Harvard Economist Alvin Roth Details Life-Saving Theory at Annual Brody Lecture At first glance, the search for a life-saving kidney donation may not seem to have much to do with economics. But Harvard University Professor Alvin Roth applies to that process the same market principles that drive global trade.

It’s all about “a practical application of economics to achieve an efficient outcome,” he told an audience on April 11 at the annual Alexander Brody Distinguished Lecture in Economics on the Wilf Campus. “The framework about markets in general is to think about what marketplaces do to promote markets,” said Roth. “When many people want to transact, it’s hard to manage all transactions.” Disturbed at the slow rate of kidney transplants in the United States—only 16,830 transplants were performed in 2009, out of more than 80,000 on waiting lists—Roth has pioneered the New England Program for Kidney Exchange. It is based on the principles that a flourishing market must be thick, uncongested and safe. A growing share of transplants comes from live donors, but because some family members are not compatible with their ailing loved ones, Roth’s database matches up pairs of donors who can provide compatible kidneys to each other’s designated recipient. This is logistically challenging since four separate operations must be performed simultaneously to assure that no one backs out and breaks the chain, since there is no legally binding contract.

The Exchange involves making the market “thicker” by assembling a database of donors and their blood types, coordinating hospital resources and using an algorithm that makes it safe to participate, based on game theory principles that put everyone on equal footing. The sale of organs is illegal in the United States based on an act of Congress in 1984 banning transplants in exchange for “valuable consideration.” An amendment in 2007, however, made clear that this does not apply to paired donation. Roth said that in strictly logistical terms there is a strong argument for allowing organ sales. Pairing sets of donors requires “double coincidence,” or people in identical circumstances, which is rare. “One of the advantages of money is that you don’t need double coincidence, you could buy whatever you want.” But markets, he added, are affected by what society considers repugnant, citing as one example the phenomenon of “dwarf tossing,” which involves willing, paid participants in a sometimes popular form of entertainment that has been banned in many countries and decried by the United Nations because it is considered an affront to human dignity. Allowing organ selling, Roth said, could lead to objectification, coercion and a slippery slope that could lead us to “devolve into a less sympathetic society than we would like to be.” Polling the audience, Roth found that some supported the idea of selling kidneys or eyes, but none supported the selling of hearts, which would mean killing the donor, but could be an eventual result of that slippery slope. Roth has also established the National Resident Matching Program, which has placed some 20,000 doctors a year in American hospitals. “Dr. Roth attracted a large and diverse audience, and gave a fascinating talk about his application of economics and mathematics to enable more matching of kidney donors and recipients—work that has saved many lives and has the potential to save thousands more,” said Dr. James Kahn, the Henry and Bertha Kressel Professor of Economics at YU. The Alexander Brody Distinguished Service Lecture is presented annually by the Department. It is named for Alexander Brody, a professor of economics and history who died in 1968 after a 34-year tenure at YU.