{"items": [{"author": "BDan", "source_link": "https://plus.google.com/103775592027106438640", "anchor": "gp-1340044542847", "service": "gp", "text": "There are organizations that specifically try to create chains; if you want a kidney donation to do the most good, you could contact one of them and set a condition that you'll donate only if the chain is some minimum length. \u00a0See\u00a0\nhttp://www.nytimes.com/2012/02/19/health/lives-forever-linked-through-kidney-transplant-chain-124.html\n for example.", "timestamp": 1340044542}, {"author": "Jeff Kaufman", "source_link": "https://plus.google.com/103013777355236494008", "anchor": "gp-1340053753974", "service": "gp", "text": "@BDan\n\u00a0While I don't think replaceability is an issue for standard kidney donation because there are people dying while they wait and there doesn't seem to be much if any prioritization, it does worry me more with chains. \u00a0If initiate a given chain it's possible someone else would have initiated the same or a similar chain otherwise.", "timestamp": 1340053753}, {"author": "David German", "source_link": "https://plus.google.com/111229345142780712481", "anchor": "gp-1340076905503", "service": "gp", "text": "@Jeff Kaufman\n\u00a0If it were legal to sell a kidney, what would be your reservation price?", "timestamp": 1340076905}, {"author": "Jeff Kaufman", "source_link": "https://plus.google.com/103013777355236494008", "anchor": "gp-1340078730452", "service": "gp", "text": "Not sure. \u00a0The risk of death is low enough that I think the pain, inconvenience, and recovery time would be the main issues. \u00a0Definitely at $1M, very likely at $100K, probably at $10K?", "timestamp": 1340078730}, {"author": "Todd", "source_link": "https://plus.google.com/112947709146257842066", "anchor": "gp-1340087976764", "service": "gp", "text": "Mine would be WAY higher than $10K. Probably higher than $100K as well. I think a lot of that is driven by squeamishness.", "timestamp": 1340087976}, {"author": "David German", "source_link": "https://plus.google.com/111229345142780712481", "anchor": "gp-1340109596284", "service": "gp", "text": "$10K seems low to me also, both for the amount of work you'd miss, and for the risk of death. \u00a0The global market price is well below $10K, so it may be moot. \u00a0On the other hand, a well-documented domestic kidney might command a premium.", "timestamp": 1340109596}, {"author": "Alexander", "source_link": "https://plus.google.com/112848664856303870204", "anchor": "gp-1340311755010", "service": "gp", "text": "I wrote a fairly long response on LessWrong:\u00a0\nhttp://lesswrong.com/lw/d4v/altruistic_kidney_donation/6vpw", "timestamp": 1340311755}, {"author": "Jeff Kaufman", "source_link": "https://plus.google.com/103013777355236494008", "anchor": "gp-1340313378116", "service": "gp", "text": "@David German\n\u00a0In my $10K I wasn't thinking about the cost of the missed work time, though depending on the company's medical policy that might be paid leave. \u00a0If it did cost something to me, my price would go up by that cost.", "timestamp": 1340313378}, {"author": "Todd", "source_link": "https://plus.google.com/112947709146257842066", "anchor": "gp-1340321029157", "service": "gp", "text": "@Alexander\n\u00a0Your thought experiment in which you inevitably end up donating a kidney, no matter how much you'd pay to avoid doing so, makes me think that's the wrong way to think about the problem. \n@David German\n's question about a reservation price seems better, in that regard.", "timestamp": 1340321029}, {"author": "Alexander", "source_link": "https://plus.google.com/112848664856303870204", "anchor": "gp-1340341868836", "service": "gp", "text": "@Todd\n\u00a0I don't think that donating a kidney is inevitable in my scenario. The point I was trying to make is that \"paying not to donate a kidney\" is not a one shot game: once you do it once, there's a question about whether you'd do it again. I didn't mean to say that you do this infinitely and that you necessarily donate a kidney, but rather that you \neither\n donate a kidney \nor\n reach your $ donation limit.", "timestamp": 1340341868}, {"author": "Todd", "source_link": "https://plus.google.com/112947709146257842066", "anchor": "gp-1340353407696", "service": "gp", "text": "@Alexander\n\u00a0I don't follow. When do you hit a limit where you both stop donating money and retain your kidneys, under the scenario you've outlined?\n
\n
\nPaying not to donate a kidney would be a one-shot game if you are obligated to meet a certain threshold of donation/giving/altruism per unit of time, and it doesn't matter how you do it. If the kidney is worth $400 (the correct amount isn't important for this), you can only save yourself that $400 once by donating a kidney instead. So you also only pay not to donate it once, although it's not clear to me when you do that (perhaps the payment is always considered part of your most recent donation).\n
\n
\nOf course, I'm not sure if Jeff or anyone else takes that view of obligation to donate.", "timestamp": 1340353407}, {"author": "Christine", "source_link": "https://www.facebook.com/jefftk/posts/396693657034926?comment_id=399654423405516", "anchor": "fb-399654423405516", "service": "fb", "text": "This note reached me through google alerts, and I fear you're minimizing the risk of kidney donation. The 3/10,000 stat originated in 1987 and repeated in 1992 (which was a phone survey). During both these time periods, all nephrectomies were open versus now, where they are all forms of the laparoscopic procedure. Segev came up with the number again in 2009, but he used the 'woefully inadequate'* OPTN database, only counted deaths within 90 days of surgery, and again, counted both open and lap nephrectomies (this is important because the two procedures have unique risks, and there is a steep learning curve for surgeons performing the lap procedure).
According to an OPTN presentation in 2010, 4.4 living kidney donors died every year in the US within 12 months of surgery between 2000-2009. At approximately 6000 living kidney donor transplants per year, that equates to 7.3/10,0000.
But dying isn't the only risk. 20% of living kidney donors experience complications: permanent nerve damage, pancreatitis, intenstinal blockage, abdominal adhesions, hernia, adrenal dysfunction, chylous ascites, testicular swelling and sensitivity, etc.
In addition, 20-30% suffer from depression, anxiety, and PTSD. Not a single transplant center offers structured aftercare or support services for living donors.
We have NO national standards of living donor evaluation, selection or treatment in the US. Each of the 200+ transplant programs make up their own rules and are accountable to no one.
We also have NO comprehensive short or long-term data. The Secretary of Health mandated one year of follow-up on all LDs in 2000 (extended to two yrs in 2006) yet 30% of LDs are still reported 'lost' by one year with no evidence contact was attempted. Meanwhile, transplant recipients have a govt funded ten-year registry to monitor their health and well-being.
A kidney donor's remaining kidney doesn't grow, but hypertropies, which mean the cells actually swell under the increased pressure. This leaves the kidney more vulnerable to damage, disease, age and toxins. Consider what happens to a balloon when it is blown up.
A 10% reduction in renal function has been shown to significantly increase one's risk for cardiovascular disease and death. Kidney donors lose 50% of their nephrons and 20-30% of their pre-donation kidney function. In fact, of those diagnosed with chronic kidney disease stage 3, most will not progress to kidney failure because they'll die of heart disease first.
And FYI: 300+ kidney donors have been wait listed in need of their own kidney transplant since 1994. 63% of those people were 18-34 when they donated.
I appreciate your desire to contribute meaningfully to your community. As the sister of a kidney transplant recipient, I appreciate the importance of donated organs. However, as a living kidney donor myself, I find the constant omission of kidney donation's real risks dangerous and unethical. If you decide to continue with the donation process, I strongly encourage you to research far beyond the information perpetuated by the transplant industry and it's related organizations (inc. national kidney foundation). Take care of yourself first.
*OPTN's own data task force used that phrase in 2009.", "timestamp": "1340404870"}, {"author": "Alexander", "source_link": "https://plus.google.com/112848664856303870204", "anchor": "gp-1340485425096", "service": "gp", "text": "@Todd\n\u00a0In my framework, I was starting from the assumption that the agent wasn't already maxed out on how much they were willing to sacrifice.\u00a0I didn't realize that Jeff plans to reduce his charitable donation if he donated a kidney.\n
\n
\nSo say his \"suffering limit\" is something like \"live with Julia on $22K/year \nand\n retain both of my kidneys,\" then in my framework he is already at his limit, and he doesn't donate more (money or kidneys).\n
\n
\n(This doesn't have the regress issue because he's already at the limit.)", "timestamp": 1340485425}, {"author": "Todd", "source_link": "https://plus.google.com/112947709146257842066", "anchor": "gp-1340510868134", "service": "gp", "text": "@Alexander\n\u00a0I don't think it matters whether the agent is maxed or not. The kidney can only fill the knapsack by a certain amount. The agent is, perhaps, repeatedly weighing the trade-off between donating a kidney and the next marginal $X of donation. But that's not the same as paying increasing amounts not to donate the kidney, since if the agent did donate the kidney, they'd still donate the same amount of money, minus $X (assuming no additional alternatives for donation).\n
\n
\nThe only way you get that regression, I think, is if the agent feels obligated to leverage the altruistic value of his kidney, does not otherwise feel obligated to donate (or considers any other donation obligations as completely separate concerns), and also places value on not having the surgery. Then each time the agent donates money, it's a way of putting off having the surgery.", "timestamp": 1340510868}, {"author": "Jeff Kaufman", "source_link": "https://plus.google.com/103013777355236494008", "anchor": "gp-1340513797170", "service": "gp", "text": "@Todd\n\u00a0My understanding of \n@Alexander\n's view here is that being people we're not really going to be filling a knapsack with charitable actions. \u00a0Instead we think about things on a case to case basis, where choosing to give now may increase our willingness to give later. \u00a0In his followup comment [1] he wrote:\n
\n
\n\"I think of moral sacrifice as something closer to a muscle: it can be used up, but it can also be worked out, flexed, strengthened. I think of donating a kidney as something more like a workout that will train the moral muscle than like a marathon that will exhaust it.\"\n
\n
\nI'm taking this seriously; while I still think that the fixed-knapsack analogy is the right approach logically, it may not be the right approach for people. \u00a0Perhaps I can grow my giving-knapsack with training, getting to where I'm willing to accept more self-sacrifice.\n
\n
\n[1]\u00a0\nhttp://lesswrong.com/r/discussion/lw/d4v/altruistic_kidney_donation/6w9j", "timestamp": 1340513797}, {"author": "Todd", "source_link": "https://plus.google.com/112947709146257842066", "anchor": "gp-1340514739650", "service": "gp", "text": "@Jeff Kaufman\n\u00a0Yeah, I realize he doesn't use your knapsack framework, but I think that part of his argument was designed to apply to your framework- otherwise, he'd need to first convince you to drop that framework. I could be wrong about that, though.\n
\n
\nAlso, growing the knapsack doesn't change the fundamental conception of or the trade-offs involved in deciding to donate a kidney. It would only be abandoning the concept entirely and treating the decision to donate a kidney as totally separate from monetary donations (which I think is how he\u00a0views it) that would do that. Though I guess it might change the trade-off in the sense that it might decrease your reluctance to donate a kidney, and thus lower the \"price\".", "timestamp": 1340514739}, {"author": "Jocelyn", "source_link": "https://plus.google.com/104170190078271978439", "anchor": "gp-1368711306112", "service": "gp", "text": "anybody needs kidney? i dnt mind to donate one of mine. if anyone interested just email me to my personal email, effects_slying@yahoo.com i am O+.", "timestamp": 1368711306}, {"author": "Chris", "source_link": "https://plus.google.com/113090308897979380085", "anchor": "gp-1431458662031", "service": "gp", "text": "@Jocelyn\n\u00a0\n
\nsign up at\u00a0\nhttp://matchingdonors.com", "timestamp": 1431458662}, {"author": "Chris", "source_link": "https://plus.google.com/113090308897979380085", "anchor": "gp-1431459830199", "service": "gp", "text": "Hi Jeff, you might be interested to know that the application at \nhttp://matchingdonors.com\n specifically asks if you have any requirements for the recipient of your kidney. This is what I wrote:\n
\n
\nMy blood type is O-.\n
\n
\nI'm not picky, but being that there are a lot of people on the waiting list, I want to know that you plan use your life extension (so to speak) to give back in someway.\n
\nIf you're new to altruism, get involved on \nhttp://givewell.org\n
\n
\nI elaborate in my profile:\n
\nI'm part of the growing effective altruism community. We mostly work at nonprofits, volunteer, \u00a0and/or donate significant parts of our income to the best charities (Check out \nhttp://givewell.org\n to find them).\u00a0\n
\n
\nEven before joining this community, I thought it was a shame that people died from easily treatable diseases like kidney failure. I'm happy to help one person avoid this fate, as I have an extra kidney that is of little use to me. :)\n
\n
\nI would really appreciate you making a significant donation to GiveWell as a sign of solidarity to the cause of preventing suffering/death when it is easy to do so.", "timestamp": 1431459830}]}