How to stop losing 17,500 kidneys | Hacker News Reader

How to stop losing 17,500 kidneys

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126 pointsMichelangelo11102 comments

For a contrary view, this comment on Marginal Revolution is worth considering (https://marginalrevolution.com/marginalrevolution/2024/04/un...)

> My spouse works for a doctor who specializes in kidney transplants. This post has numerous errors and misleading statements; so many that it probably should be taken down.

> Firstly, there is a very good reason why some recovered organs are not transplanted. It’s because they arent healthy kidneys. Either due to the health of the donor or a long cold ischemic time, these kidneys would not function properly in a recipient. The center my spouse works for is nationally recognized as being aggressive; making use of kidneys that other doctors reject, but there are plenty of kidneys that they will mot use and no center will.

> Secondly, organs are GPS tracked.

> Next, UNOS requires each center to remove someone from the wait list within 24 hours of finding out about the death. My spouses center checks in with patients once every 3 months, so, at most, there can be a 3 month delay between death and list maintenance. In practice, the family or dialysis center will notify the doctors office much earlier than that. I highly doubt the 17 percent of matches are against deceased patients stat because it has never happened in all the years my spouse has been working there

> Also prior living donors are given priority

This is just a comment from someone whos "spouse works for a doctor who specializes in kidney transplants" on a semi-related internet post by a professor of economics.

The actual article here is an interview with the people who accumulated all this data and have spent years researching UNOS.

Besides:

> There have been some tremendous surgeons who have spoken up, and three have testified before three different congressional hearings in recent years, saying that too many of their patients are dying, and the system has to be fixed.

> Also prior living donors are given priority

This does not conflict with the Marginal Revolution post. Tabarrok is suggesting a policy where registered potential organ donors (i.e., people who sign up to be organ donors in the event of their own death) should receive priority if they later need an organ. There are vastly more such people than living donors.

> Secondly, organs are GPS tracked.

This seems wrong. If they all were tracked, it would be a very silly mistake to make to claim otherwise. The most likely resolution is that the organ transport firm who works with this particular doctor (the commenter's spouse) does do tracking, but that tracking is not universal and perhaps not common. In which case Tabarrok's criticism would stand.

Here's the source of the claim that GPS tracking is not required, which indeed notes that some transport firms track and some do not:

> Jones noted that his firm ships organs only on direct flights and uses GPS tracking to monitor them.

> However, GPS tracking isn’t universal — or required by UNOS or HRSA. Some couriers and airlines use it; many don’t. Many OPOs monitor organs through a combination of verbal handoffs, automation and label scans, Brown said.

https://kffhealthnews.org/news/how-lifesaving-organs-for-tra...

Seems that 17% is from 2008-2015 data (this is the link from the original article linked in the post) https://www.amjtransplant.org/article/S1600-6135(22)09789-1/...

Also it mentions a policy of relying on SSA data, which makes more sense than checking on each patient manually every 3 months (though the data access got worse due to a policy change). Curious why this doesn't match ther personal experience of the commenter's spouse, should be a high enough number to be noticeable?

> Secondly, organs are GPS tracked.

While they're transported or while they're in you?

I saw an interesting article arguing that we should legalize paying for kidney donations. [1]

I'm not sure how I feel about it, but the article was well argued. The main argument is that even if it is immoral, we are still short hundreds of thousands of kidneys unless we can somehow make them, and so this would save lives.

[1] https://www.nytimes.com/2024/04/02/opinion/kidney-donations-...

> and so this would save lives

lives of people who can buy a kidney.

this is a transfer of longevity from poor people to rich people.

and since because everything balances, in the future it will take selling a kidney to get to the average, and poor people will end in the same place but with only one kidney

The linked article suggests that the federal government would be a monopsony buyer in the US kidney market. My understanding is that most serious policy proposals along these lines would have the same feature. Medicare already covers care for nearly all US citizens with severe chronic kidney disease; paying for kidney donations would move some number of patients from dialysis to transplant but they wouldn’t be out of pocket.

I don’t see how that solves the potential problem. You could still end up in the same place of “balancing out” where the extra money from your kidney becomes something you need i.e. a transfer from poor to rich people.

Well, the people receiving the kidneys won’t be rich on average, although it’s possible they’ll be richer on average than the compensated donors.

There’s a big shortfall of available kidneys but the number is pretty tiny compared to the number of people living paycheck-to-paycheck in America. So it seems unlikely to me that in the future everyone needs to donate a kidney just to stay in the same place—that’d be a couple orders of magnitude more kidneys than we need.

Fair point that there isn’t a high enough demand to cause a lot of poor people to be monokidneys.

Great example of how simply allowing a market to exist can result in inequality, compared to if the market were illegal.

>this is a transfer of longevity from poor people to rich people.

Wealthy people can in any case already often buy kidneys and other organs if they desperately need them, and if they're famous, or influential politicians, they might even get a jump ahead for donor kidneys. At least with a legal market, buying a desperately needed organ wouldn't require that you be someone with special connections and all kinds of unique advantages. You'd just need the damn money.

The hatred towards what should be an obvious market of voluntary exchange in which people trade something so obviously theirs and personal to others who need it for obvious reasons is absurd and irrational.

The current system is disastrous and in need of aperture for experimentation. Clamping down on this because of bullshit dogmatism is disgusting. Lives are literally at stake.

If you are rich enough to think buying kidneys makes sense, I implore you to advocate for better health care which improves the odds of keeping your own original equipment from the manufacturer functioning adequately.

Transplant is not all upside. You remain on drugs for life. You may die anyway if your body rejects the transplant.

I see a lot of pro-transplant headlines on HN. People don't seem to want to hear any criticism of organ transplants.

But I think organ transplants are "ooh, shiny tech" that makes for good headlines not actually good medicine. I think good medicine would fix you, not turn you into Frankenstein so doctors can feel powerful.

Keeping people healthy is boring, doesn't really get tracked, no one cares. Letting their lives go to hell and then "saving" them makes for good headlines.

I have a condition that accounts for a lot of organ transplants. I would rather keep my own organs functioning.

All of HN loathes me for having that opinion. But if you think you are at risk of "needing" a transplant and have resources, I encourage you to actively look for other solutions to advocate for.

We mostly don't hear the horror stories about transplant. If that got more publicity, maybe people wouldn't be so quick to act like I'm some kind of nutter for having opinions about the topic.

> If you are rich enough to think buying kidneys makes sense, I implore you to advocate for better health care which improves the odds of keeping your own original equipment from the manufacturer functioning adequately.

Congratulations on having a condition that gives you some control over whether you need an organ transplant in the future. I assume that nobody on HN cares whether you keep your own organs functioning, and nobody thinks you are a nutter just for "having opinions about the topic": they object to your declaration that they should prioritize not needing an organ transplant because of your values and the circumstances of your own life.

> Keeping people healthy is boring, doesn't really get tracked, no one cares.

That's a fun contrarian statement too. If only there was ever anything written about preventative health care and lifestyle improvements. Maybe you can publish the first book on it!

Congratulations on having a condition that gives you some control over whether you need an organ transplant in the future.

I'm not supposed to have any such control. I exercised it anyway, thus my opinions.

I don't expect anyone to care about me or my opinions or my agenda and I don't know what the PC language is for this. There seems to be none.

But "more access to transplants" isn't your only option if you are thinking long term about your own health issues.

> If you are rich enough to think buying kidneys makes sense,

Again: when serious people (i.e. not a bunch of stoned Silicon Valley überlibertarians at Burning Man) discuss this topic it’s generally assumed that the government is the sole buyer of live organ donations. The United States is certainly rich enough to make it work—indeed, it already covers a huge percentage of dialysis in the country via the Medicare ESRD program.

Anyway, I’m not a doctor but I don’t think it’s especially controversial that some people today will die without a kidney transplant, and it’s a bit too late for preventative efforts for them. Personally I would rather they have the option to get a new kidney rather than tell them “sorry, we don’t want to play God and turn you into a Frankenstein.” But maybe I’m too rich to understand.

For the record, I have never once advocated for denying anyone transplant nor do I understand why people act like that's a reasonable interpretation of things I say.

All I'm saying is I would like to see more effort put into preserving our original organs and I feel the emphasis on how "cool" organ transplantation is actively undermines that.

I'm not "against" organ transplants. I'm for trying harder to help people keep their original organs healthy and functional.

There is a difference -- a quite large difference -- and I never said anything about "playing God."

I'm not religious. I don't generally use such phrases because that's not really part of my world view.

I find the idea repulsive. Saving lives by paying poor people to part with organs that they would keep if it wasn't for the cash.

This is a common opinion in bioethics and it doesn't really make sense. It's not moral to reward people for doing something because it might cause them to do it?

It's like the idea that people shouldn't be paid for growing food or building houses because they'll profit for it. Which leaves people only being able to profit from making useless things because then nobody needs them.

Why are you comparing growing food with selling a part of your body?

I think that any country that wants to consider legalizing the sale of body parts from living people should probably illustrate how they have effectively eliminated human trafficking for other forms of exploitation first.

Generally speaking, it is not a moral act to reward people for harming themselves, or allowing themselves to be harmed. Most society overlook this in the name of sport, or in the name of freedom (e.g. drugs, alcohol, driving, and other massively harmful, but shockingly profitable ventures), but the balance of respecting freedom while preventing exploitation is generally a complete shit show as evidenced by the rampant human trafficking, and the ongoing exploitation of addiction that the illicit drug trade represents.

The moral arguments also set aside the fact that the overall quality of "ethically sold" organs are likely to be lower due to the overall impact that a life of poverty on individual health has, and that selling an organ is most likely going to be an option of last resort for most people.

Personally profiting from an act of self harm doesn't stop it being an act of predation or exploitation.

If donating an organ is self-harm why are you allowed to do it for free?

Because when you remove the financial incentive that leads to outright exploitation, there still remains the case where self-harm can be a moral action.

Donating a kidney, for example, or bone marrow, is harmful to the donor, but the trade-off is that it may save the life of another person. People make trade-offs that result in self-harm as part of a moral decision all the time. Firefighters are a great example of this.

We (humans and societies in general, because this comment applies to all societies) generally block or allow moral and immoral activity based on the ability of those with power to regulate things. Some things are simple, like murder - generally, killing people is considered immoral, but even then, there is flexibility (for example, measures taken to stop an attacker from causing harm). Some things like organ donation are considered moral complex, and demand extra focus to prevent exploitation.

Why do we assume cash ?

It can be in kind, we already do this a bit current donors get preferred for donations when they need it themselves.

Why cannot we extend that and say entire health care expenses for the rest of the donor’s life the state will take care for example ? it doesn’t even have to in. full , they can even just improve coverage , and make insurance companies remove restrictions like pre-existing conditions for such donors .

There are plenty of benefits like this the state can do, perhaps tax credits , exemptions, priority in any government program , cheaper mortgages and so on , even private sector can step in with benefits like we do for veterans.

I think the point is not to pay and make it an economic transaction , but to reward I.e. incentivize people to do donate more.

The benefits can also extend to next of kin like say financial aid for college etc(donors shouldn’t be that young to directly benefit from education aid)it would then also factor for non living donors

I might find it reasonable if sums involved were life changing. So a kidney would start at something that will pay invested for rest of the donators life. Let's say 10 million. So rich who can afford them can get one. And donators don't have to work anymore.

I interpreted the original idea as the government / public health system paying the person for the kidney. Your idea is incredibly more repulsive.

I tried to elaborate, but I can't even entertain the idea for long enough to type out something I would be comfortable with submitting.

I wonder if this article would shed some light on the difference between your response and others: https://www.overcomingbias.com/p/systems-explain-stem-vs-cul...

(I'm not judging or trying to persuade, but wish to increase understanding between people with very different viewpoints.)

I think I do understand why the other people in this thread wrote what they did. It's true their worldview is probably extremely different from mine.

I find the extreme wealth inequality we witness to be a great tragedy. That people are destroying their minds and bodies to be given the privilege to exist on this planet, while people lucky enough to be rich can simply order 99% of other humans around, and convince them that it's a good thing. That it's fair they're giving away their health, their sexuality, their blood or all of their time, as they are getting paid money in exchange. Something that to them is only achievable by hard work and extreme sacrifice, and in small quantities, while the same amount represents a minuscule value to the person on the other side of the deal.

Adding to that legally selling your organs, is inconceivable to me. What's next, selling babies for adoption?

I'm sorry if this seems poorly thought out and weakly formed argument, but I don't even know how to begin expressing my opinion on this matter. I can't see how I can be convinced this is all OK and something to be intensified.

I’m fine with a nominal payment. Like how they charge you 1 cent for paper bags. Enough to make it “not nothing”, but not enough to sway your conscience.

I could see an argument that paying for donations from the dead via a bidding system could promote actually caring if the organ gets where it is going.

It would probably be a decent first step to commit to covering all the direct and indirect costs of donating a kidney. Not everyone can afford the time off work and life required to go through the operation and recover, and then guarantee that they'll have reliable health care for the rest of their lives. There's lots of room to debate whether income replacement should be included and at what level, but among the dozens of existing systems that do it (jury duty, unemployment, disability leave, parental leave...) it should be plausible to find a model that people feel is acceptable.

I don't agree with paying for kidney donations, but I think we should pay people to be organ donors via some tax deduction if you've been registered as a donor for the past 2 years (so you can't like, register then file taxes then unregister)

17,500 doesn’t really hit that hard, at least for me—I don’t have a good intuition for how many kidney transplants happen per… whatever, day, year. The number in the article is more intuitive, I wonder why they didn’t put it in the headline.

> If you're an organ donor in the U.S., there's a 25% chance your kidney ends up in the trash.

That’s a wild number of wasted kidneys compared to the supply.

> That’s a wild number of wasted kidneys compared to the supply.

It's not that wild if you dig in a little; not every kidney you take out is going to wind up suitable for transplantation. There's some research into expanding the "suitable" criteria:

https://www.kidney.org/news/kidneys-initially-deemed-unfit-t...

> The study tracked 291 kidneys that became available from 172 deceased donors but were at first rejected for transplant between January 2014 and December of 2016. The kidneys were initially refused using code 830, which indicates that the organ was of low quality or the donor’s age was too advanced. The organs were subsequently procured by Southwest Transplant Alliance in Dallas and transplanted into patients on the kidney waitlist.

https://www.nhsbt.nhs.uk/organ-transplantation/kidney/receiv...

> There may be problems with the donor or organ that mean the kidney has a higher risk of failure than you or your transplant team are willing to accept. You may have problems, such as a recent infection, that makes you unsuitable to undergo transplantation at that time.

When I was late teens early twenties, someone would have been lucky to get my organs. Especially my heart. Today not so much.

You can list yourself as an organ donor and have health issues. You kidneys might be good and your liver shot. Or your lungs and corneas good and everything else a disaster.

That's pretty much my take on it too. Mid-40s, and to be honest if you got my corneas you've hit the jackpot. If you're after anything else .. I've got bad news for you.

The idea that 25% of us have goods that aren't worth selling, does not blow my mind.

> higher risk of failure than you or your transplant team are willing to accept

Emphasis mine. Transplantation in the US is a gigantic stats same, and a lot of transplant teams will pretty blatantly try to fake their stats.

I read a news article the other day about a "lead transplant doctor" in the US had been only accepting patients highly likely to recover, thus leading to his high success rate (and the deaths of other, potentially saveable patients). The hospital he was at released a statement defending him, citing...his high transplant success rate.

Comments on the article included anecdotes of people who were living kidney donors, who had felt chronically ill/weaker since their transplant, who had transplant teams insisting that it was not in fact related to the transplant because it would affect their stats.

The reason I'm not an organ donor is simple. Everyone in the chain makes money: the OPO, the hospital, the doctor, and the insurance company. The only one who doesn't is my family, but they're the ones offering the scarce resource. If there were a pre-registered organ market then I would gladly opt-in if the price were sufficiently high.

If no one else will work for free, I will not either.

> If no one else will work for free, I will not either.

If you're deceased, what sort of labor are you doing exactly?

To me, your argument seems to fall more along the lines of your body and organs being property that can be inherited by your family in the same was as cash, real estate, etc. Which is an interesting idea.

But ultimately it's called "donation" for a reason. If you donate to, say UNICEF or Red Cross, you're also the only one in the chain who doesn't get paid.

>If you're deceased, what sort of labor are you doing exactly?

Keeping the kidney healthy so that it is usable upon death?

The one piece of labor necessary to become an organ donor is to check a box when applying for or renewing your driver's license.

You have no obligation to do anything else or even think about it ever again. You can make exactly the choices you prefer without regard for your organ health, if you like.

They asked what labor you'd be doing to be compensated for upon donating an organ after death. Simply checking the box doesn't ensure that your organs are healthy enough to donate. The monetary compensation would be for keeping the organs in a healthy enough state to be actually donatable (rather than just potentially donatable, as is the case with just checking the box).

If you make life decisions that keep your organs healthy enough to donate, the primary beneficiary of that isn't the organ procurement agency, it's *you*. You'll live longer and have better health. I wouldn't call optimizing your personal wellbeing "labor" or "work."

That's not a requirement to be an organ donor though. Unless you have religious beliefs about the sanctity of an intact corpse, then the only potential harm is wasted resources checking if your organs are viable.

You're not doing much of that once you're dead.

Frequently I do things for which the reward arrives later. The labour comes first, the reward for it comes later. If someone will parasitize my labour, I will block him.

Unlike donation to UNICEF, if I don't do it, people don't call me a Nazi, a paedophile, or other such things https://web.archive.org/web/20240417004658/https://news.ycom...

But I am right, and society will turn to my view in time. For now, the rich will harvest the poor for free. But in time, at least they will have to pay them what they want. We will fix this bug.

To everyone else: I hit my rate limit responding to you all, so I'm afraid you must remain unresponded to.

As an organ transplant recipient who would have died 20 years ago without one, I hope you reconsider.

I will. Please write your representative asking to reform NOTA to permit compensation to the estate through a 20% tax on all transactions involving an organ transfer. For the $700k liver transplant, it is not unreasonable that my family receive $140k. For the $20k the OPO receives, it is not unreasonable that my family receive $4k.

Once NOTA is reformed, I will register to provide.

Fine, but you should be ineligible to receive, in that case.

Fine by me. I'm in a minority ethnic group here in the US. I'm not going to match that easily anyway.

EDIT: Sorry to you ceejayjoz, I was trying to reply to others by adding info to this because the rate limit doesn't let me but that's going to get discussions confused. I edited it out once I thought about that. So I'm fine with this so-called donation being a de-facto self-insurance pool. If the terms are like that, then I opt out.

> It's called "donation" not a "risk pool".

Unsympathetic people get fewer donations throughout society, and I'm inclined to see someone who'd rather let their organs rot in the ground or be cremated when they could save lives as... quite unsympathetic.

But doesn't that mean you're specifically planning to allow one or more members of your own minority ethnic group to die in order to prevent some other person from making some small amount of money off of you without paying into your estate?

There's a whole chain of novels by Larry Niven about what might happen when human organs enter a market economy. It assumes it works like any other closely-regulated market, producing a robust black market quickly dominated by organized crime.

Also, none of the people in the chain you list are profiting from your 'scarce resource,' but from providing skills and facilities to enable transplantation. (Insurance companies are just parasites, no argument there.)

Further, you left out the primary motivating factor behind the program: the recipient.

> There's a whole chain of novels by Larry Niven about what might happen when human organs enter a market economy. It assumes it works like any other closely-regulated market, producing a robust black market quickly dominated by organized crime.

This is like when people quote Pournelle's Law like it's a fact. The only thing this paragraph means, just like the only thing Pournelle's Law means, is that the person who wrote it is a Republican. It doesn't actually demonstrate anything factual or even related to reality.

(You can get paid for plasma and sperm donations but there isn't a black market for those.)

> Insurance companies are just parasites, no argument there.

They provide insurance, and they're probably more aligned with your interests than the rest of the supply chain is.

> (You can get paid for plasma and sperm donations but there isn't a black market for those.)

There were plasma black markets during and after the COVID pandemic [1][2][3][4][5]. There are black markets in sperm [6][7][8][9][10].

[1] https://www.indiatoday.in/india/story/exclusive-coronavirus-...

[2] https://www.al-monitor.com/originals/2020/07/iraq-coronaviru...

[3] https://www.al-monitor.com/originals/2020/06/egypt-coronavir...

[4] https://www.occrp.org/en/daily/12644-blood-plasma-black-mark...

[5] https://www.deccanchronicle.com/nation/medical-experts-warn-...

[6] https://www.dailymail.co.uk/health/article-12370461/Facebook...

[7] https://www.dailymail.co.uk/news/article-13298869/sperm-dono...

[8] https://www.dailystar.co.uk/news/world-news/wild-west-sperm-...

[9] https://worldcrunch.com/culture-society/undercover-hunt-in-i...

[10] https://www.thehelper.net/threads/seedy-world-of-the-super-s...

I feel the same way.. Why can’t my family benefit from making money from my organs?

Because then poor people are incentivized to kill themselves or their relatives to sell their organs.

A living kidney donor faces lower mortality risk than a logger but we allow people to be loggers. Explain that.

We allow people to risk their lives to provide for their families, except in this way. Unless your position is that whenever mortality risk exceeds living kidney donor mortality risk we should immediately ban the job. If so, let's ban logging. We can take this to its absurd conclusion.

On the other hand, Matt Yglesias points out why it's so much better to have a market here https://www.slowboring.com/p/solving-problems-by-letting-peo... including for kidneys

And specifically points out the plasma-donation situation as a contrast.

I imagine it's because we find it morally gross to harvest organs from the healthy poor.

I get that it leads to a lot of people dying who otherwise wouldn't die, and that's awful, but I think it's similar to prostitution. It makes sense to allow two consenting people who might agree to do something with each other for free to also do that same thing for money, but when you allow that, it tends to suddenly lead to a lot of people who are not actually very "willing." I think there are very real concerns that an "organic donation for money" industry quickly leads to a lot of trafficked people losing kidneys.

> I imagine it's because we find it morally gross to harvest organs from the healthy poor.

That is correct. The objection is solely from having a high divinity quotient in one's moral foundations causing one to rationalize visceral reactions to an obviously sensible process.

After all, the argument you then propose applies to egg donation, sperm donation, surrogacy, logging, and life insurance. People who might do it for free, might be coerced instead. And yet we have flourishing industries there and life is better for it.

Egg donation, sperm donation, life insurance, and logging are pretty different, but surrogacy is a good comparison. And, like organ harvesting, a lot of people find surrogacy for money to be morally objectional, for example the Pope, and also the governments of most countries.

The Pope protects child abusers. His opinion usually means the opposite is better.

If you donate your family don't benefit. If you don't donate, your family don't benefit. The only logic I can find here is spite.

So you've chosen to potentially sentence a patient to death because you don't like the infra around the donation process? Basically the definition of throwing the baby out with the bathwater.

Some things jumped out from the article as feeling sloppy.

> The tech is so bad. The United States Digital Service found 17 days of downtime in recent years.

If anyone is curious, a total of 17 days since 1999 according to a report obtained by the Washington Post from 2021.

> Until recently, the algorithm that was protecting all organ donor patient information in the country, so STI status, mental health, every physical history, was from 1996.

The algorithm? Huh? But it actually does seem serious that they have "denied nearly 100 federal requests to audit source code, reported The Washington Post." UNOS said they would have pentesting done in the WaPo article, but I couldn't find any reporting on if they actually followed through.

Additional sources:

https://fedscoop.com/usds-organ-transplant-system-shakeup/

https://www.washingtonpost.com/health/2022/07/31/unos-transp...

> Until recently, the algorithm that was protecting all organ donor patient information in the country, so STI status, mental health, every physical history, was from 1996.

I take issue with the way this point is presented. I'm willing to believe that healthcare data wasn't encrypted with the SOTA methods and one that was regarded as "good enough" instead, but the age of the algorithm has nothing to do with it's security. After all, RSA encryption is from 1977.

Right. I also didn't find anything to corroborate this sentence with anything, so it could also be a case of a layperson referring to everything as "the algorithm".

There was a recent article in the NYT on technology being developed to better deliver organs: https://www.nytimes.com/2024/04/02/health/organ-transplants-... "Perfusion, as its called, is changing every aspect of the organ transplant process, from the way surgeons operate, to the types of patients who can donate organs, to the outcomes for recipients." I don't know if the red tape described involving UNOs and OPTN will get in the way of more progress. But this seems like an area that could use a lot more attention.

Also make donation opt-out instead of opt-in because most people don't care either way and with opt-out those who actually care have to take measures and not the other way around. That's how it works here in my and in many other European countries.

Turns out that doesn't make much of a difference in the numbers, because even opt-out countries tend to ask permission from the next of kin and the refusal rates there are higher if the dead person hasn't actively opted in and told people they want it.

>First pig kidney transplant in a person: what it means for the future

https://www.nature.com/articles/d41586-024-00879-y

paired kidney exchange is a Market Design, see “Who Gets What and Why” by Alvin Roth

I was amazed we spend $38B/yr on kidney failure.

The airlines are less likely to lose your suitcase than this organization is to lose your kidney and one percent of the federal budget goes to dialysis.

I hope they fix this and I'm a longstanding critic of organ donation who routinely gets mountains of hatred and downvotes for it.

Oh good, we’re going to Let the Free Market Fix the Problem.

"Eschew flamebait. Avoid generic tangents."

"Don't be snarky."

https://news.ycombinator.com/newsguidelines.html

    Our Market, which art invisible,
    hallowed be thy hand;
    thy equilibrium come;
    thy allocation be done
    on earth as it is in theory.
    Give us this day our daily goods,
    and forgive us our regulations,
    as we forgive those who regulate against us.
    And lead us not into market failure,
    but deliver us from inefficiency.
    For thine is the kingdom,
    and the power, and the glory of wealth creation,
    forever and ever. Amen.

Soylent Red, the for profit recycling of corpses.

Valued at $4.2T and currently losing less than $2B per year.

this isn't some libertarian nonsense, there's plenty serious people in medicine and economics who advocate organ markets (but not in the dystopian way you probably imagine)

if you read up about it you might even learn something

> but not in the dystopian way you probably imagine

How do you end up with any other way? (serious question)

https://impact.stanford.edu/article/how-does-applied-economi...

It seems weird to describe this technique as a market.

and yet without economists and economics, whose entire purpose for existing is studying all the ways in which markets DON'T work and how to fix their resulting problems (the opposite of "shilling for neoliberal free market trickle down policies" which is what most people seem to think they do), this kidney market (because it is a market) wouldn't exist

How many decades of central planning organ-management failure would you like before concluding the experiment has failed?

If you read the article, there isn't really any central planning. It's one of those "regulated monopolies" with only one (private) contractor. These kind of things always end poorly for the customers in my experience... Either go full free market or have it ran by the government.

It seems to me, based on the article, that the main issue is the profit-seeking ghouls (err.. I mean... "Job Creators") exploiting the government, its limited resources, and faulty regulations-- which are slowly being fixed.

There is ample evidence (e.g. the entire rest of the industrialized world vs. the US healthcare system) that decentralized capitalist control of the donor organ system would lead to an exploitative nightmare that would make the current system look like unassailable perfection.

Playing devils advocate, that exploitative nightmare already exists elsewhere in the world. If a consenting adult wants to sell a kidney or lung, why shouldn't they be allowed to?

> that exploitative nightmare already exists elsewhere

Expanding it seems like the wrong approach?

> If a consenting adult wants to sell a kidney or lung, why shouldn't they be allowed to?

Because it leads to horrific results. Desperate poor people get peanuts and life-long health problems. https://www.aljazeera.com/news/2022/2/28/desperate-afghans-r...

    “If I don’t sell my kidney,
    I will be forced to sell
    my one-year-old daughter.”

It's an odd sort of cognitive bias to conclude from this article that the selling of kidneys is the problem. You don't think they should be given the option of selling their kid or their kidney?

My takeaway from this article is that the market just isn't developed enough. If they were able to sell their kidneys to richer westerners then they could easily get 10x or 100x as much money.

In that part of the world that's easily enough to make the best way to extend your statistical lifetime be to sell your kidney. You'd get access to better healthcare for life, your children could get an education etc.

> You don't think they should be given the option of selling their kid or their kidney?

I think we can aspire to give our citizens better choices than "sell child or sell kidney", yes.

"Our citizens"? I didn't know the Taliban could be found on HN. You should do an AMA.

What I'm pointing out is that you seemingly only care because the proposed scheme might cause you or other affluent people to interact somehow with the desperately poor. So the knee-jerk reaction is that we should ban the scheme entirely.

But those people will still be desperately poor without it, even more so. It's really arrogant to say that they shouldn't be given the option.

Would I sell my own kidney if there was a market for it? No, almost certainly not. But I don't live in those circumstances.

But we're talking about a country where the life expectancy is around 60 years, and where people are making something in the very low 4-digit USD/yr.

It's not hard to imagine how that could be turned into a win-win if the more affluent were able to buy kidneys.

> "Our citizens"? I didn't know the Taliban could be found on HN. You should do an AMA.

The proposal is expanding this practice, correct? Permitting Americans to sell their kidneys?

> What I'm pointing out is that you seemingly only care because the proposed scheme might cause you or other affluent people to interact somehow with the desperately poor.

Ooof, a body blow to that strawman. Bravo! Well fought!

> But those people will still be desperately poor without it, even more so. It's really arrogant to say that they shouldn't be given the option.

They'll be even more desperately poor when the remaining kidney fails, they lose their job (and thus health insurance), and donor kidneys aren't available because they've all been bought up for $100k.

How is that a strawman? You're arguing against any market mechanism on the basis of a human interest story discussing Afghanis who sold their kidneys for what you'd expect to pay for a new laptop.

I'm assuming you aren't actually in Afghanistan, so I thought the out-of-sight-out-of-mind comment was fair.

   > They'll be even more
   > desperately poor when
   > the remaining kidney fails.

Make that case statistically, how many statistical years do you lose from kidney donation with access to modern medicine?

    > and donor kidneys aren't
    > available because[...]

Everyone's born with two, you generally only need one, and failure is rare.

That's why it's such a perfect example for why a market-based approach could be a win-win for everyone. Nobody would die from kidney failure.

Afghanistan offers an example of the market-based approach to kidney donation and its downsides. There are certainly Americans desperate enough for a few grand in a similar fashion.

> Everyone's born with two, you generally only need one, and failure is rare.

https://www.kidney.org/transplantation/livingdonors/long-ter... lists a number of potential downsides to donating a kidney while alive.

    > Afghanistan offers an example
    > of the market-based approach
    > to kidney donation and its
    > downsides.

And upsides, e.g. the person who avoided selling their child by selling their own kidney.

Is that an overall terrible situation? Yes, but I'd like to think any parent would make the same choice.

Anyway, to respond to this and your up-thread (which I believe you added in an edit after I replied to that comment):

    > The proposal is expanding
    > this practice, correct?
    > Permitting Americans to
    > sell their kidneys?

No, let's narrowly stick to Afghanistan, since that's the example you brought up. It avoids getting into the muddy waters of introducing multiple variables.

Afghans are selling their kidneys right now, for the equivalent of around 1/2 to 1 year of local median salary. They're selling them to other Afghanis, or Pakistanis etc. willing to travel there.

Now, let's say an American dying of kidney failure was allowed to fly over that same Afghani to the US as a paid kidney donor for hire.

They'd still be out of a kidney, but now they might have gotten 20-40 years worth of the median salary in Afghanistan as a reward.

Don't you think that would be better for everyone involved?

    > [<URL>] lists a number of
    > potential downsides to
    > donating a kidney while alive.

I'll take that as a "no" to the question about whether you're able to support your up-thread "when the remaining kidney fails" claim with any numbers.

Non profit is such a silly term. All it means is that shareholders don't profit (because there are no shares). It says nothing about employees or executives.

IMO, we should be honest. Only volunteers or those sworn to poverty should be allowed employment in these things. This is why they were originally implemented, so things like your local Masons or Knights of Columbus or convent can have some legal structure.

They were not intended for something like this. Let's be honest. We have new corporate structures like public benefit corporations that make more sense.

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