So, I admit this is a very unlikely scenario, but since it deals with difficult moral trade-offs and counterintuitive ways of doing good, I thought it was one that we as Effective Altruists ought to consider. Suppose I see an innocent person about to be murdered by a mass shooter. Intuitively, it seems like the best thing to do is jump in front of the bullet to save them. However, it occurs to me that the damage to my body might render it unsuitable for deceased-donor organ donation. Since deceased donors have a chance of saving multiple lives, while jumping in front of the bullet will only save one life (for simplicity's sake, let's assume the shooter commits suicide after firing the particular shot that I'm considering stopping, so we don't have to consider the potential benefits of me staying alive to stop the shooter and prevent further murders), I wonder if it would actually be best not to jump and instead to try to maximize my chances of dying a natural death while being monitored in a hospital, which seems like it would have a better chance of preserving my organs as suitable for donation. To decide whether the expected benefit of saving one life is worth the expected cost in this scenario, does anyone know the expected value of lives saved for a donor who's about 20 in the year 2020 (I mention the year because we have to account for the possibility that medical advances will make organ donation obsolete and unnecessary by the time the donor dies a natural death), assuming the donor is of average health and lives in a relatively wealthy country, and therefore has access to high-quality medical care? Also, supposing I do jump in front of the bullet, what's the expected value of lives saved if I'm listed as a donor and they try to recover my organs anyway? I'd appreciate any thoughts, resources, or answers you guys can offer, especially if you have a background in surgery, organ donation, or organ transplant. If you can, though, please let me know what sources you use to inform your answer.




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I’ve tried to estimate the number of life years saved by the typical organ donor, and the latest estimate was I think something like 0.1.

This seems surprisingly low to me. Do you have some notes or a writeup of the analysis somewhere?

Josh Jacobson
It looks like I accidentally took credit for Zach Weems' estimate, made here:
Edited for clarity I can imagine such a low number if we're talking about posthumous donations. According to this, only 3/1000 people die in such a way that their organs are useful. When you add that to the fact that deceased organs are less good than living ones,  you can get something as low as this. For example, this says that the QALY's from a deceased kidney is 4.31. If only 3/1000 donors have such kidneys, you get 0.013 QALY's. It will probably get higher when you account for all other organs. I should also mention that it's not clear if all organs are damaged equally, so a less naive estimate would be useful.

How much time do you think you have to decide if to jump in front of the bullet? 1 second? 5 second? How far to the future do you want to consider? One generation or two? How likely the bullet will hit your livers or other organs suitable for donation? What if you live for too long afterwards and pass the age limit for organ donation? Will the shooter stop shooting immediately after seeing your sacrifice? Why? Who is the person you want to save? …. Whatever the end result of this analysis is, I don’t think it’s going to be helpful for you or anyone in a mass shooting.

I was once told that so many contrived variations of the famous trolley problem have been invented that there is a sub field of moral philosophy called trolleyology. Some thought experiment reviews something we don’t about the world or ourselves. Others are only useful for writing papers.

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