Results for “organ transplant” 69 found
Dutch Treat
Holland’s Health Minister has proposed a system for organ donation similar to what I have called (in Entrepreneurial Economics) "no-give, no-take." Under the proposed system people who sign their organ donor cards would receive points which would raise them on the waiting list should they one day need an organ.
My main argument for no-give, no-take has always been efficiency, it would increase the incentives to donate. It’s fairness, however, especially as it intersects with the politics of immigration that is driving the change in Holland.
The Liberal VVD minister defended his proposal by pointing out that
Muslims often refuse to donate organs based on religious beliefs. This
is despite the fact they are willing to receive an organ if they are
ill. "That creates a bad feeling," he said."If you say: ‘I refuse to donate an organ because of my religion,
but I don’t want to receive one either’, than I will respect it. But I
won’t respect a one-sided attitude of receiving and not giving. I find
that problematic," Hoogervorst said.
Thanks to Dave Undis for the pointer.
Paying for Kidneys
In a new paper, Gary Becker and graduate student Julio Elias estimate that for a price of $15,000 the shortage of kidneys could be eliminated from live donors. The risk of death to a live donor is no more than 1 in a 1000. Combine this with a value of life estimate of $3 million and add in some costs for time off work and so forth and you get the Becker/Elias figure of $15,000.
$15,000 seems too low to me but it probably would since my income is above average. As a robustness check, the authors note that in India a kidney can be had for about $1000 and US per capita income is about 15 times that in India so $15,000 looks to be in the right ballpark. A similar calculation from Iran, where kidney sales are legal, is also consistent. In anycase, even if they are off by a factor of 2 the point is well taken that for a modest sum many lives could be saved. (In fact, dollars would be saved also because transplants are cheaper than dialysis.)
Becker and Elias have a useful response to (so-called) moral objections. Take any argument against kidney sales and apply it to the volunteer army. Do kidney sales "commodify the body?" Perhaps, but then the volunteer army commodifies life. Would kidney sales eliminate altruistic donation? As the example of Pat Tillman and many others demonstrate people still volunteer for the military for non-monetary reasons. Are there difficulties for donors to calculate risks? Again, perhaps, but these also apply to joining the military (and if so we could allow for a cooling-off period for both donating an organ or joining the military, as we do in some states for auto purchases).
If you are not in favor of the volunteer army then Becker and Elias don’t have any knock down arguments but I suspect that many people who are against kidney sales also favor the volunteer army and for these people Becker and Elias are posing a consistency challenge.
Kidney swaps II
The Wall Street Journal reports (subs. required) that the kidney swap idea I wrote about earlier is beginning to be implemented. Here are they key points:
Last year, 43% of kidneys transplanted in the U.S. came from living donors, up from 28% a decade ago.
But a biological barrier often blocks a transplant from a relative. In about a third of all would-be pairs, blood types are incompatible. In others, the sick person has antibodies that can initiate a rejection of the donated organ. It’s heartbreaking “to have the treasure of the live donor and then have that not go forward because of a biological obstacle,” says Massachusetts General Hospital transplant surgeon Francis DelMonico.
Occasionally, transplant centers spot a way out: One New England father with blood type A couldn’t donate a kidney to his daughter with blood type B. So he gave a kidney to a teenager with blood type A, and the teenager’s sister gave a kidney for the man’s daughter.
Such swaps, however, typically occur only when happenstance alerts surgeons to the possibility. Economist Alvin Roth and co-authors have devised an algorithm, however, that computes all the possible swaps and which is incentive-compatible.
…when Dr. Saidman gave the economists details on 45 pairs in which the would-be donor was unable to give a kidney to the intended recipient. Even though each of the 45 had a donor willing to spare a kidney, all were stuck waiting for the right person to die. With swaps involving two kidneys, the economists found, eight transplants were possible. If swaps involving three kidneys were possible, then 11 transplants were possible.
Addendum: Alert readers will note that kidney swaps are quite similar to organ clubs an idea for saving lives that has been implemented by Lifesharers.
Further thoughts on artificial hearts
A number of people emailed me or blogged (eg. here and here) on my post, Artificial heart won’t save lives. The number of transplants is constrained by the number of donated organs thus the main effect of the artificial heart, which is just a temporary stop-gap, is to redistribute organs. The artificial heart makes some people better off at the expense of other people who are made worse off. No one challenged this conclusion but it seemed to make some people uncomfortable. Two arguments were raised in opposition, both of which are weak.
First, the heart does allow some people to live a little bit longer – this is a benefit, but a few weeks of life while chained to a big machine doesn’t seem like a big breakthrough to me. Second, the artificial heart could allow for better matching. Theoretically true, but there are already many more patients on the waiting list than there are hearts available so the opportunity for better matching is negligible. Consider, that for a given heart there are now 3500 people on the waiting list to choose from – how much better is the match going to be if we add a few more people to this list?
I am not against artificial hearts (some people say I have one!) perhaps one day the technology will improve enough so that someone on an artificial heart can be taken off the list, but the issue is comparative. Suppose that we put the funds gong into artificial hearts into programs to increase organ donation. One donated organ is say good for 10 years of extra life. Average time on the artificial heat is 77 days and it is not clear how many of these days represent extra days of live. Let’s say very charitably that 50 days are extra then this means that one real heart is worth 73 times as much as an artificial heart (10*365/50) and that is before adjusting for quality of life.
Artificial heart won’t save lives
An FDA panel announced today that they would support approval of a new artificial heart. NPR and other media suggested that the new heart, which is designed only for temporary use and is not portable, would save lives by extending survival time until a transplant became available. But even if the artificial heart performs exactly as designed and even if it prolongs the lives of those who receive it, it won’t save lives overall.
The mathematics is simple; there are approximately 2200 hearts donated for transplant every year (data here). That means we can save 2200 lives a year and no more. All the artificial heart can do, therefore, is change who gets saved. Some people who previously died will live long enough to receive a transplant but this means there will be one less heart available for someone else on the waiting list. The artificial heart will make the waiting list longer but it will not save lives.
The only way we can truly save lives is to increase the number of organ donors. As readers of Marginal Revolution will know I have suggested financial compensation and organ donor clubs as the only realistic solutions.
Kidney swaps
Your spouse is dying of kidney disease. You want to give her one of your kidneys but tests show that it is incompatible with her immune system. Utter anguish and frustration. Is there anything that you can do? Today the answer is yes. Transplant centers are now helping to arrange kidney swaps. You give to the spouse of another donor who gives to your spouse. Pareto would be proud. Even a few three-way swaps have been conducted.
But why stop at three? What about an n-way swap? Let’s add in the possibility of an exchange that raises your spouse on the queue for a cadaveric kidney. And let us also recognize that even if your kidney is compatible with your spouse’s there may be a better match. Is there an allocation system that makes all donors and spouses better off (or at least no worse off) and that maximizes the number of beneficial swaps? In an important paper (Warning! Very technical. Requires NBER subscription.) Alvin Roth and co-authors describe just such a mechanism and show that it could save many lives. Who says efficiency is a pedestrian virtue?
See here for more on how to alleviate the shortage of transplant organs.
When Affirmative Action Kills
The United Network for Organ Sharing says that “justice refers to allocation of organs to those patients in the most immediate need.” As such, skin color should be irrelevant in deciding who gets a transplant. But although proponents are loath to make race an explicit factor in transplant policy they are surreptitiously redesigning the organ allocation system in order to increase the number of blacks who receive transplants. The system is being redesigned to meet the ideals of the social planners despite the fact that such “affirmative action” will result in more deaths overall. As a proponent of financial incentives for organ donors I have often been accused of being immoral. But my conscience is clear – I have never advocated killing people to serve my idea of social justice.
From the Wall Street Journal (Friday, Feb. 6).
New rules for allocating scarce kidneys will result in 6.4% more blacks getting transplants, while slightly increasing the number of unsuccessful transplants, a study finds.
Blacks and other minorities have long been disadvantaged on transplant waiting lists — in part because the scoring system gave strong priority to compatibility between a recipient and the donated organ. Although blacks donate organs as often as whites, they have an extremely wide variety of protein markers on the outside of their cells — making an exact match much harder to find than for whites.
Making matters more acute, kidney disease in blacks is very common, owing to their higher rates of high blood pressure, which takes a toll on the urine-filtering organs. Blacks make up 12% of the U.S. population, but account for 36% of the 56,544 people in the U.S. waiting for a kidney. Prior to the scoring system overhaul, they were 33% less likely to get a kidney than whites.
The new rules, implemented in May by the United Network for Organ Sharing, stop giving priority for a certain type of immunological match known as HLA-B.
The report on the new system, in Thursday’s New England Journal of Medicine, used a statistical method to predict what will happen under the new rules. It finds that, had the new rule been in effect in the year 2000, 2,292 blacks would have gotten kidneys, up 6.4% from the actual number of 2,154 blacks. Meanwhile, 3,954 whites would have gotten the organs, a decrease of 4%. Hispanics would have seen a 4.2% increase. Asians would have seen a 5.9% increase.
Critics feared the new rule could reduce the success rate of transplants, effectively wasting precious organs on people whose bodies were likely to reject them. About 2% more organs will be rejected in people of all races, resulting in the need for another transplant, the study predicts.
The best new ideas in applied science
Read this feature article from Popular Science magazine, or just buy the December issue. My two favorite new products are the following:
1. Binoculars that repeat the last 30 seconds. Instant replay, right there in your hands, and only $600 from bushnell.com.
2. Speakers that know how to listen. The speakers can measure what kind of sound they are producing in a particular room, and adjust their output accordingly to sound even better, they are called Beolab 5. This item costs a steeper $16,000, I will buy them when they start paying bloggers, from Bang-Olufsen.
Alex will be interested to hear about the new “Lifeport Kidney Transporter,” see organ-recovery.com, now FDA-approved, which makes it easier to move kidneys around the world, the device makes a soon-to-be transplanted kidney last for 17 more hours than previous technologies.
Lloyd Cohen to Guest Blog at MR
This week we are pleased that Professor Lloyd Cohen of GMU’s School of Law will guest blog for Marginal Revolution. Lloyd has published widely in law and economics especially on creating a market in transplant organs, marriage and divorce, wrongful death, tender offers, and free riders and holdouts. We look forward to Lloyd’s bracing style!