All of joshcmorrison's Comments + Replies

Kidney donation is a reasonable choice for effective altruists and more should consider it

The claim about donor survival is more based off of Segev, 2010, which does use controls matched on health (http://jama.jamanetwork.com/article.aspx?articleid=185508&resultclick=1). (There was an editing error in the footnote above, sorry about that).

Good point about the age-matching, which I'll update our website to reflect. Agree that the Mjoen piece definitely has value (which is why we included it), but there are other reasonable criticisms (like the controls all being drawn from the same region and from an earlier time period) raised as well.

1rpdrewes6yThanks for your reply. The JAMA article you cite is not a good one for this discussion, I think, because the median followup was just 6.3 years. The mortality curves for donors and properly matched controls don't start moving apart until about 10 years. At 15 years, the difference is quite pronounced. At 20 years post donation, donors are looking at 50% increased mortality compared to properly matched controls. Kidney donation is still a huge benefit for recipients, and may be a net benefit, but it is a much bigger risk (I believe) for donors than has been portrayed. Yet major donor web sites (Stanford, Maryland Medical Center) haven't caught up to the research.
Kidney donation is a reasonable choice for effective altruists and more should consider it

The U.S. is third in the world for deceased donation per million persons. The difference between us and the #1 (Spain, which has a suite of good deceased donation policies, one of which is a version of presumed consent) can be explained by our generally not accepting deceased donors over 70 and Spain doing so. http://onlinelibrary.wiley.com/doi/10.1002/lt.23684/full

Also, the kidney shortfall is 20K/yr. Total deceased donor kidneys are about 12K per year. Opinions differ as to what percent of those eligible to be deceased donors donate, but the official go... (read more)

If you were try to adapt the EA message to be more successful in the Spanish context, how do you think you'd do so?

Kidney donation is a reasonable choice for effective altruists and more should consider it

To follow up on Alexander's point a bit, I think applying the charitable benefits standard to non-charity decisions leads to some really weird results. For example, say someone who identifies as an EA chooses to give 10% of her income each year to a GW charity, and she’s choosing employment between being a schoolteacher for $50K a year or a job that’s not especially prosocial that pays $55K a year; say she has no innate preference between them, prefers to make more money all things being equal, and that being a schoolteacher would be worthmore than the $50... (read more)

Kidney donation is a reasonable choice for effective altruists and more should consider it

In terms of opt-out, I only know the data in the U.S. but basically while it might be a good idea, it's unlikely to yield significant increases: it seems like such an attractive decision architecture/nudge type intervention, but when you dig in, it's a much closer call (which is why Sunstein and Thaler don't recommend it, for example).

The current American system is more of a hybrid than clear opt-in. Right now, about 75% of those who could become deceased donors ultimately consent to do so (about 40-50% are registered as organ donors and of the remainder,... (read more)

1lukeprog6yI haven't studied organ donation, but I was under the impression that the current state of the (admittedly non-experimental) evidence suggested that switching to opt-out would likely yield significant (though not huge) increases in organ donation, e.g. see here [http://www.biomedcentral.com/1741-7015/12/131] and here [http://www.bmj.com/content/338/bmj.a3162.long]. Is it easy for you to explain, or link me to, the reasons for your skepticism?
Kidney donation is a reasonable choice for effective altruists and more should consider it

(re: political credibility) -- Ehhh, let's say you become a doctor because you think healthcare is important. You want to help people and by being a doctor, you hope to have the status to advocate politically for expanding access to healthcare. I don't see how your authority is impugned because of your desire for advocacy. I think what you're going for is the loss of authority if you have an ulterior motive that cuts against the stated motive -- e.g. if you join a church for political gain but don't believe in god. As a kidney donor, though, your desire to give and desire to change policy are aligned.

Kidney donation is a reasonable choice for effective altruists and more should consider it

Austen, I see your point but think you have the wrong model of how social movements work. Basically any successful social movement I can think of (e.g. civil rights, women's rights, gay rights) has had extremists who were important to the movement and has included acts of extremism that were historically important to the movement's self-identity. More to the point, it's impossible to know ahead of time what acts will end up considered extremist, so it's silly to criticize an action that aligns with the movement's values as being against the movement becaus... (read more)

3Austen_Forrester7yI think you are confusing radicalism of getting attention with that of the form the social change will take. For example, Emily Davison ran onto a race track as a PR stunt, but all she was seeking was voting rights for women, not the right for them to walk around naked. Nelson Mandela was jailed for economic terrorism to bring attention to his cause, but he simply wanted blacks to enjoy the freedoms whites had – nothing radical about that. PETA does crazy publicity stunts sometimes, and perhaps they've had a net benefit, but they do them to bring attention to the abuse of animals on farms, mostly, not to emancipate domesticated dogs and cats. We should make a distinction between extremism in publicity measures with that of the demands that activists are making on society. To look at EA, the demands it makes on people should also be reasonable: give according to impact, not feelings; be irreplaceable, especially for the more important causes, etc. Making unreasonably large demands on people could result in people rejecting even the easier actions. For instance, studies demonstrate that to promote veganism, it's actually more effective to promote vegetarianism, and let the vegetarians eventually gravitate towards veganism, than it is to directly promote veganism, which results in people not even giving up meat, because avoiding animal products completely is so demanding to people that they end up rejecting the whole veg thing altogether. Please don't take my comments as policing, I like your post and I think donating kidneys is great, I just wouldn't want to see a CNN segment on EA discussing kidney donation as viewers may use it as an excuse to reject EA altogether.
Kidney donation is a reasonable choice for effective altruists and more should consider it

Politically, it probably wouldn't be feasible to allow organ sales, but there are a lot of intermediate policy alternatives likely sufficient to end the shortage by supporting donors better (just to start, you could pay lost wages and travel, but you could also provide health insurance, tax credits, or an annuity to donors). If you think that's a good idea (we think it would save about 160K QALYs annually), donating your kidney gives you unique moral authority and power in advocating that policy.

Also you might be interested in signing this open letter if you support benefit for donors --http://www.ustransplantopenletter.org/home.html

0RyanCarey7yBut it's a kind of moral authority that might disappear when you look at it too closely right? If the reason you're donating is to get the moral authority, then it's not clear that it's a virtuous act anymore! Another policy change is opt-out for (after-death) organ donation rather than opt-in. How do you feel about the likely effectiveness of that?
Kidney donation is a reasonable choice for effective altruists and more should consider it

Got it! Thanks for explaining that, and I do think we wrote it in a confusing way (sorry!). There are two separate facts --1. the half-life for all living donor grafts is 14.2 years (figure 6.7 here http://srtr.transplant.hrsa.gov/annual_reports/2012/pdf/01_kidney_13.pdf). 2. Expected lifespan for those who receive any kidney transplant between the years of 60 and 64 in particular is 14.0 years. (See p. 266 here -- http://www.usrds.org/2013/pdf/v2_ch5_13.pdf).

Expected lifespan can vary from graft survival half-life both because half-lives are different fr... (read more)

Kidney donation is a reasonable choice for effective altruists and more should consider it

Bernadette, maybe I'm misunderstanding your point, but the 14 year estimate is for patients 60-64 who receive a transplant (this might be a bit unclear as we wrote it though). Patients 60-64 on dialysis can expect 5.1 years of life, so that gives a 8.9 differential, which when you discount years by disability comes to 8.29 or about 8, which is our (admittedly imprecise) estimate. We don't think it's skewed in an optimistic direction though. To be clear, the 14-year overall estimate is 8 per transplant * 1.75 per marginal transplants created by starting a c... (read more)

2Bernadette_Young7yHere's how you present the calculation * average half life of graft is 14.1 years across all transplants (which I've confirmed is what your defence data is discussing) * patients aged 60-65 on dialysis have life expectancy 5.2 years * therefore patients aged 60-65 on dialysis will gain 8.9 years from transplant. I think that's implausible for the reasons above.