A kidney donor at 18 now regrets it | Hacker News Reader

A kidney donor at 18 now regrets it

washingtonpost.com

204 pointsdanso134 comments

I admire the author's selflessness. At the same time, it seemed easier to be selfless as a teenager, probably for similar reasons for why it's easier to draft 18-year-olds than it is 28-year-olds. Given young persons willingness to sacrifice for the greater cause without realizing that life extends well past your 30s and 40s, I wonder if more shouldn't be done to let young donors think of the risks, so that their naïveté isn't something that the system takes advantage of.

The author's right to ask for better data and tracking of donors. That said, his current worries are likely to be heavily informed by selection bias:

> Five years after the surgery, when I was 23 and getting ready to go to medical school, I began working in a research lab that was looking at kidney donors who had gone on to develop kidney failure. For that research, I talked to more than 100 such donors. In some cases, the remaining kidneys failed; in others, the organ became injured or developed cancer. The more I learned, the more nervous I became about the logic of my decision at age 18 to donate.

If you spend a lot of time talking only to donors where things have gone wrong, yeah, you'll be paranoid. Reminds me of being a cops reporter in which you strongly associate certain neighborhoods with shootings and murders because, professionally, those incidents are the only times you ever visit those neighborhoods.

>At the same time, it seemed easier to be selfless as a teenager, probably for similar reasons for why it's easier to draft 18-year-olds than it is 28-year-olds. Given young persons willingness to sacrifice for the greater cause without realizing that life extends well past your 30s and 40s

I totally agree, the biological basis of this is Pre-frontal Cortex development.

"The [prefrontal cortex] isn't fully developed and won't be until the person is 25 years old or so." https://www.urmc.rochester.edu/encyclopedia/content.aspx?Con...

"This brain region has been implicated in planning complex cognitive behavior, personality expression, decision making, and moderating social behaviour. The basic activity of this brain region is considered to be orchestration of thoughts and actions in accordance with internal goals." https://en.wikipedia.org/wiki/Prefrontal_cortex

I can't understand any other context for drafting 18 year olds other than taking advantage of their youth and incomplete development, but avoiding Presentism and the comfort of Mutually Assured Destruction / Pax Americana, I can understand why when the cards are on the table and your entire society is at risk, why you must call all hands, young and old, into Total War a la WW1 or WW2.

As far as donations go, that's got to be a morally gray area as well for all the reasons you mention.

> I can't understand any other context for drafting 18 year olds other than taking advantage of their youth and incomplete development

18-year-olds have been volunteer recruited and drafted for perhaps the entire history of organized armies. Child soldiers also have (and in some countries still are) enlisted also. I suspect this is only out of extreme necessity, as the moral and practical drawbacks are overwhelming.

When the United States has instituted the draft, it has encompassed 18-to-45 year-olds for immediate enlistment. 18-25 year-olds comprise the largest age group of new volunteer enlistees in the US. The largest barriers to military service qualification are health reasons and family situations. It would follow that younger enlistees would have lower likelihood of physical injuries and being the sole caretaker of a dependent.

Your post made sense until your bizarre digression to armed service being linked to incomplete prefrontal cortex development. It can be appealing to find sinister motivations behind institutions you dislike, but there isn't a basis in fact here. The explanation is tradition, health, and lack of obligations.

It's hardly bizarre, but it's not put in terms of cortical development either. It is however a bit of, "Give me a girl at an impressionable age, and she will be mine for life."

Ignoring that reality, and why 12 year olds are more likely to pick up a machete than a 30 year old, is what's bizarre.

Is it true that 12 year olds are more likely to pick up a machete than 30 year olds?

In a general context, or in the context of what we're talking about here? In general, I don't know, in context... yes. You can get most kids on board with almost anything, and those you can't, you can generally abuse or otherwise force to submit. They're not set in their ways, they don't have as clear a sense of the world, and their impulse control usually stinks.

There's a reason that everyone, for better or worse, wants to get to kids early, and often. Advertisers, religions, people trying to teach kids how to deal with advertisers and religions, militaries, etc... all see the value in "getting them young."

Humans are beastly, violent primates with marginal cognitive advantages over our cousins. Empathy is learned. I don't know if a 12 year old is more likely to kill than a 30 year old, but the former certainly has had much less social normalization toward empathy than the older one, other things being equal.

Also kids are easily guided to do just about anything. They're easily impressed and even the brightest lack the experience to temper their judgement of what is a good idea versus what isn't.

No, healthy people are born with empathy. Which is why childhood animal mutilation is a standard test for sociopathy.

> No, healthy people are born with empathy.

Most of the reading I've done seems to suggest that that's something that's developed at a very young age, and very sensitive to early childhood environment, rather something people are born with.

It's a normal part of childhood development. The original comment suggests that hate is inborn and empathy is learned - no real evidence for that.

Empathy is a far more complex emotion.

Dogs have empathy.

No, healthy people learn empathy, they aren't born being empathetic. They should learn it very early, and certainly should demonstrate some empathy by the time pre-K rolls around.

This back and forth sounds a great deal like "NO U" being shouted on 4chan.

Are there any sources, papers or studies indicating whether it is learned, innate or both?

Sources and empiricism are what we should be resorting to, not down-votes.

A down-vote instead of a link, I don't know what I expected.

You're not going to find a lot of people jumping through that hoop, given that 5 seconds with Google is all that it takes. This isn't some controversial developmental theory, and this isn't a formal debate.

I am not taking sides. I may even have done some reading up already, but I want to remain neutral.

I want to know why the people going back and forth think one way or the other. If I rely on my own research I might not get the nuance that a psychologist or other person with a vested interest would be able to share.

There seems a great deal smoke but no light in this discussion. This is uncommon here on hacker news, normally sources are appreciated and I frequently see them brought in well before an argument begins, even on extremely casual topics. They often earn an few upvotes too.

Then shed some light on it, don't spend a handful of posts complaining about it while cryptically suggesting the value of your own neutrality and what you might or might not know. Again, this isn't a controversial topic, and just a case of one poster who didn't seem to know about the topic in general, as indicated by believing that one aspect of the Macdonald triad being diagnostic for a child.

So again, if you want to add to the discussion, add to it, don't try to control it.

As a general rule, in scientific circles anyway, the person making an assertion is the one who gets to support it. Asking "Why do you believe that?" is always valid.

That question was asked, and answered by several people. "Why do you think that?" and "You haven't cited to my satisfaction, although I've done my research... which I'm not sharing for... reasons..." isn't the same thing at all.

Lets not pretend that it is.

[citation needed], people generally need to pass a crank test or be ignored as not worth the effort of speaking to.

In this context someone explaining themselves would be nice, even without citations (they would be nice though). Instead I was getting downvotes for asking "why" just with a few more words.

At the moment there is no reason to believe either side and plenty of reasons to dismiss both, not as cranks, but at least as cranky.

/I assume the thread is dead so..

Complaining on a form inherently lowers it's quality. As a rule Down-vote, Flag, or say nothing don't clutter up HN with posts that make for poor reading.

And yes, mass downvoting both sides of a thread is often better than getting in the middle of a heated debate.

Given that this is your response, and you've chosen not to shed some light on the subject yourself, the options left to describe your motives are not positive.

It's a complex emotion, and we don't have good tests to measure any but the most basic emotions in infants. But we do have good indicators that 12 month old babies show empathy.

As well as dogs. Dogs have empathy, even for humans.

So yeah, the idea that an 18 year old is struggling with an emotion that babies and dogs don't have much trouble with is a silly proclamation IMO.

It's not a test, it's not diagnostic, it's part of a hypothetical triad of indicators, in the context of an adult's childhood history. You can't even diagnose a child as antisocial, at best you'd have "Conduct Disorder".

Well, trigger warning: discussion of child soldier recruitment, and deadly violence.

Recruitment of child soldiers usually involves drugging the targets. 12 year olds are probably less susceptible to be able to realize that they're being drugged and to have the mental fortitude to retain their self through the grooming process. I suspect that even when drugged, a 30 year old will have a better sense of being drugged and is less likely to be brainwashed. There are also other shock-inducing factors that have a greater dislocating impact on 12 year olds, such as killing their parents (both it happening in front of them, and/or in some cases, them being forced to do it as part of the indoctrination process). I suspect that a 30 year old would be more likely to channel their anger at the "recruiter" than a 12 year old would.

That is atrocious. Do you have any citations to back those up?

http://www.accord.org.za/conflict-trends/understanding-recru... https://www.hrw.org/news/2000/05/31/sierra-leone-rebels-forc... https://childrenandarmedconflict.un.org/effects-of-conflict/... http://www.unicef.org/sowc96/2csoldrs.htm https://childrenandarmedconflict.un.org/effects-of-conflict/...

Personally, I am less likely to take risks as I age because I have invested more in myself over time. It seems natural to value that which you have dedicated money, time, and effort. Before adulthood that investment came primarily from my mother and she valued my life waaaaay more than I did.

I get that this is a dissociative POV.

So often these discussions are about youthful feelings of immortality, more courage, foolishness, etc., but that never rang true personally.

> Personally, I am less likely to take risks as I age because I have invested more in myself over time. It seems natural to value that which you have dedicated money, time, and effort.

No no. Prefrontal cortex development. Who needs an entirely plausible rational explanation when you can point to mysterious and poorly understood brain-physical reasons?

> I can't understand any other context for drafting 18 year olds other than taking advantage of their youth and incomplete development

Physical fitness surely? Isn't 18 or 19 around the physical fitness peak? I'm guessing that people are on average are significantly stronger and more robust at 18 than they are at 28. I think the British Army has 26 as the limit for joining in the first place for officers at least.

Also people are married by 28. At 18 they're generally single and more able to deploy.

18-year-olds are also inexperienced in the travails of supporting yourself in life, and as a result of this, are much easier to sway with ideals rather than pragmatics.

I'd say the peak strength must be 22-26, because 18-years-olds are really thin and lean (source: I love men ;)) – unless they've been practising musculation, but once again, if they practice musculation at 24, they'll be much bigger. But it takes well above 2 years to train a professional, so profesional recruitment takes them earlier. However, concerning draft followed by almost-immediate use on the battlefield, given this subjective data, it makes little sense to me, physically, to draft them so young.

It kinda depends on what kind of strength. For things where the athlete is rather lightweight/small and does some kind of fast/twitchy power moves you peak out somewhere before 30. But when all you need is pure strenght you have 30 to 40 year old world champions in many sports (you still have to start training when a lot younger to make it though) for example in power lifting where you have a lot of todays world champions born in the late 70s/early 80s.

One of the advantages (and disadvantages) of sending 18-20 year olds into battlefield is that if they die society spent less money/effort into teaching them some other valuable skill that would have been lost without getting the benefit out of it (due to the person being dead)

Based on my cursory research men peak physically in their mid to late 20's.

It may be that it takes less effort to get you to sufficient fitness at that age, but it's nowhere near your peak. Unless you follow an elite athlete training program, it'll take you well over a decade of exercise to max out your potential. E.g. for muscle strength, most peoples bodies simply isn't capable of synthesising muscle fast enough in even a decade to max out your potential unless you use performance enhancing drugs.

You may have a point about average fitness and rate of improvement, though.

Drafting 18-year-olds: well, they are less likely to have employment in strategically important industries, they are less likely to be supporting a family, and they are seldom in mid-college, i.e. to be held aside for a commission upon graduation. Those, that I can think of, were the three big sources of deferment in the WW II draft.

They are also approaching peak physical fitness, both as to capacity for difficult physical work, and to the ability to recover from severe trauma.

[Edit: one should probably not exaggerate the idealism of draftees. Maybe it was there in WW I, but the accounts of WW II and since suggest that it fell off.]

I've considered offering to be a kidney donor. Now that I have a kid, I'm glad I didn't - what if my kid needs it? What if my wife does?

Do you not get a "+1" for anyone of your choosing at any point in time if you donated to a stranger in the past?

How could they guarantee that? What if you need to call that right in and they can't find anyone compatible?

There's kidneys, just not for you if you're at the bottom of the list.

Compare to kidney exchange (http://transplants.ucla.edu/site.cfm?id=112): if your friend or spouse needs one, but you're incompatible, you can find another pair who has the inverse compatibility problem and swap with them. Or more, and form a chain (e.g. this 35-kidney chain: http://abc27.com/2015/03/30/paired-exchange-record-70-people...).

What I was referring to is Good Samaritan donation:

Many Good Samaritan donors choose to start chains because it is a way to help more than one person suffering from kidney failure. One chain typically facilitates anywhere from 2 to 30 transplants. The NKR pays for donation insurance for all Good Samaritan donor who start chains through NKR.

http://www.kidneyregistry.org/living_donors.php?cookie=1

EDIT: Ah, found it---they're called Kidney Vouchers :) http://transplants.ucla.edu/site.cfm?id=406 great name. Although limited to one predetermined person, so not exactly a blanket "+1".

It still seems like it's an exchange, just not an immediate one.

Still, all of those things are excellent ideas.

Are shootings and murder common in all neighborhoods? Isn't it correct to strongly associate a neighborhood with shootings and murder if you are repeatedly visiting the neighborhood due to a shooting and/or murder?

You can say that a neighborhood has more shootings/murders than other neighborhoods. What I'm talking about is the phenomenon of thinking of that neighborhood just in terms of those incidents, because that's all you ever hear about them. You aren't there for the 99.9% of the time when things are mundane.

Yes, despite that you are grayed at this point, that example is not logically the same as the phenomenon under discussion.

If you talk to a lot of people with kidney failure you might conclude kidney failure is more likely than it is. This makes no sense as you are specifically looking for people with kidney failure, but humans aren't great at perspective here.

If you are looking for murder victims and a separate attribute--where these murders take place--is clearly correlated with murder victims, it is correct to notice that correlation.

> I admire the author's selflessness.

But if he is publicly regretting donating a kidney, won't he be preventing many kidneys from being donated?

I just don't him going public with his opinion as a good thing. It may become something he regrets even more than his kidney donation.

Even the reporter and the post's title is irresponsible. If I were just reading through the headlines, it would influence my feelings about donating a kidney.

Instead, the title could have been "Kidney-donating doc pleads: please register as an organ donor" and have similar content in the post, but with the main point being that people should register to be an organ donor if they die.

Maybe it should influence you. From what it sounds like, he was essentially misled as to how unlikely it is that he could suffer complications down the road. If you (or anyone else) is less likely to donate because of that, perhaps that's a good thing. Not good for the potential recipient, perhaps, but good for you, which is just as important.

Kidneys are amazing -- filtering blood, removing excess liquid, regulating blood pressure. And they're redundant! My brother lost one kidney in an accident that also left him paralyzed and with a slew of other problems. Recurring UTI and kidney infections took the other kidney a decade later. When he started on dialysis around 1988, the machine was the size of an Asteroids arcade game. It did half the job of a fist-sized kidney maybe half as well. A few years later, we had a home machine a bit smaller than Asteroids. In 1994, I gave him one of mine (kidneys, not arcade games).

The doctors said if the transplant lasted 10 years, we should be delighted, especially with all his post-accident reconfigured internals. My brother's quality-of-life improved immediately — at least he didn't have to be hooked up to a machine and stationary for several hours at a time. My quality of life was essentially unchanged. The transplant worked well for 22 years. Recurring infections -- kidney, liver, bedsores, staph/mercer -- eventually took their toll. I'm pretty sure I wouldn't have done it for "my stepfather's brother" or the like, but I'm glad I did what I could for my brother when I did. I was 23 at the time and now 46. I drink plenty of liquids. My GP's a nephrologist and I have kidney function tests as part of my annual bloodwork. Maybe I'll be pissed if shit goes wrong as I age. With hope I'm still glad I did what I could when I did. And, with hope, the redundancy remains very good.

There are real risks in the actual donation, of course. And some lifelong things you need to worry about. It does affect treatment of other things. For example, if you happen to have a rotator cuff injury, you can't just take high doses of anti-inflammatory meds for a month. You have to do physical therapy and steroid injections. And, in our wonderful US healthcare system, you'll get near-zero aftercare beyond a few months worth of checkups. You'll have to advocate for yourself for later extra checks on your remaining kidney's health and often have to foot the bill yourself because your overpriced insurance will refuse to pay for it.

Source: Am a kidney donor living in the US that has experienced both of the above and several similar issues

Can you explain the part about injury recovery? Are you not allowed to take the medications because it would stress your kidney too much? (Also, do you mean NSAID drugs, or are there issues with pretty much all anti inflammatories?)

What are some of the things that you find yourself needing to advocate for yourself about? Isn't long term care just annual creatinine level tests (which looks like a simple blood draw)?

My physiology professor told our class to never donate, especially at our age group (18-23). His presentation included some of the complications listed in the article. However, his reasoning was straightforward: Assuming a long lifespan, if you are in the position with your only kidney failing, you're screwed.

He was speaking generally of course. Not every situation has an easy solution and Poulson took a noble route, albeit when he was young and not fully informed. I have heard med students suffering from slight paranoia because they learn all kinds of diseases and their symptoms (as another comment has stated). I wish all the best to Poulson.

Assuming a long lifespan, if you are in the position with your only heart failing, you're screwed.

And the article mentioned increased risk of cardiovascular disease.

>Another study that same year raised the possibility that they may face a heightened risk of dying of cardiovascular disease ...

So there you go.

So don't donate that, either.

> if you are in the position with your only kidney failing, you're screwed

Well... unless you can find a kidney donor, that is...

Kidneys tend to not fail independently. Most failures are the result of systemic causes.

There's some down-thread armchair speculation about why humans have two kidneys. I found it interesting, but instead of conniving my own theory did some searching.

The gist of it is that nobody seems to know, but the most simple explanation is that lateral symmetry is common in general because it's more efficiently encoded in the DNA. The organs & structures that don't come in twos are the odd exceptions, not the other way around.

1. https://www.quora.com/Why-is-it-that-humans-(and-many-animal...

2. https://www.reddit.com/r/askscience/comments/po4v6/why_did_w...

Most probably the kidneys are vital enough yet inexpensive enough to allow a pair to exist. You do not get two hearts because that muscle is very expensive. Also because a vascular injury to a major artery will also end your life. Similar reason for the liver - too expensive and also easy to regenerate from a partial injury. The brain is well protected and partly redundant. Lungs are fully redundant and protected by the ribcage. Spleen is not critical enough, stomach can heal. The pancreas is probably an odd one.

This is going to rub a lot of people the wrong way as unethical, but the best way to incentivize organ donation is if the donors get paid a market price for the organ. The donor is giving up a valuable piece of their body, taking time and large medical risks in surgery, and likely reduced life expectancy.

If you walk through the current process, everyone in the donation gets paid -- doctors, nurses, hospital, pharma -- except the donor.

There are a number of advantages of donors getting paid:

1. The supply market would increase dramatically. Thus many more people receiving organs who would have otherwise died waiting.

2. Heirs to people who have died young, with healthy organs could get paid for donating their organs.

3. Black markets would be dramatically reduced, since people in desperate need of an organ could pay in the open, rather than secretly paying a donor.

4. People without money can legally open a Kickstarter to raise funds for an organ donation.

Note Iran has partially done this, and the results have been very positive [1].

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1819484/

A big issue with allowing organ markets is that impoverished people can practically be forced to sell their organs.

Yes, often welfare systems won't give you aid if you have assets such as cash or a home. Would your organs be considered assets?

I'm not sure if it was ever verified, but reminds me of this story from 2005 - http://www.telegraph.co.uk/news/worldnews/europe/germany/148...

At the risk of sounding bitter: it's from a UK "newspaper" and it concerns mainland Europe. You should assume the article needs additional proof, not just verification.

I don't have worry about the welfare system not giving aid. The condition are generally often quite reasonable and there are going to be plenty of organisation to watch that over.

What I worry about, is in countries like the US/UK where "having a student debt" has somehow become a badge of honour, I can see "selling a kidney" to get through university becoming the same honourable demonstration that you are committed to do what it take to succeed.

... and by extension, show people who are not as committed. You can see it coming: "my son sold his kidney to succeed, why should we give even more to the people that are not even ready to take such a small step".

In general, we seem to expect people to take an ever growing amount of risk for the reward of maintaining their social standing. Being able to sell your body in piece is just raising the bar even higher.

That's what's happening right now on the black market. With a real market you can ensure that this kind of things does not happen. (or at least control it)

I'm sorry, but why would you risk death to make a few thousand dollars if you're not poor? This practice significantly targets the poor and desperate. The same issues that come with legalization of prostitution and sex trafficking impact the organ trade.

So do the same failed arguments -- how has legalization and regulation of the market gone for Germany? Or rather how has it gone for German prostitutes, because from a tax revenue perspective Germany is doing wonderfully, with the perverse incentive to keep exploiting poor and trafficked women.

a rather easy solution to that would be to bar the poor from being paid. Sounds unfeasible, but for example -- we were also able to bar the poor from investing with the "accredited investors" title.

Does not work. Middle men and black market will still exist.

the black market exists regardless.

Middle men are easy to fix. Require the kidney transplant be done in a registered location and don't accept "nameless" kidneys.

Why would they be forced to sell their organs?

Because a common occurrence when your poor is: You need $500 to pay for some debt now or a chain reaction will destroy your life. You've taken as much as your family has been willing to lend you and you've taken as much as the system (as much as you can understand it) is willing to loan you. You don't have that money.

Luckily, someone is offering $1,000 for a kidney and you're compatible! You can fix your car / post your bail / pay the loan shark, with $500 left over!

You're pretty much forced to sell your organ at this point. And this point is reached all the time by the economically disadvantaged.

Of course, without the last resort of selling body parts they'd be even more screwed, so I don't know the right thing to implement in this case. Just wanted to answer your question.

I don't disagree the poor would be targeted or coerced to participate. I do disagree people would be "forced," en masse, to donate organs. I also think removing it as an option misses a lot of opportunities.

If you can't get government assistance because you have an "extra" kidney, and you need to feed your family, I wouldn't call that decision anything other than forced.

Is a government somewhere witholding assistance from anyone because they're not donating blood or an organ? Or is this a "logical conclusion" you presume it would be taken to should monetary compensation be made available to donors?

I request you to kindly read up more on this subject. Your 'big issue' already exists today! The poor in countries like India are already forced to sell their organs to rich donors in the West through the black market where they are paid a pittance. Debt collectors in India make a killing by preying on the poor. The rich pay the middle-men a truck load of money, but the actual donor gets very little at the end. Formally paying donors will at-least give them a much better price without the middle-men taking most of the money.

But who pays and how do you avoid adverse selection problems? In the study you cited, it sounds like compensation often comes from the recipient (in addition to a payment from the government). This seems like it would skew towards ability to pay on the recipient side, and towards the less affluent on the donor side.

While there is a short fall of viable organs for donation, the issue the author raises here is one of long term risk.

This is what gets brushed aside when the organ donation process is activated. Only now do we have results from long term study of donors and some of them as pointed out by the author are not good at all.

This problem is not confined to kidney donations for instance, is a growing body of evidence that points to long term complications from another medical procedure - laser surgery (lasix). Here many patients suffer degenerative vitreo-reinal changes over time (if you can, avoid it).

It is not actually the case that donors do not benefit from the current process. Outside the US in the largest market for kidney surgeries India, they are paid; as well as in the Thailand and the middle east. End stage renal disease is one of the worst conditions to die from, and everyone involved with an afflicted patient is desperate for a solution since they suffer almost as much as him/her.

So,No. Paying for organs will not solve this particular problem. But neither will doing nothing. One solution that can improve the number of donor organs is to make it mandatory that organs from qualified people who die violent or accidental deaths be immediately considered for transplant to those who need them. But you can guess this proposal would be (illogically imo) opposed in many countries.

Edit: On a related note, I have been mulling over an idea for a while for a startup to reduce the cost of dialysis for patients with renal disease. At present, it is prohibitively expensive and some patients require 2 sessions a week. If anyone is interested in joining me, reach out. My email address is in my profile.

Wow! I had no idea that there were any links to long term problems with lasix. I have been considering the procedure for over 15 years, but never pulled the trigger. If there are long term risks, I think that I will just stick to glasses.

> illogically

The ethical problem there is how hard the hospital works to save a patient as opposed to letting them die so they can harvest the organs.

Well there's that of course.

But a huge problem also is that many relatives will baulk at the idea of their loved ones being harvested and also some religions have injunctions against this

You know, I hear those stories - that hospitals won't work as hard for you if they know you are a donor. Yet I've not seen any numbers on this. The same folks usually state things about an open casket and other such things. I'm guessing it happens, but I'm also guessing that most times, this isn't on the Doctor's and Nurses's minds in an emergency. Besides that, one can have some policies that help negate this: For example, no financial kickbacks.

I suspect that if organ donation is widespread, it becomes much more normal, and this would cease to be an issue/rumor at all. And I do think the OP is correct - the bigger problem is families and religious views more than folks simply letting people die.

I am a donor myself, so I'm not too worried about it. But perverse incentives should always be checked for.

"Lasix" is not one technology or surgery. If you meant the oldest variant of LASIK or LASEK, the complications are known, it is quite major eye surgery. Newer variants have lower rate of both short and long term complications. (femto-LASIK, the Epi-LASIK and more modern no-touch variants)

Also there are a few big studies comparing long term quality of life. Pretty favourable for surgery. This easily trumps "we found changes in cornea".

You are right and I appreciate the correction. I meant to write LASIK (the surgery) not lasix (the drug, furosemide)

You're missing a very big point

5. The quality of organs goes down.

It's been extensively studied for paying for blood donations, and the consensus is widely to discourage the practice.

https://www.statnews.com/2016/01/22/paid-plasma-not-blood/

http://www.radiolab.org/story/308403-blood/

The biggest difference between blood and organs is scale. Organs are sold for largest sums of money which means that there is much more money and time available to do full medical work ups and tests to verify the quality of the organs.

As well as a significantly stronger motivation to deceive in order to secure the payout. Assuming that verification procedures against a hostile donor can maintain quality vastly overestimates the tests.

The deception is made more difficult via the significant match screening required. When I donate blood, they ask me a series of questions. I can answer as truthfully as I like. How much testing they do to the whole or processed blood likely differs widely from facility to facility.

Before donating a kidney, I went through half a dozen invasive, detailed medical exams that didn't depend on my given answers at all.

The blood market is very different from the kidney market, and simply translating conclusions from one to the other is very dubious.

Blood donations produce the needed amount of blood, and that system basically works. So it makes sense to not take any risks to expand the already sufficient supply.

Meanwhile the kidney transplant world is desperately tragic. About a dozen Americans die each day from lack of a kidney. Even if an added kidney supply would be lower quality on the margin, it would save a huge amount of lives.

Why not cut out the pretense and just farm poor people?

Because then there would be no possibilities for new startups to arise. I already have a good idea: Something Tinder-like for potential donors and receivers ("Let me fuck you for a kidney!", "Suck my dick for a part of my liver.", etc.)

I wish I was at home so I could type out a full reply. I have lots of thoughts on this as I found out my kidneys were failing a short time ago. At least for kidneys I think we need to attack the problem well before it reaches transplant stage. Better proactive screening would help a lot. Some simple medicines would help a bit it given earlier. There is some research on alternatives to transplants. UCSF has plans for an artificial kidney but they are still looking for more funding. There is also some early work to use stem cells to heal kidneys. This stuff needs more research. With a little bit of assistance many could stretch their weakened kidneys through their lifetime. Transplants are not a cure. One has to live with a life of anti rejection drugs with their risks.

My initial reaction to this suggestion is horror, in part because I feel strongly that it disincentivizes finding other solutions to serious health issues. I have a condition that accounts for something like a third of all lung transplants and half of all pediatric lung transplants. I find the emphasis on heroic medical interventions instead of improved diet, prevention, etc. to be really horrifying. Pursuing improved diet, prevention, etc. has gotten me extremely good results. I never know how to convince people of that. It happens to be a fact, but it is not acceptable to really say that anywhere at all and the whole thing makes me feel postal at times.

But, please, let's stop parting people out as the easy answer and try a little harder to solve serious medical conditions some other way.

This is so very UGH.

One change could make a difference to the availability of transplantable organs in the US: make donation upon death opt-out vs opt-in on drivers' licenses.

There are arguments on both sides of opt-out ("presumed consent"), but even the cons argue more about ethics and lawsuits -- re dead people who clearly no longer need the organs -- than that there'd be more organs available to the living who might.

pro: https://sparq.stanford.edu/solutions/opt-out-policies-increa...

con: http://www.hopkinsmedicine.org/news/media/releases/presumed_...

I think an unfortunate side effect of this would be increased organ theft.

This may be a dumb question, but why are previous kidney donors not given a free pass to the top of the recipient list if they have a problem with their remaining kidney?

Came here to post exactly that question/suggestion.

I could imagine that it might also be "and can put one blood relative or immediate family member into a high-priority category" to encourage donation/control for the "yeah, but I'm saving mine in case my kid needs one" objection.

Seems like the way to solve this, without opening up market pricing for them. In theory, this would create a marketplace where supply outstrips demand.

They do get priority. But there is still issue of compatibility. And one still needs to take a lifetime of medicines. I myself found my kidneys were failing recently and did a lot of research.

..... or get your kidney back when the person you donated it to dies

Not a doctor, but I'm guessing that it's hard to re-transplant one and you have to get the person to die the right way such that any donation is even possible.

Every med student I know went through a hypochondriasis phase. I wonder what Poulson will think in a few years, once he is out of school.

That's really what this article seems to boil down to. There doesn't seem to be any concrete data that should lead a completely objective donor to worry. The issue is that the author is not completely objective (nobody is).

I wish they had included another option in the survey. What if you were given a lifetime of free health insurance in lieu of cash? This way, some organization (the govt, AMA, some independent trust) could create a large, insurable pool of all kidney donors. This scheme would work around the problem of moral hazard in both directions. On the Donor side, donors get a substantial financial reward but not in terms of cash. And if it's true that most kidney donors will live healthy lives on par with the general population, then this pool is no riskier to insure than any large company. In fact it might be a lower risk pool than the general population because the process of selecting the donor candidate involves intensive medical checks. Basically kidney donors are likely to be a healthier sample of the general population than random selection.

On the recipient/govt side, you get better outcomes for a larger number of kidney patients (and thus save lots of money on very expensive Dialysis costs). Financially, recipients (or their insurance providers) can be charged enough to cover the insurance premiums on the pool of donors without encouraging a black-market of organ donations.

It's most likely a win for Insurance companies too since they have to foot a large part of the dialysis bill too.

Honest question. It sounds like the recipient was older so if something were to happen to them (passing from old age, etc) would it be possible to move the kidney back? After all it would be a perfect match... still the same age as the donor, and as long as it hasn't been compromised in any way should still function well.

The organ has had x years in a foreign environment. The new host / donee has taken an ongoing regimen of anti-rejection drugs for the duration to prevent that foreign environment from being overly hostile. The organ is not particularly suitable for re-transplantation even back to the original host.

As a surgeon who is 48, I will say that on my transplant rotation ( I am not a transplant surgeon ) the theory of the safety of donation was in the Vietnam War era data that said that soldiers who lost a kidney from injury were at no increased risk of renal failure as the general public given similar risk factors. I know that if you have hypertension or diabetes, it is near impossible to donate a kidney as they have a high propensity to develop renal failure. I have not researched the literature about the war data, but that is what I was told.

That isn't really a fair comparison. There's a selection bias among kidney donors (they must pass some minimal health requirements) and are at a lower risk than the general population.

I suspect that this regret probably has quite a lot to do with the recipient being the stepfather's brother. I.e. not a blood relative; kind of distant.

Not as distant as you'd think. I could actually see it being that the recipient is close enough you'll get information regularly about the person (i.e. small events that happen), rather than a complete stranger who you'd hear from only occasionally if at all.

I also wonder how much pressure he was under to help because of the match, and how much he felt that he'd be disappointing the people around him if he didn't. I know as a kid that kind of pressure would have weighed on me heavily and has lead me to have some regrets about my past (though nothing nearly this large).

Says who? I know many people personally who are closer to their step-families than they are to their blood families. Just because someone donated some of their DNA to produce you doesn't necessarily make them worthy of being family.

Or hell, what about adopted children?

" All-cause mortality, cardiovascular mortality, and end-stage renal disease (ESRD) was identified in 1901 individuals who donated a kidney during 1963 through 2007 with a median follow-up of 15.1 years. A control group of 32,621 potentially eligible kidney donors was selected, with a median follow-up of 24.9 years. Hazard ratio for all-cause death was significantly increased to 1.30 (95% confidence interval 1.11-1.52) for donors compared with controls. There was a significant corresponding increase in cardiovascular death to 1.40 (1.03-1.91), while the risk of ESRD was greatly and significantly increased to 11.38 (4.37-29.6). The overall incidence of ESRD among donors was 302 cases per million and might have been influenced by hereditary factors. Immunological renal disease was the cause of ESRD in the donors. Thus, kidney donors are at increased long-term risk for ESRD, cardiovascular, and all-cause mortality compared with a control group of non-donors who would have been eligible for donation." https://www.ncbi.nlm.nih.gov/pubmed/24284516

Hmmm in hindsight this is logical, you got 2 kidneys of a certain size. Expected do 1 job together. And since biology doesn't like wastefulness (as it cost energy, room, and nutrients to maintain) the kidneys are dimensioned to a safe/good size. Now when you remove 1, the other one has to do twice the job. Possibly severely dipping under the safe size.

In short, redundancy != excess

He's probably going to regret writing this article in ten years.

Has the stepfather's brother with the new kidney not made the donor feel how valuable his gesture was?

Wait, he's complaining cause there's a higher theoretical risk, even though he's experienced exactly zero consequences?

What is he writing about? "Sometimes something you do has potential future consequences." Sounds like life.

Well, this article did a good job in scaring me off of donating any organs whatsoever. I currently disallow donating organs upon my death, because I think if I'm a known donor, the doctors might not try as hard to revive me. And now after this, I'm pretty certain I won't take any tests to determine if I'm compatible with anyone needing a kidney.

You might change your mind if a first-degree relative has ESRD. (Or perhaps not).

> I currently disallow donating organs upon my death, because I think if I'm a known donor, the doctors might not try as hard to revive me.

Sorry, but that really is such a nonsensical argument I'm not sure if you're serious. Why would a doctor not want to revive you? So another doctor somewhere could save a patient? Why would that be preferable to saving your life there and then? Why would the doctor risk their own career for that?

I presume that if you're refusing to donate any organs after your death, you'd refuse one if you ever needed one (unless you're a huge hypocrite). In which case, surely scenario A is far less likely than scenario B?

Reading these comments makes me believe the HN crowd no longer believes in human exceptionalism, something I believe fueled our predecessors into building mile long structures over bodies of water, landing on the moon, striving to colonize mars, and other giant leaps of technology. Makes me sad reading these comments.

TL,DR: author voluntarily donated a kidney to his stepfather's brother, against the advice of much of his family. Years later, the recipient is doing fine but the author (on his way to becoming a doctor), has reviewed the risks of being a donor and now is nervous about the whole thing.

Also, our worthless medical system doesn't do even the most basic data analysis to answer basic questions for common procedures and runs on half-truths and inertia.

is that true ?, I thought there were stats on the outcomes of a lot of procedures.

According to the author:

> The truth is, it is hard to get good numbers about what happens to donors. Hospitals are required to follow them for only two years post-donation, which does not catch such long-term complications as chronic kidney disease, cardiovascular issues or psychiatric issues. There is no national registry for kidney donors or other large-scale means of tracking long-term outcomes.

That's surprising to me. Seems like it's one of the easier things to track. Though what is the status quo for health tracking beyond chronic diseases?

This is an accurate summary. One thing I'd like to add is that there was nothing that the receiver did that provoked the regret. I read this assuming that something happened that caused it to not be worth it.

While this is a good view on this situation, the article is basically a guy saying that his comfort and security to have a long life is more important than the other guy's life. So I assumed that the other guy had done something to bring this to light but that is not the case. The donator had simply researched more and decided he was nervous.

To be clear: His interest in being secure in his life is fine and expected and I'm not judging him by what I said.

"...the article is basically a guy saying that his comfort and security to have a long life is more important than the other guy's life. So I assumed that the other guy had done something to bring this to light but that is not the case."

This is how I went into the article as well. I expected seeing something about the recipient being a substance abuser or otherwise not careful with his gift, or some related drama. But it's really some light hypochondria and the recklessness of youth on display.

I don't begrudge his regret; I don't know if I would have donated in the first place if I had been in his shoes. I'm just not entirely convinced of the overall worth of the article.

I thought the article has overall worth because it's an honest reflection about something we usually think of as a simple feel-good story. We pay attention to selfless deeds when they happen, but usually don't follow up with the aftermath. Apparently, according to the author, neither do hospitals, which means there's a lack of data to do more longitudinal study.

He's also saying it would be nice to have long term data on donors, which no one is going to disagree with.

I guess he's going to be careful with his diet and not drink.

To be fair, there's lots of other organs in your body that are already single points of failure. Regardless, there's probably a reason we evolved with two kidneys. My personal theory (i.e. I have no idea if there's any actual research on this hypothesis) is that before humans discovered cooking, agriculture, sanitation, etc., there were a lot more diseases and toxins and such in the food we ate, so the organs responsible for handling them were much more active than they are now. This is why you can get rid of your tonsils, appendix, a large fraction of your liver, and one of your kidneys and still be "fine".

(To reiterate, though, I don't know how much research there is to support this theory.)

Keep in mind that fish also have 2 kidneys and 1 liver.

(humans have much else in common with fish: https://en.wikipedia.org/wiki/Chordate )

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