmen as far as possible, usually in a bar or discotheque. 
repugnance can be hard to predict
Repugnance can be hard to predict
  • But see e.g. Tetlock et al. on taboo tradeoffs and Baron et al. on protected values…
  • Why is dwarf tossing widely regarded as repugnant?
  • It’s not just the small size of the dwarfs
    • E.g. jockeys are small
slide32

Wife Carrying—Not Repugnant?

US champs 2005--traditional

World champs—Estonian position

repugnant or not
Repugnant or not?
  • Pollution markets:
    • Title IV of the 1990 Clean Air Act Amendments (tradeable emissions entitlements)
    • Summers’ 1991 World Bank memo on dirty industries in LDC’s
  • “Price gouging”
    • After disasters (e.g. Hurricane Katrina)
    • Ticket scalping
      • But TicketMaster is now running ticket auctions
  • Kickbacks, bribes, etc.
    • But frequent flier miles are ok.
reproduction
Reproduction
  • Adoption
    • Limits on cash payments to mothers
  • Surrogate mothers, egg and sperm donation
    • Largely unregulated markets (cf. Debora L. Spar The baby business : how money, science, and politics drive the commerce of conception.
    • Egg donation for research (may not be compensated in MA)
  • abortion, birth control
cadavers
Cadavers

“RESURRECTION MEN” (editorial)The Lancet, Volume 1, Issue 19, 8 1824

  • Opens with the observation that a resurrection man has recently been sentenced to transportation for seven years, and deplores that it is illegal to obtain bodies for dissection, except executed murderers.
  • “The legislature should be entreated to…devise…some plan that would [make cadavers legally available], and which at the same time would not irritate the feelings of those who are naturally prejudiced against dissection. All that the legislature now does to forward this science…is to give the bodies of criminals executed for murder to be dissected; this we fear…tends to keep up…the prejudice which is at present so strong against the obtaining of bodies for dissection.”
laws can change
Laws can change

“Cheapest mode of procuring Bodies.—Resurrection Men”  •The Lancet, 3, 61, 27 November 1824, (unsigned letter)

  • “The procuring of bodies, for the purpose of dissection, will probably always be considered an illegal act in England…”
  • But the Anatomy Act of 1832 considerably expanded the sources of legal cadavers for dissection.
money and repugnance
Money and repugnance
  • Often x+$ is repugnant, even when x alone isn’t.
    • E.g. interest on loans,
    • payments to birth mothers in adoption,
    • prostitution
taboo tradeoffs and protected values
“Taboo tradeoffs” and “Protected Values”
  • Tetlock, P.E., Kristel, O., Elson, B., Green, M., and Lerner, J . The psychology of the unthinkable: Taboo trade-offs, forbidden base rates, and heretical counterfactuals. Journal of Personality and Social Psychology.
  • Fiske, A. & Tetlock, P.E. (1999). Taboo trade-offs: Constitutive prerequisites for social life. In S.A. Renshon and J. Duckitt (eds), Political Psychology: Cultural and Cross-cultural Perspectives. London: MacMillan.
  • Tetlock, P.E. (1999). Coping with trade-offs: Psychological constraints and political implications. In S. Lupia, M. McCubbins, & S. Popkin (eds.), Political reasoning and choice. Berkeley: University of California Press.
  • Fiske, A. & Tetlock, P. E. (1997). Taboo trade-offs: Reactions to transactions that transgress spheres of justice. Political Psychology, 18, 255-297.
  • Ritov, I., & Baron, J. (1999). Protected values and omission bias. Organizational Behavior and Human Decision Processes, 79, 79–94.
  • Baron, J., & Leshner, S. (2000). How serious are expressions of protected values. Journal of Experimental Psychology: Applied, 6, 183–194.
slide41

“We didn’t have time to pick up a bottle of wine, but this is what we would have spent.”

(New Yorker cartoon.)

money and repugnance42
Money and repugnance
  • There seem to be three principal lines of argument about how adding money makes a non-repugnant transaction repugnant:
    • Objectification
    • Coercion (“exploitation”)
    • Slippery Slope
objectification
Objectification
  • Article 21 of the Council of Europe’s (2002) Additional Protocol to the Convention on Human Rights and Biomedicine, on Transplantation of Organs and Tissues of Human Origin states “The human body and its parts shall not, as such, give rise to financial gain”
coercion
Coercion
  • The National Bioethics Advisory Commission (2001), writes that paying subjects to participate in medical experiments may be coercive. They go on to say that, if an institutional review board is concerned that the subjects in an experiment may be economically disadvantaged, it may require, to protect the subjects from coercion, that the researchers reduce the payments they make to participants
  • (In contrast, experimental economists often think that paying subjects in economic experiments, based on their performance, is an essential element in creating an economic environment in the laboratory in which the experimenter can exercise some control over subjects’ preferences.)
slide45

Declaration of IstanbulPublished ahead of print on August 13, 2008Clinical Journal of the American Society of Nephrologyhttp://cjasn.asnjournals.org/cgi/content/abstract/CJN.03320708v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Istanbul&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

  • “The Istanbul Declaration proclaims thatthe poor who sell their organs are being exploited, whetherby richer people within their own countries or by transplanttourists from abroad. Moreover, transplant tourists risk physicalharm by unregulated and illegal transplantation. Participantsin the Istanbul Summit concluded that transplant commercialism,which targets the vulnerable, transplant tourism, and organtrafficking should be prohibited.”
slippery slope
Slippery slope
  • Dystopias resulting from changes in terms of trade?
    • E.g. kidneys used as collateral on loans?
  • See e.g. Basu (2003) on bans on sexual harassment.
kidney transplants
Kidney transplants
  • There are over 70,000 patients on the waiting list for cadaver kidneys in the U.S.
  • In 2006 there were 10,659 transplants of cadaver kidneys performed in the U.S.
  • In the same year, 3,875 patients died while on the waiting list (and more than 1,000 others were removed from the list as “Too Sick to Transplant”.
  • In 2006 there were also 6,428 transplants of kidneys from living donors in the US.
  • Sometimes donors are incompatible with their intended recipient.
  • This opens the possibility of exchange .
slide50

Section 301,National Organ Transplant Act (NOTA), 42 U.S.C. 274e 1984:

“it shall be unlawful for any person

to knowingly acquire, receive or otherwise transfer any human organ for valuable consideration for use in human transplantation”.

charlie w norwood living organ donation act
Charlie W. Norwood Living Organ Donation Act

Public Law 110-144, 110th Congress, Dec. 21, 2007

  • Section 301 of the National Organ Transplant Act (42 U.S.C. 274e) is amended-- (1) in subsection (a), by adding at the end the following:
  • ``The preceding sentence does not apply with respect to human organ paired donation.''
kidney exchange creating a thick and efficiently organized market without money
Kidney Exchange—Creating a Thick (and efficiently organized) Market Without Money
  • New England Program for Kidney Exchange—approved in 2004, started 2005.
      • Organizes kidney exchanges among the 14 transplant centers in New England
  • Ohio Paired Kidney Donation Consortium, Alliance for Paired Donation (2007, Rees)
    • 60 transplant centers and growing…
  • National (U.S.) kidney exchange--2009?
    • Looks like it’s (slowly) on the way (with some questions still about how well it will be designed and executed)
kidney exchange clearinghouse design
Kidney exchange clearinghouse design

Roth, Alvin E., Tayfun Sönmez, and M. Utku Ünver, “Kidney Exchange,”Quarterly Journal of Economics, 119, 2, May, 2004, 457-488.

____ “Pairwise Kidney Exchange,”Journal of Economic Theory, 125, 2, 2005, 151-188.

___ “A Kidney Exchange Clearinghouse in New England,” American Economic Review, Papers and Proceedings, 95,2, May, 2005, 376-380.

_____ “Efficient Kidney Exchange: Coincidence of Wants in Markets with Compatibility-Based Preferences,”American Economic Review, June 2007, 97, 3, June 2007, 828-851

and in the medical literature
And in the medical literature

Saidman, Susan L., Alvin E. Roth, Tayfun Sönmez, M. Utku Ünver, and Francis L. Delmonico, “Increasing the Opportunity of Live Kidney Donation By Matching for Two and Three Way Exchanges,”Transplantation, 81, 5, March 15, 2006, 773-782.

Roth, Alvin E., Tayfun Sönmez, M. Utku Ünver, Francis L. Delmonico, and Susan L. Saidman, “Utilizing List Exchange and Undirected Donation through “Chain” Paired Kidney Donations,”American Journal of Transplantation, 6, 11, November 2006, 2694-2705.

Rees, Michael A., Jonathan E. Kopke, Ronald P. Pelletier, Dorry L. Segev, Matthew E. Rutter, Alfredo J. Fabrega, Jeffrey Rogers, Oleh G. Pankewycz, Janet Hiller, Alvin E. Roth, Tuomas Sandholm, Utku Ünver, and Robert A. Montgomery, “The First Never-Ending Altruistic Donor Chain,” April, 2008.

Rees, Michael A., Alvin E. Roth, Tuomas Sandholm, M Utku Unver, Ruthanne Hanto, and Francis L. Delmonico, “Designing a National Kidney Exchange Program,” April, 2008.

arguments for and against monetary market for kidneys
Arguments for and against monetary market for kidneys

Religious scholars:

  • Pope John Paul II: organ donation is heroic, but objectifying human organs is immoral
    • (similar views in Protestant denominations)
  • Jewish responsa (e.g. R. Shlomo Zalman Auerbach):
    • Donating a kidney is allowed (pikuach nefesh)
    • It isn’t required
    • So it falls in the category of things for which money might be accepted.
  • Islamic Republic of Iran: compensating kidney donors is legal
  • Economists
    • Voluntary transactions between consenting adults improve welfare
    • Unwanted consequences can be reduced by careful regulation of the market.
additional arguments related to kidneys
Additional arguments related to kidneys
  • “crowding out” of altruistic giving
  • Hippocratic oath (“first do no harm”)
    • Nephrectomys aren’t the best part of the transaction, and some surgeons who aren’t wild about them already may feel reluctant to take part if the donor’s interest is commercial.
  • Coercion: Even in the absence of money, transplant surgeons are eager to avoid accepting organs from donors who may feel coerced, e.g. by family pressure.
    • Interestingly, Ghods and Savaj, 2006, express the view that the availability of paid unrelated kidney donors in Iran has reduced the coercion of unpaid related donors.
transactions between consenting adults
Transactions between consenting adults
  • Test yourself for repugnance: are you willing to contemplate carefully regulated, sales of live:
  • Kidneys?
  • Eyes?
  • Hearts?
regulated market for kidneys
Regulated Market for Kidneys?

Design might address coercion or slippery slope concerns (but probably not objectification objections…)

  • Single buyer (UNOS?)
    • At above the competitive price (i.e. so more donors would be available than are required)?
  • Informed consent?
  • Long term health insurance?
  • Psychiatric exams?
  • Kidneys can’t be used as collateral?
  • Restrictions on foreign imports?
causes of repugnance to kidney sales representative sample survey with steve leider
Causes of repugnance to kidney sales? Representative Sample Survey (with Steve Leider)
  • We wanted to find out a bit more about
    • Who finds kidney sales repugnant?
    • What is such repugnance correlated with?
  • Approximately 40% of respondents find at least some kinds of kidney sales repugnant and/or think they should be illegal. (Sales by individuals to individuals arouse the most repugnance.)
  • Looking at individual variables, women, self-identified social conservatives and religious evangelical Protestants find kidney sales more repugnant that do others.
    • But these aren’t explanatory variables, they lose significance when we regress on underlying attitudes
attitudes correlated with repugnance to kidney sales
Attitudes correlated with repugnance to kidney sales:
  • Repugnance to other “body” markets predicts repugnance to kidney sales:
    • Paying for blood
    • Paying for cadavers for dissection in anatomy classes
    • Paying a surrogate mother
  • Repugnance to excessive use of takeout foodand restaurants (by a family with children)
interpretation
Interpretation (?)
  • Blood, cadavers, surrogate wombs: repugnance about bringing body parts and functions into the market.
  • Takeout food: repugnance to purchasing some services that families and communities customarily produce for themselves “for free”.
slide62

When Robin Young interviewed me on NPR's show Here and Now, she remembered "when the first MacDonalds came to our neighborhood, my mother treated it as some sort of heathen place...Go somewhere else but home to eat?"

conclusions kidney transplants
Conclusions: Kidney transplants
  • One way that the severe shortage of transplantable kidneys might be solved is if xenotransplants (e.g. pig kidneys) became possible.
    • But they presently face immunological barriers that we don’t know how to surmount.
  • Another way the shortage might be solved is with a monetary market.
    • But this also faces very real obstacles, in the form of repugnance.
  • I wouldn’t want to bet which barrier will fall first.
  • In the meantime, we can bring to bear the tools of market design to increase the number of transplants (through kidney exchange, through ways of managing the DD lists, donations, etc.)
repugnance constraints in market design
“Repugnance” constraints in market design
  • In some of the examples I’ve discussed, “repugnance” or even “revulsion” is exactly the right word for how some transactions are or were once regarded.
  • In others, a milder word would be more apt: some transactions are seen as
    • distasteful,
    • inappropriate,
    • unfair,
    • undignified
    • unprofessional.
repugnance broadly construed as a constraint on market design
‘Repugnance’ (broadly construed) as a constraint on market design
  • In Boston, one of the strategy proof mechanisms we proposed for their new school choice procedure was rejected because it would have allowed the "trading" of sibling priorities, and the schools folks didn't think that sounded right, sort of like trading your older child.
  • In the NYC high school match, a key question revolved around the fairness of different ways to randomize for schools that don’t have preferences. Note that in public school choice, money wouldn’t be acceptable for allocating spaces, although it is in private schools.
  • And in the gastroenterology match, the issues that came up involved whether it would be unprofessional for applicants to be allowed to renege on acceptances of early, exploding offers (ultimately the gastro associations did adopt policies that allow that, as we recommended...:) (the situation is different in other markets, e.g. law, early and regular college admissions, etc., cf. Niederle and Roth 2006)
slide66
“Students are under no obligation to respond to offers of financial support prior to April 15; earlier deadlines for acceptance of such offers violate the intent of this Resolution. In those instances in which a student accepts an offer before April 15, and subsequently desires to withdraw that acceptance, the student may submit in writing a resignation of the appointment at any time through April 15.
should people be able to change their minds about early offers they have accepted
Should people be able to change their minds about early offers they have accepted?
  • Not in neuropsychology (president of professional organization):
  • “I have said it once, and I will say it again: Two wrongs do not make a right. To state it another way: The end does not justify the means.I will be strongly opposed to any attempt at [a]… policy that allows candidates to accept an offer outside of the match, participate in the match anyway, and then renege on their earlier "acceptance".”
opposite of repugnance protected transactions
Opposite of Repugnance: Protected transactions
  • Home ownership in the US
    • E.g. Federal bailout of Fanny Mae and Freddy Mac (GSEs: Government Sponsored Entities)
  • Small farmers
    • Subsidies, price support
  • Small fishing boats
    • Daily limits on catch
  • Marriage: monogamy between a man and a woman?
    • Marriage with bride price, dowry, polygamy, gay marriage, prenuptial agreements
conclusions repugnance
Conclusions: Repugnance
  • Repugnance can be a real constraint. It can change over time, but it can be persistent.
  • Behavioral economics has mostly been concerned with how individuals make choices. But the manner in which attitudes towards the appropriateness (or repugnance) of transactions shapes whole markets (and therefore shapes what choices people are confronted with) may be one of the important ways that “behavioral” considerations affect the economy.