Alice does a lot of drugs. As a result, Alice’s kidneys fail catastrophically and now she needs a new one. Consider the following scenarios:

1. Bob reads about Alice’s heartwrenching tale on 4chan. He donates his kidney out of the kindness of his soul.
2. Chuck is a heavy drinker with cirrhosis of the liver. He trades his kidney for a liver donation from Alice.
3. Donald is a farmer. Alice gives Donald two hectares of arable land and a couple of goats in exchange for a kidney.
4. Alice offers Warren Buffett $10,000 for his left kidney. Buffett, being extremely old, recognizes that he may not get much more use out of his kidneys. He decides this is a Very Good Deal and accepts the offer.
5. Eve is a homeless single parent who lost her job to a robot. Alice pays Eve $10,000 for a kidney so that Eve can afford to feed her kids.

Legally, we draw the line between 3 and 4. Most would condone 4, but not 5. Why?

Maybe it’s exploitative. Allowing organ sales might encourage the rich to take unjust advantage of the poor. Of course, you could say the same thing about wage labor. Low-income jobs allow rich people to exploit poor people by paying them chump change to do demeaning things.

Maybe it’s unfair. Only rich people will be able to afford kidneys, creating a concentration of internal organs in the upper class.

Neither are arguments against organ markets though. It just means the markets ought to be regulated. For example, prevent exploitation in organ sales by requiring a minimum income for participants. Ensure equal access by handing out organ subsidies the same way we distribute food stamps.

We feel that scenario 4 is less exploitative than scenario 5 because Warren Buffett has the option to decline the offer. Eve requires paternalism because she’s too poor to have that option. In that case, isn’t it better to give Eve more options, not less? Make other markets available to her, like selling weed or sex, while we’re at it*.

Convicted felons are restricted from occupational licensing, which rules out 30% of the jobs held by US workers. They also lose the ability to receive social benefits or live in public housing. That doesn’t leave a lot of options. No wonder there’s a 77% recidivism rate.

*Some parties prefer to guarantee freedom through social security. That is also a type of optionality, I guess.

See Also:
J. Brennan and P. Jaworski. Markets without Limits: Moral Virtues and Commercial Interests