Making Moral Markets: Comparing the Institutionalization of Kidney Exchange

• In Event: 4341 - Markets and Morality

Abstract

Organ transplants have saved and improved countless lives, but the supplies for vital organs – kidneys in particular, have far outstripped the demands worldwide. Given the organ shortage, nation-states have developed schemas for donations that are generally thought to reflect culturally specific understandings of bodily integrity and death. As donating body parts involves both pure gifts and monetized trades (if not some forms other than the two), organ donation also characterizes “moral exchange.” When and where do financial and political incentives increase rates of kidney exchange, and why do they sometimes fail to do so?

Within a comparative historical framework, East Asia is the only region that includes all schemas of both living and cadaveric exchange. Living exchange may be financially incentivized (Singapore), kin restricted (Taiwan), or general (Hong Kong). With respect to organ procurement from cadavers, citizens may opt out of a presumption that they are willing donors (Singapore), opt in (Hong Kong), or opt in with a written consent of relatives, where a relative can veto the consent even if the donors have opted in (Taiwan). These diverse schemas are often explained by invoking “culture,” but each has been adopted by at least one postcolonial polity with a significant population representing the Chinese diaspora.

Building on the moral economy scholarship, I use archival research and interviews to identify “market state” (Singapore), “state-moralized market” (Taiwan), and “static market” (Hong Kong) as types of moral markets shaped by institutional arrangements and processes. These trajectories also explain why the most generous incentives have failed to produce substantial increases in donation. Tracing how the policies were established and subsequently modified, I further extend the political-culture approach by examining when and why ethical concerns affect the building of institutional mechanisms to create or circumvent markets.

Author

• Wan-Zi Lu, University of Chicago