Nobel Economist Alvin Roth Advocates for Legalizing Kidney Sales to Save Lives

In a recent Washington Post op-ed, Nobel Prize-winning economist Alvin Roth makes a compelling case for legalizing kidney sales to address the severe organ shortage in the United States. Roth, a world-renowned expert on taboo markets and related economic topics, argues that the current system is failing patients and calls for urgent reform.

Why Legalizing Kidney Sales Could Save Thousands of Lives

Roth highlights the staggering statistics surrounding kidney failure in the U.S.:

• Approximately 130,000 new cases of kidney failure are diagnosed annually.
• Kidney failure disproportionately affects the poor and is four times as likely to impact Black people as White people.
• Medicare spends over $55 billion per year on kidney failure treatments, primarily dialysis.
• More than 500,000 people are currently on dialysis, with about half dying within five years of starting treatment.

While kidney transplantation is the most effective treatment for kidney failure, the supply of available kidneys remains critically low. In 2025, fewer than 30,000 people in the U.S. received kidney transplants. This leaves tens of thousands of patients without lifesaving treatment:

• About 90,000 people are on the national waiting list for a deceased-donor kidney.
• Thousands die each year while waiting for a transplant.
• Thousands more are removed from the waiting list when they become too sick to undergo surgery.

Roth’s Advocacy for Organ Markets

Roth has long advocated for legalizing organ markets, arguing that doing so would:

• Save thousands of lives annually.
• Spare countless individuals from years of painful dialysis.
• Increase bodily autonomy for donors and recipients.

In his recent book chapter, "The Presumptive Case for Organ Markets," Roth addresses common counterarguments to legalization, including claims that:

• Organ markets would exploit the poor.
• Legalization would corrupt ethical standards.
• Paid donations would crowd out altruistic donations.

Roth emphasizes that legalizing organ markets should be a high-priority issue for anyone committed to saving lives and expanding personal freedom.

Addressing Concerns About Kidney Sales

While Roth supports legalizing kidney sales, he acknowledges potential concerns that must be addressed:

"We wouldn't want inappropriate donors to be unduly influenced to give up a kidney." — Alvin Roth

Roth clarifies that existing safeguards, such as screening processes for unpaid kidney donors, could be adapted to ensure the quality and suitability of paid donations. He also addresses fears that only the wealthy would benefit from a legalized market:

"I am not entirely sure what Roth means by 'inappropriate donors.' But if he means people whose kidneys are in poor shape or who are bad matches for a particular patient, health care providers would have strong incentives to screen kidneys for quality."

Roth’s perspective is particularly significant given his status as one of the world’s leading economists and his left-liberal political leanings, which make his advocacy difficult to dismiss as ideologically driven.