Morality-Efficiency Tradeoffs in Repugnant Markets: The Case of Payments for Organ Donations

We use results from a randomized online choice experiment involving 1400 US residents to estimate preferences for morality and efficiency in the context of payments for organ donations. Our results indicate that (a) ethical considerations are an important determinant of attitudes toward payments for organs, (b) most individuals are not opposed to payments per se, but rather to their implications for the fairness of the resulting allocation of organs, (c) there is wide variation in the estimated "marginal rate of substitution" between efficiency (lives saved) and morality, (d) most individuals are willing to sacrifice "morality" if sufficiently more lives are saved thanks to a paid-donor system, (e) a subset of individuals reject payments altogether irrespective of the lives potentialy saved.