Donor Cycle Dynamics

It’s an ill-wind that blows no good and in Allocating Scarce Organs, Dickert-Conlin, Elder and Teltser find that repealing motorcycle helmet laws generate large increases in the supply of deceased organ transplants. The supply shock, however, is just the experiment that the authors use to measure demand responses. It’s well known that the shortage of transplant organs has led to a long waiting-list. The waiting-list, however, is only the tip of the iceberg. Many people who could benefit from a transplant never bother getting on the list since their prospects are already so low. In addition, some people have access to substitutes for a deceased organ transplant namely a living donor. Finally, there is a quality tradeoff: as more organs become available the quality of the match may increase as people may pass on the first available organ to get a better match. The authors use the supply shock to study all these issues:

We find that transplant candidates respond strongly to local supply shocks, along two dimensions. First, for each new organ that becomes available in a market, roughly five new candidates join the local wait list. With detailed zip code data, we demonstrate that candidates listed in multiple locations and candidates living out-side of the local market disproportionately drive demand responses. Second, kidney transplant recipients substitute away from living-donor transplants. We estimate the largest crowd out of potential transplants from living donors who are neither blood relatives nor spouses, suggesting that these are the marginal cases in which the relative costs of living-donor and deceased-donor transplants are most influential. Taken together, these findings show that increases in the supply of organs generate demand behavior that at least partially offsets a shock’s direct effects. Presumably as a result of this offset, the average waiting time for an organ does not measurably decrease in response to a positive supply shock. However, for livers, hearts, lungs, and pancreases, we find evidence that an increase in the supply of deceased organs increases the probability that a transplant is successful, defined as graft survival. Among kidney transplant recipients, we hypothesize that living donor crowd out mitigates any health outcome gains resulting from increases in deceased-donor transplants.

In other words, increased organ availability increases the quality of the matches for organs that cannot be given by a living donor (hearts, lungs, pancreases, partially liver) but for kidneys some of the benefit of increased organ availability accrues to potential living donors who do not have to donate and this means that match quality does not substantially increase.

The authors also critique the geographic isolation of kidney donation regions. As I wrote when Steve Jobs received a kidney transplant:

Although there is no reason to think that Apple CEO Steve Jobs “jumped the line” to get his recent liver transplant, Jobs did have an advantage: He was able to choose which line to stand in.

Contrary to popular belief, transplant organs are not allocated solely according to medical need. Organs are allocated through a complex system of 58 transplant territories. Patients within each territory typically get first dibs on organs from that territory. That’s great if a patient happens to live in a territory with a lot of organ donors and relatively few demanders, but not so good for a patient living in New York, San Francisco or Los Angeles, where waiting lines are longest.

As a result of these “accidents of geography,” relatively healthy patients in some parts of the country get transplants while sicker patients in other parts of the country die waiting.

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I've heard it said that people in some ethnic and religious groups happily accept transplants but decline to have their own organs, or their children's, used as transplants. I have no idea if there is any evidence for this claim.

If it were true could it bias studies that overlooked the effect?

I've also heard - this time from somebody with expertise - that tall people and people with blood group O are less likely to get a heart transplant than others. Is this true?

I imagine that a lot of people are more willing to receive organs than give them. Whether this is concentrated in particular religious groups, I don't know. I don't see how it would bias a study like this, though.

People with blood type O are definitely less likely to get organs, because the blood types must be compatible. O is only compatible with O, while A or B are compatible with their own type and O as well.

I have no idea what the association with tallness would be.

The context implied to me that a tall, well built, middle-aged man might not be suited to, say, a heart from a teenager killed in a car crash. He might simply need a larger, more powerful heart, I suppose.

Your O argument sounds conclusive to me; thank you.

Why is there no pressure group protesting against blood groupism and sizeism? Lefties don't normally let scientific facts stand in their way.

P.S. Congrats to Mr Tabarrok: I assume his apparent muddling of liver and kidney was a subtle way of signalling "yeah, yeah" about the Jobs' transplant.

'Why is there no pressure group protesting against blood groupism and sizeism?'

Probably for the same reason there are no pressure groups against breathing oxygen. Even if the religious right doesn't normally let scientific facts stand in their way when opposing them.

Seriously! It is the religious right who ignores science???

Mainly they don't want to consider the evolution hypothesis, despite the strong evidence. Typically, the rest of science supports what they want.

The Left only accepts the version of evolution that stopped 100,000 years ago and only occurs from the jawline down.

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This just in! People ignore evidence that they disagree with!

Mainly the people I disagree with do this, because they are the worst. They also have the most confirmation bias.

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'It’s an ill-wind that blows no good'

Obviously, dead motorcycle riders is an utterly trivial detail, and not an ill wind blowing from all those deaths that could be prevented through wearing a helmet.

'find that repealing motorcycle helmet laws generate large increases in the supply of deceased organ transplants'

But this just increases the health care burden on everyone, as often enough noted by the insurance industry - for example, here 'Nebraska reinstated a helmet law on January 1, 1989, after repealing an earlier law in 1977. The state then saw a 22 percent reduction in serious head injuries among motorcyclists (Muelleman et.al.,1992). Acute medical hospital charges for injured motorcyclists declined 38 percent.'

Or this - 'In 2000, Florida's universal helmet law was weakened to exempt riders 21 and older who have at least $10,000 of medical insurance coverage. An Institute study found that the motorcyclist death rate in Florida increased by about 25 percent after the state weakened its helmet law (Kyrychenko & McCartt, 2006). Hospital admissions of motorcyclists with head injuries increased 82 percent during the 30 months following the law change (Ulmer & Northrop, 2005). The average inflation-adjusted cost of treating these injuries went up from about $34,500 before the helmet law was weakened to nearly $40,000 after — 4 times the $10,000 minimum medical insurance requirement.' https://www.iihs.org/topics/motorcycles#helmet-laws

The repealed helmet laws simply allowed them to study the impact of a change in organ supply. They are not making any claims about the helmet laws themselves.

'The repealed helmet laws simply allowed them to study the impact of a change in organ supply.'

Read the IIHS link - this mandating and repealing of helmet use has been going on for decades, and while one can make a certain point that the first time deaths and organ donations from deceased riders increase one can take advantage of that reality to do studies, at this point, it is bizarre to talk about how preventable deaths are not an ill wind due to the opportunity to make even further studies.

It is somewhat libertarian, as there are no clear victims to this self harm, but I agree it might make sense to require $50-100K in medical coverage to legally ride without a helmet.

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Yeah, God forbid that the wealthiest areas in America ever have to have people stand in the slow lines. Or that places which repeatedly opted to undermine social bonds have to live with the consequences.

It is almost like that whole Blue State/Red State culture thing has real world consequences.

Re. the “accidents of geography,” if the regions were eliminated we could have a situation of organs flowing from red states and counties to blue. This would exacerbate our tribal divide.

Yes, but in compensation blue states could provide vouchers to subsidize red state helmetless motorcycling.

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What a grim thought, taking organs from people in red states to give them to people in the few hundred counties that Hillary won! That is so sick. How do y'all think of these things?

But! - if we must: after we run through all the motorcyclists I nominate the folks who drive cars without mufflers, or with those noisy custom exhausts or whatever.

Organ donation rates used to be more similar between regions. Over time the residents of some regions opted to make choices that resulted in diminished adherence to religion, less family formation, less voluntary association, and similar cultural outcomes. One of the results of these changes has been that these regions now have organ donation rate more similar to Europe's abysmal numbers than the historical US average.

Rather than second guess their commitment to secularization, sexual libertinism, soft social democracy, and the like and save the most possible lives ...

the solution is to kill people in places that haven't made these choices to spread the pain around.

If some regions of the country think that it is better to have high rates of STI transmission which taints the organ pool and drives down the usable liver number ... okay. Its a democracy. But that does not mean that they should be able to foist the costs of their decision on the rest of the country.

After all, have we not had any number of judicial decisions come out of the 9th Circuit holding that policy decisions made elsewhere cannot harm Californians?

Frankly, this just a more pathos ridden version of the SALT debacle. Some jurisdictions have made policy choices that they want other jurisdictions to subsidize. The fact that both would just so happen to benefit the wealthiest and most powerful people in the country was completely immaterial. Right.

"the solution is to kill people in places that haven't made these choices to spread the pain around."
Yeah, we all remember when Obama bombed Texas to harvest livers for alcoholic Democratic insiders. Wow. The little Talibans are restless today.

Ted Kennedy let that poor girl drown just so he could get her liver to replace his cirrhotic organ. Of course the press memory-holed this.

Not true at all. Kennedy actually left the body behind.

No, that was a corpse planted as a double. They switched them at the autopsy, just like with Ted's brother.

I don't think it is true. There is no evidenxe at all.

President Captain Bolsonaro investigated it personally!

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Regions with poor rates of organ donation could either try to change donation rates within their own areas, perhaps by adopting some supports for the cultural elements that tend to be associated with higher rates of donation, and leave everyone better off.

Or they could fight for nationalized donation areas which on net leave fewer people dead in their regions, more dead in regions that have been donating more, and have mostly a wash overall (organs going to sicker patients ... but having more unperfused time).

They appear to be choosing the latter.

I just do not get it. Absolutely nothing stops the wealthy areas from donating at the same rates as the rest of the country. But for some reason they really need the rest of us to let them keep doing their special thing.

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Ha.

Seriously, though, if past is prologue regardless of geography, I think the little Talibans, domestically, are more likely to give you some mild trouble over the sexualization of children.

"are more likely to give you some mild trouble over the sexualization of children."

I am not sure. Judge Moore's supporters made it clear it is kosher. Something about Joseph and Mary.

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Central Banks Don’t Need Their Own Digital Currencies
---
Tyler's latest Bloomberg column.
Coming up and he will be trashed on this by me.

Stop bullying my son! He's crying and shaking with terror in his room now, thanks to you.

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Of course there is a flourishing market in body parts. The market in child sex is in plain view, so why not a market in body parts. I once represented a co-founder of an organ transplant company. The company had offices in places like the islands. I assumed it was to provide an excuse to go to the islands for a little R&R. The West Virginia mountains might not be as appealing a place to visit, but organ harvesting would likely be as productive. We are depraved. When I read this morning that the president suggested shooting immigrants in the kneecaps, well, it worked for his mafia friends. We are depraved. From the top. To the bottom. And the organs in between. It's harvest time!

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Why isn't there a secondary market for donated organs that are unsuitable (due to immunological mismatch, damage, etc) for donation? I imagine both cannibals and certain niche religions would pay good money for what is otherwise thrown away. This money could go to the donor's estate or be used to subsidize medical donation.

Human organ consumption is associated with some very devastating and expensive prion diseases (e.g. Kuru); some of these may survive cooking processes.

In any event, there is a secondary market. Bodies, or parts thereof are often donated for medical education. Once that happens they often end up with body brokers who rent/sell them out for things like surgical training. Organs for training typically run around a couple hundred per depending on quality.

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"ind that repealing motorcycle helmet laws generate large increases in the supply of deceased organ transplants."

My wife used to work in the transplant field. She refers to motorcycles as donorcycles.

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