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Altruistic Kidney Donation

19 Post author: jkaufman 17 June 2012 08:02PM

People are dying because their kidneys have failed, and you probably have an extra one: should you donate it? A dialysis machine can do most of the work of a kidney, but it's not as good. A donated kidney gives someone an average of 10 additional years. [1] (Some of them reject it right away, others live for years before having problems.) This is pretty good: if you volunteer to be a kidney donor and are selected as a match, you give someone an average of another 10 years of life. [2]

A kidney donation is a surgery, however, and does have some risk for you. It's hard to calculate the risk because people who are selected for kidney donation are a weird group: they're heavily screened (so they tend to be healthier) but they're likely to be related to the person they're donating to (so they tend to be at risk for kidney problems themself). An ideal study on the dangers of kidney donation would compare donors with people who were going to donate and then didn't for some nearly-random reason. I can't find such a study, but I've heard people give odds of around 1:3000 for dying due to donating. You also spend several days in the hospital, miss some weeks of work, and take several months to fully recover. [3] This sounds like a lot, but giving someone 10 years of life is a lot too.

The question isn't so much "does this do good," however, but "does this maximize the good I can do for the amount of sacrifice I'm willing to accept?" GiveWell estimates that each $1600 given to the AMF for antimalarial net distribution prevents the death of someone with an average life expectancy of maybe 40 years [4]. So another way to give a stranger 10 more years of life is to give $400 to the AMF. Kidney donation is in the same ballpark as this, in terms of the ratio of benefit (to others) to cost (to you) [5], but even ignoring the risk of death [6] I would pay that $400 just to avoid the hospital and recovery time.

Update 2012-06-22: BDan and Alexander Berger have convinced me I was wrong to write off chains. At least right now there are more possible chains than kidneys to start them, and they can be quite long. My updated estimate is that this gets you a 3x multiplier on the value of a donated kidney, bringing the $400 charity equivalent to $1200. Which is still less than the $10-$100K at which I think I would sell a kidney, but substantially higher.

 

 

(I also posted this on my blog)

 


[1] Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. (1999), table 3. This is from a longitudinal study on 23,275 people who got kidney transplants from cadavers and had never had one before. In our case we're interested in live donation, but I would guess it's about the same.

[2] It's possible that you could do better than this if your donation to a stranger set off a chain of donations. The idea is that there are lots of people who would give their kidney to a friend of family member if they could, but are for whatever reason incompatible. You can make donor-donee-donor-donee chains where it just takes one altruistic person to set the whole thing off. (Cycles are also possible, but they don't need someone to get them started.) The question is, though, how likely are these chains to happen anyway? And how long a chain can you reasonably expect? My understanding is that these are quite rare, with most altruistic kidney donors not starting one. I'm going to ignore chains.

[3] Someone who gave their kidney wrote in a Guardian article: "I was in hospital for four days--the worst part of the whole ordeal was removing the catheter. In just two weeks I was back at work (the full recovery is supposed to be three months)."

[4] I would love to find a GiveWell estimate of what life expectancy for the people who don't die of malaria because of a net, but I can't find one. So this "40 years" is a guess after looking at life expectancies for different ages in the countries where the AMF works.

[5] There are huge costs to both dialysis and kidney transplant, so as a health intervention distributing antimalarial nets [makes much more sense]. From the perspective of a prospective donor, however, I don't think this matters.

[6] You might think that if you're someone who gives a substantial fraction of their earnings to effective charity, a 1:3000 risk of death would be pretty bad because you'd be able to help other people much less. But 3000 is really big: if you're giving $20K/year and have an expected additional 30 years of working life, a 1:3000 chance of not being able to do that has an undiscounted expected value of only $200 less donated. [7]

[7] $20K * 30 years * 1:3000 = $200

Comments (41)

Comment author: AlexanderB 21 June 2012 08:12:43PM *  14 points [-]

A couple disclosures right off the bat: I donated a kidney to a stranger last year and I work for GiveWell (but this post represents my views, not GiveWell's).

I think this is a really interesting and informative analysis (you might also be interested in David Barry's post along the same lines). However, I think these both miss a few important points:

  • Living kidney donation operations involve significant savings for the health system, on the order of $100,000 (coming from averting the need for dialysis, which is extremely costly) (Matas and Schnitzler 2003). Giving $100K to medicare or a private insurer is obviously not the best conceivable use of money, but it's hardly a 100% waste. Similarly, most people on dialysis are not able to work, but most who receive transplants are able to do so; the economic benefits from recipients returning to work are not included in the $100K figure.

  • I don't think it's the right decision to assume away chains. For most altruistic donors in the U.S., chains are possible, and if you opt against a chain, you can choose a recipient who is demographically likely to achieve greater than average benefit from a donated kidney (someone young and healthy) through a website like matchingdonors.com. I've talked to some fairly senior transplant surgeons and people who helped write the algorithms for matching kidney exchanges, and they don't think chains have been saturated in, e.g., the National Kidney Registry, so adding another altruistic donor is expected to increase the number of kidneys passed along. That said, the right multiplier to use is unclear; the average chain length has been declining over time, giving some credence to the worry that more donors are just shortening the length of the average chain. My personal guess is that the chain multiplier is something like 2x; that's meant to be conservative, if haphazard, but it certainly could turn out to be too aggressive. That is significantly less than the average chain length: I've never heard of a chain that included fewer than 3 kidneys; mine had 8.

  • I think DALYs are the wrong ethical framework and that adult lives matter more than the DALY framework makes them seem. Undiscounted DALYs assume that saving a newborn is twice as good as saving someone midway through their life, whereas I believe something roughly like the converse (see this discussion at the GiveWell blog ).

  • I don't think the AMF cost-effectiveness figures and the kidney-donation figures are comparable in the way that you're reporting. Holden's posts about Bayesian charity evaluation give some reasons for my view here, but the basic story is that I don't think the expected value of a $1600 donation to AMF is actually anywhere near one life saved. The reason for this has nothing to do with how AMF works and is more a feature of its place in the total distribution of charity cost-effectiveness. I think there are a variety of practices in cost-effectiveness estimation that push in favor of a difficult-to-estimate positive bias (e.g. using evidence from RCTs, which are generally conducted in the most promising circumstances), that the most extreme cost-effectiveness estimates are more likely to be biased, and that the benefit of a marginal contribution is almost always less than the benefit of an average contribution. All of these conspire to make me think that the estimate that GiveWell provides for the "cost-per-life saved" for AMF is not the correct number for estimating the expected value of a contribution to AMF. (I do think it is extremely useful for deciding between charities. I just don't think these numbers mean what they appear to mean. I haven't discussed this thoroughly with other GiveWell staff and don't know whether they agree; GiveWell hasn't published a clear view about how these cost-effectiveness estimates should be used.)

  • As a practical matter, most people I've heard of who have been altruistic donors have been able to take medical leave of some kind from their job (many states have a law requiring this), which does't entail using up vacation. This doesn't answer the point about being willing to pay $400 to avoid the suffering, but it does answer the "just work and donate the money" objection.

Separately from the fact that I don't think $400 gets as much benefit as you seem to, I don't think the idea that you would be willing to pay $400 to avoid a nephrectomy is a good reason not to donate a kidney, at least without the additional stipulation that you're not willing to donate $400 more. Imagine a case where an individual believes that donating a kidney is worthwhile for benefits to others, but that they would happily pay $400 to not undergo the surgery (this may be your case, I think it would be mine, too). He pays the $400, and then face the question again. He still has both kidneys, can still benefit someone else by the same amount as before, but he has $400 less, so then he decides again whether to donate a kidney or donate $400. (...induction...) Eventually, he either donates a kidney or decides that enough has been asked of him. Another, perhaps more straightforward, way to put this is to say that the fact that there's some amount of money that achieves equivalent benefit to donating a kidney only tells you not to donate a kidney if you're sure you're not willing to give more money; the implication could just as easily be that you need to give a lot more money. I'm actually not sure what the amount of money (i.e. the $400) has to do with it in your framework, since for any given amount of money the repeated question means that you eventually reach your limit in willingness to pay to avoid surgery.

The model I have of what you're trying to say here is something along these lines:

As rational altruists, we can achieve great outcomes for others at relatively little harm to ourselves. In order to maximize the return to others for the sacrifices we're willing to accept, we should sort potential actions by their expected return and work our way down the list until we've used up our willingness to sacrifice.

In this framework, if you thought the return to donating a kidney was high enough that it fell above your marginal charitable contribution on your ranked list, it would offset that contribution below the limit for sacrifice you're willing to endure. Because of the very general framing of "sacrifice," donating a kidney--if it were "worth doing"--would imply that you thereby reduce your charitable obligations.

I find this an unlikely conclusion, and I don't share your very general conception of "sacrifice." I have a policy on how much money I give to charity, and I decided to donate a kidney, but both decisions depended on the specific circumstances of what would be asked of me. Envisioning people as having a fixed amount of suffering they're willing to undergo does not strike me as a very accurate psychological model, and living on the margin of the maximum suffering you're willing to endure to benefit others doesn't strike me as a good life choice (or at least self-conception).

A final consideration is that I think we relate differently to our bodies than we do our cash. I think that donating a kidney is fundamentally different from donating money in terms of impact on a donor, and that may or may not be something that matters to you. Relatedly, donating a kidney may also have different implications for a professional giving advocate than simply giving more money does. I suspect that it opens up publicity avenues that wouldn't otherwise be available, and changes the tenor of conversations with people who might be more typically emotional in their giving.

Comment author: jkaufman 22 June 2012 04:12:10AM *  4 points [-]

Living kidney donation operations involve significant savings for the health system, on the order of $100,000

Does this account for the costs of the transplant operation and followup costs such as anti-rejection drugs?

While I agree that a donation to the health system is positive, I would expect it to have an effect mostly by decreasing how much we pay into it instead of health outcomes.  I would be surprised if the benefit here was even 1:1000 compared to AMF.

most people on dialysis are not able to work, but most who receive transplants are able to do so; the economic benefits from recipients returning to work are not included in the $100K figure.

This applies on both sides of the question, though.  There are also economic benefits of fewer people getting malaria.  I don't know the relative magnitudes of these.

My personal guess is that the chain multiplier is something like 2x; that's meant to be conservative, if haphazard, but it certainly could turn out to be too aggressive. That is significantly less than the average chain length: I've never heard of a chain that included fewer than 3 kidneys; mine had 8.

Ok; I'm going to update the post with a 3x multiplier due to chains.

I think DALYs are the wrong ethical framework and that adult lives matter more than the DALY framework makes them seem. Undiscounted DALYs assume that saving a newborn is twice as good as saving someone midway through their life, whereas I believe something roughly like the converse

Because I estimated DALYs just from an overall $/life-saved and an estimate at life expectancy then we the question here is whether I'm right to treat one life saved via a malarial net as four times more valuable than ten additional years via a kidney donation. We don't have to bring DALYs into it.

(I do think DALYs are a pretty much the right thing to look at. As far as I can tell, I care about happiness and avoiding suffering, where two years of at joy-minus-suffering level X matter twice as much as one year at level X. For saving a newborn vs an adult there's the further issue that emotional attachments to the deceased of people who survive are probably much larger in the adult's case, causing a lot more pain at their death. But neither the AMF's nor kidney donation's benefit comes much from an effect on newborns, so that doesn't apply here.)

I don't the expected value of a $1600 donation to AMF is actually anywhere near one life saved.

That's unfortunate. I would really like it if GiveWell could give me $/life-saved that corrected for these issues and was as accurate enough to take literally.

How far off do you think this number is? 2x? 100x?

altruistic donors have been able to take medical leave of some kind from their job

Isn't medical leave generally unpaid, especially for elective surgeries? If you miss two weeks of work and take home $50K/year then that's about $2K in missed pay.

As rational altruists, we can achieve great outcomes for others at relatively little harm to ourselves. In order to maximize the return to others for the sacrifices we're willing to accept, we should sort potential actions by their expected return and work our way down the list until we've used up our willingness to sacrifice.

This is how I think we should think about it, yes. Well phrased.

In this framework, if you thought the return to donating a kidney was high enough that it fell above your marginal charitable contribution on your ranked list, it would offset that contribution below the limit for sacrifice you're willing to endure. Because of the very general framing of "sacrifice," donating a kidney--if it were "worth doing"--would imply that you thereby reduce your charitable obligations.

Yes. I would do this.

I find this an unlikely conclusion, and I don't share your very general conception of "sacrifice." I have a policy on how much money I give to charity, and I decided to donate a kidney, but both decisions depended on the specific circumstances of what would be asked of me.

Let's say I, as you seem to be suggesting, compartamentalize my giving. I might have compartments for donation of body parts, career choice, doing without, volunteer time, and abstaining from certain foods. Within each compartment I would optimize, giving to the best charity I could find, avoiding high-carbon footprint foods, but I would get worse results for less happiness on my part than if I optimize overall. Perhaps volunteer time doesn't matter much but monetary donations are huge. Or it makes me really unhappy to give up eating beef and I would be happier to work a somewhat less fulfilling but more lucrative career. Without being able to trade off between categories I make choices that benefit everyone less than if I could.

Envisioning people as having a fixed amount of suffering they're willing to undergo does not strike me as a very accurate psychological model

It doesn't? As long as you account for things like "giving up meat is hard at first but gets easier" it seems about right to me.

living on the margin of the maximum suffering you're willing to endure to benefit others doesn't strike me as a good life choice

I'm careful not to put the limit in a place where it would make life too unpleasant, but yes, I try to do this. It seems to work well for me, while also working well in terms of how much good I can do.

(For example, in 2009 Julia and I lived on about $22,000 and gave about $45,000. This still meant we could eat ice cream and go dancing, but it was a level at which we would have had to start giving up some things we really enjoyed if we were to increase our giving more.)

we relate differently to our bodies than we do our cash. I think that donating a kidney is fundamentally different from donating money in terms of impact on a donor, and that may or may not be something that matters to you.

This seems to be a case of fuzzies and utilons. Every charitable act gives some amount of personl benefit (fuzzies) and benfit to others (utilons). For the most part actions that give a lot of fuzzies (volunteering at a day care) don't give a lot of utilons, and the reverse. Kidney donation is unusual here in that people often find it highly personally fulfilling while it is also at least in the same ballpark as the most effective known charities. For me, however, I have lots of sources of fuzzies in my life and so I basically ignore personal benefit when choosing between giving opportunities. This is a case where I expect the answer to vary a lot between people.

donating a kidney may also have different implications for a professional giving advocate than simply giving more money does. I suspect that it opens up publicity avenues that wouldn't otherwise be available, and changes the tenor of conversations with people who might be more typically emotional in their giving.

No argument here.

Comment author: AlexanderB 23 June 2012 08:14:02PM *  3 points [-]

At the framework level

The basic framework you envision seems to have a certain fixed level of charitable resources (potential "sacrifice"), to be stewarded and spent in a utility-optimizing way over time. Once spent, these resources are gone. In this framework, asking "is the amount I would have to donate to the best charity to accomplish the same benefits as donating a kidney less than the price for which I would sell my kidney?" is a coherent and useful question, because you plan to offset your charitable contributions by that amount if you decide to donate a kidney, in order to maintain a stable level of personal welfare.

This sense of a broad scarcity of "charitable resources" (meant to include money, time, organs, etc.) is well-expressed by Julia's comment:

People think about doing their good deed for the day. I bet if you asked someone who'd just undergone major surgery to save someone's life if they now wanted to donate money as well, they'd say, "Look, I've sacrificed enough."

My framework is different. 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. If you think that donating a kidney would exhaust your moral capacity, I agree that you probably shouldn't do it.

Julia pointed to (a LessWrong writeup of) a study that purports to show that people behave less ethically after purchasing "green" products because they have "licensed" some immoral behavior with their positive actions. I think this dynamic makes a lot of sense with my experience in small actions but, big, life-changing decisions like donating a kidney or giving away a large portion of your income seem more likely to have the opposite effect: reinforcing an identity as a "charitable person" who is committed to the welfare of others. A couple weeks after I donated my kidney, I made my annual charitable donation; I'm nowhere near you and Julia, but I tithe. I don't think this is especially idiosyncratic: there's a psychology literature on "moral identity" that shows more or less the exact opposite of the literature on "moral licensing."

Of course, in these psych studies, the sample sizes are small and the conclusions are based on sample averages. The psych studies showing that any mention of statistics or more than one victim reduces donations clearly aren't characterizing GiveWell donors, and in the same vein I don't see much reason to think that these studies, even the one I cited, are characterizing people like me. So even if the "moral licensing" phenomenon is the dominant one in a broad swath of social activity or individuals, I think that gives me little reason to believe it dominates in my case or yours.

Details

Does the $100K account for the costs of the transplant operation and followup costs such as anti-rejection drugs?

Yep.

There are also economic benefits of fewer people getting malaria. I don't know the relative magnitudes of these.

Agreed, though the far greater productivity of workers in the developed world (and the social support that they draw on when not working) means that the dollar magnitude of those economic gains will be much higher. Conversely, the higher baseline also means that the welfare returns to the developed-world economic gains are lower than the developing world returns for similar dollar values.

Because I estimated DALYs just from an overall $/life-saved and an estimate at life expectancy then we the question here is whether I'm right to treat one life saved via a malarial net as four times more valuable than ten additional years via a kidney donation. We don't have to bring DALYs into it.

Agree that we don't literally have to use DALYs, but I don't think this is responsive. You're saying that you value saving the child's life at 4x the amount of extending the adult's life by 10 years; my point is that I value additional life for mid-life people much more than I do for infants, so I don't share your value here. I'm not sure what my multiple is, but it tilts the other direction (i.e. for your value of 4x, I have a value of less than one).

As far as I can tell, I care about happiness and avoiding suffering, where two years of at joy-minus-suffering level X matter twice as much as one year at level X.

How do you deal with the repugnant conclusion?

But neither the AMF's nor kidney donation's benefit comes much from an effect on newborns, so that doesn't apply here.

AMF's benefits don't come from newborns, but the $1600/life saved estimate assumes that the entire benefits of bednets come from protecting children under 5.

That's unfortunate. I would really like it if GiveWell could give me $/life-saved that corrected for these issues and was as accurate enough to take literally. How far off do you think this number is? 2x? 100x?

I don't know the right answer to this question. I agree with what Holden wrote about why what you're asking for is too hard to do in a reasonable way.

Isn't medical leave generally unpaid, especially for elective surgeries? If you miss two weeks of work and take home $50K/year then that's about $2K in missed pay.

I don't know of the general case here. I know a guy who got paid medical leave from his law firm, and I don't explicitly know of any cases where people had to take unpaid leave. The federal government offers 30 days of paid leave for organ donation for federal employees, as do many state governments (PDF). I would be mildly surprised if Google wasn't willing to give paid leave for altruistic kidney donation. My general guess is that this is going to track the overall generosity of the benefits of your employer. I do agree that this consideration could easily be decisive.

"Because of the very general framing of "sacrifice," donating a kidney--if it were "worth doing"--would imply that you thereby reduce your charitable obligations." Yes. I would do this.

I tried to address this in the framework section, above. You've shown that you can live happily and healthily on the amount of income that you and Julia save for your own consumption. I don't really understand why would you decide to keep more money in response to another, totally non-fiscal decision.

To put it in a different context, let's say that your job becomes far more pleasant because you got new coworkers who you liked more. Should you thereby give a higher portion of your salary to charity, to offset the increase in pleasure? If something negative happened in your personal life, would you begin withholding a higher portion of your salary for personal consumption? I have a feeling that I'm probably not being fair with these examples, but I'm genuinely not sure why.

Anyway, as much as a I don't understand this approach, I do agree that the bar for donating a kidney should be high if it leads you to reduce your fiscal charitable contributions. If you would reduce your charitable contributions by $10K, I'm not sure if it's worth donating a kidney; if you would reduce your contributions by $50K, I'm pretty sure it's not (with the exception of the hard-to-quantify outreach benefits).

"Envisioning people as having a fixed amount of suffering they're willing to undergo does not strike me as a very accurate psychological model." It doesn't? As long as you account for things like "giving up meat is hard at first but gets easier" it seems about right to me.

I addressed this in the framework section, but I wanted to add that I think "giving up meat is hard at first, but gets easier" dynamics are pervasive. I think giving a big portion of your income is hard at first but probably gets easier over time. If you weren't giving at all, giving 50% of one's income might seem inconceivable; after giving 25% for a long time, it might seem far more doable (even though the next 25% is harder). Most of the studies I've read on hedonic adaptation suggest that humans are quite good at adapting (over time) to new circumstances and new forms of suffering.

Comment author: jkaufman 24 June 2012 04:42:43AM *  2 points [-]

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. If you think that donating a kidney would exhaust your moral capacity, I agree that you probably shouldn't do it.

This is potentially a critical flaw in my framework. I wasn't think about it this way, but training myself to be ok with giving more would be a very good thing.

(Below I answer your questions about my framework as though I still follow it, because while your point is good enough that I may give it up, I haven't yet.)

$1600/life saved estimate assumes that the entire benefits of bednets come from protecting children under 5

I had forgotten that. In this case, then, you're right that our respective valuations of saving the life of an under-5 year old and giving an adult with kidney failure another ten years are going to be different. (My natural draw is actually even stronger towards saving/protecting children than a DALY approach gets you, but I think this is instinctive and excessive.)

I don't really understand why would you decide to keep more money in response to another, totally non-fiscal decision.

The big problem is that my money can go so much farther in generating happiness and reducing suffering when spent on other people that it has the potential to make every money-related decision really hard. If every dollar I spent on myself came with the question "why aren't you giving this to people that need it more?" I would be a wreck. I want all decisions I make in my daily life to have only minor consequences. So I set an "I will donate exactly $X this year to the best organization(s) I can find" limit, and don't have to be constantly struggling with whether I should be giving more. [1]

While this is phrased in terms of money, I convert all other potential utilitarian-virtuous actions into a dollar value so that I am not constantly being pressured to change my giving limit. Imagine I think fair trade chocolate is improves the world, but that it doesn't improve the world as much as the AMF. If I thought of my "chocolate buying decision" as totally separate from my "how much to donate decision" I might buy fair trade chocolate. But I also would believe that it would be better for me to buy the cheap chocolate, which I think tastes the same, and donate the savings to the AMF. Except my donation limit wouldn't allow that. So I set things up so that if I were to spend an extra $X to buy fair trade chocolate I would donate $X less to the AMF.

let's say that your job becomes far more pleasant because you got new coworkers who you liked more. Should you thereby give a higher portion of your salary to charity, to offset the increase in pleasure? If something negative happened in your personal life, would you begin withholding a higher portion of your salary for personal consumption?

Having to constantly evaluate how happy I was and whether that meant I could afford to give more or need give less would make me less happy. I do understand where you're going with this, and that if my rule is based around giving as much as I can while staying above a happiness line I'm unwilling to cross I need to be tracking my happiness level, but the problem is I'm not sure how to track my happiness level without setting up all sorts of nasty incentives. For example I could mark down on a sheet every evening how happy I was that day, with the idea that if I'm happy enough I can give more. But then Julia might start saying nice things to me she doesn't actually mean right before I fill out the sheet, or only bring up problems right after I mark things down for the day.

How do you deal with the repugnant conclusion?

I don't find it repugnant. The larger population has lives that are, on balance, after considering all the joy and suffering of being human, happy. And there are a lot of them. What's to object to?

(Reading your comments reminds me again how glad I am that GiveWell has such smart and reasonable people behind it.)

[1] I originally started doing this to keep Julia sane, but I find now it's helpful for me too.

Comment author: juliawise 21 June 2012 11:02:48PM 2 points [-]

Wow, thanks for writing that.

changes the tenor of conversations with people who might be more typically emotional in their giving.

What has been your experience of this tenor change?

Comment author: AlexanderB 23 June 2012 07:19:27PM 3 points [-]

Not sure what to say about this. I don't talk about it much with strangers. My friends and family seemed to think that donating a kidney was a bigger deal than giving away or foregoing a lot of income; I don't really agree. Broadly, I think that donating a kidney has convinced people I have more "skin in the game" than just working for GiveWell has, and I can think of one or two cases where this has made them more likely to take my advice on charitable donations. I think that if I were more comfortable talking about organ donation, it would be possible to use that as an entree into talking about charity: "... but you don't have to donate a kidney to make a huge difference! Just donating money can also be transformative."

On the other hand, I think it's at least possible that the net effect could be harmful. Kidney donation is still widely perceived (incorrectly, I've argued) as a big deal, so if you're trying to convince people that donating a portion of their income is easy, it could be a disadvantage.

Comment author: jkaufman 22 June 2012 10:36:57PM 0 points [-]

I turned the specific question of whether my "sort potential actions by expected return and work our way down" approach is the right way to look at it into a top level discussion post.

Comment author: JGWeissman 21 June 2012 11:26:48PM 0 points [-]

Separately from the fact that I don't think $400 gets as much benefit as you seem to, I don't think the idea that you would be willing to pay $400 to avoid a nephrectomy is a good reason not to donate a kidney, at least without the additional stipulation that you're not willing to donate $400 more. Imagine a case where an individual believes that donating a kidney is worthwhile for benefits to others, but that they would happily pay $400 to not undergo the surgery (this may be your case, I think it would be mine, too). He pays the $400, and then face the question again. He still has both kidneys, can still benefit someone else by the same amount as before, but he has $400 less, so then he decides again whether to donate a kidney or donate $400. (...induction...) Eventually, he either donates a kidney or decides that enough has been asked of him. Another, perhaps more straightforward, way to put this is to say that the fact that there's some amount of money that achieves equivalent benefit to donating a kidney only tells you not to donate a kidney if you're sure you're not willing to give more money; the implication could just as easily be that you need to give a lot more money. I'm actually not sure what the amount of money (i.e. the $400) has to do with it in your framework, since for any given amount of money the repeated question means that you eventually reach your limit in willingness to pay to avoid surgery.

If the opportunity cost of donating a kidney is $400, because of the opportunity costs of not being productive during the surgery and recovery, then you are effectively donating $400 in addition to your kidney to the cause of giving someone else a kidney. It seems reasonable that the $400 would come out of your charity budget, and you should consider if another charitable cause could use it more effectively.

Comment author: AlexanderB 22 June 2012 04:13:59AM 2 points [-]

Just to be clear, I think that in jkaufman's argument, the $400 is not the opportunity cost of undergoing surgery, but rather an estimate of the amount of money AMF would require to achieve comparable benefit as donating a kidney.

I agree that if you had to forego income during surgery or incur other costs, then it would be reasonable to add those onto the other side of the ledger as you propose. As I mentioned above, though, I think that's typically not the case; medical leave policies are often quite generous in these cases, and public funds are available for incurred costs.

Comment author: PECOS-9 17 June 2012 11:46:01PM 8 points [-]

Just to make the point explicit that I think you are implying with this post: kidney donation is not an optimal source of QALY's if you can make more than $400 in two weeks (the recovery time of the surgery) at your normal job.

Comment author: satt 18 June 2012 02:13:31AM *  3 points [-]

If you lived in the UK you could take this up another notch: take those two weeks out of your statutory paid holiday time, so you can make your full salary even as you donate a kidney!

Comment author: jkaufman 20 June 2012 02:55:10PM 1 point [-]

I would take a cut of $400 in annual take-home pay to get another two weeks of paid vacation.

Comment author: jkaufman 18 June 2012 03:51:06AM 1 point [-]

Yes, but stronger: if you would rather give $400 than a kidney (and the kidney donation process sounds at least $400 worth of unpleasant to me), you should do so and not feel at all guilty about it.

Comment author: DanielLC 18 June 2012 12:11:58AM 5 points [-]

I notice that the amount of money you'd have to donate to AMF is actually less than the market price of a kidney in Iran (about $1200). Unfortunately, it would probably be pretty expensive in both time and money to go to Iran and sell a kidney, and it would be illegal anywhere else.

I don't understand why more people who need kidneys don't just go to Iran and buy one.

Comment author: CronoDAS 18 June 2012 05:57:18AM 4 points [-]

I don't understand why more people who need kidneys don't just go to Iran and buy one.

I suspect that most people aren't aware of the option; I certainly wasn't. And a U.S. citizen might still be breaking U.S. law by doing so even if it's legal in the other country. (Several U.S. laws work that way; I can't speak for the laws of other countries.) I also don't know how hard it is to get a visa to travel to Iran.

Comment author: jkaufman 22 June 2012 09:51:32PM 0 points [-]

I'm now convinced I was wrong to ignore the effect of chains, where you kick off other kidney donations that wouldn't have happened otherwise. I've added a 3x multiplier for chains to the post, which brings it about even to the market price for a kidney in Iran.

Comment author: RomeoStevens 17 June 2012 09:08:42PM 5 points [-]

I would only risk my life to save someone signed up for cryonics.

Comment author: TheOtherDave 18 June 2012 03:22:37AM 1 point [-]

I assume you don't actually mean by "saving someone" what I would ordinarily assume that phrase to mean (e.g., take steps to keep their heart beating and their lungs pumping and their brains working and so forth), but rather some specialized understanding of "save someone" like preserving their neural patterns in anticipation of subsequent implementation of those patterns in a body. But I'm not entirely certain.

If I'm wrong, can you say more about why saving such a person in that more general sense is worth doing?

If I'm right, can you say more about why it matters whether they signed up for cryonics or not? For example: if you had the ability to cryopreserve my neural patterns the instant my heart permanently stops beating, would you do so if I wasn't signed up for cryonics?

Comment author: DanielLC 18 June 2012 04:09:26AM 1 point [-]

He could also mean keep their heart beating and such if they're not in a situation where cryonics is immediately available.

Comment author: TheOtherDave 18 June 2012 04:18:21AM 1 point [-]

Ah... yes, I suppose that makes more sense than either of my interpretations. Thanks!

Comment author: lavalamp 17 June 2012 10:45:53PM 1 point [-]

Why?

Comment author: shminux 17 June 2012 11:44:30PM 7 points [-]

For a person who signed up for cryonics (and thus has an unbounded life expectancy in their opinion), it does not makes sense to risk their life to save someone who does not have a similarly unbounded life expectancy.

Comment author: gwern 18 June 2012 02:21:29AM 4 points [-]

If you exponentially discount, can't it make sense?

Comment author: shminux 18 June 2012 03:23:15AM 0 points [-]

I'm not sure how to calculate that.

Comment author: evand 18 June 2012 03:40:46AM *  15 points [-]

The value of a QALY n years from now is equal to the value of a QALY now, multiplied by a discount function. An exponential discount function would be of the form (1-r)^n, with 0 < r < 1. This is the same concept as interest rate discounting in economics. There, a payment of $1 per year from now to eternity would be assigned a finite value of $1/r, where r is the interest rate. For example, if the interest is 5%, then $1 per year has the same value as $20 now.

You can apply the same discounting to QALYs, and there are some good reasons both to do so, and to do so with a specifically exponential discounting function. If you fail to do so, then anything that even trivially reduces your odds of living forever is unboundedly bad, which seems odd. Once you have attained probable immortality, you could no longer rationally take any risk whatsoever, even if the payoff is significant. For example, you couldn't engage in manned interstellar exploration beyond easy reach of the absolute best available medical facilities, even if you were fairly confident of survival and could take a merely excellent hospital with you.

Failing to use an exponential discounting function means that your decision involving risk of death will be subject to akrasia, which hardly seems desirable.

In conclusion, the only question remaining is what discounting rate to use. 5% seems a bit nearsighted. We might compare to life expectancy without counting natural causes, which is something like 400 years. So a discount rate in the range of 0.01% to 0.5% seems plausible.

In order for a 1:3000 risk of true death by someone signed up for a cryonics program with 100% odds of success to make sense, in return for a 10 QALY (certain) life extension of a non-cryonics program person, the discount rate would have to be less than 0.3%. I'm actually rather surprised by this result; when I started writing this post, I expected to conclude that RomeoStevens was being selfish, arrogant, and overly disparaging of the value of people who haven't signed up for cryonics.

That said, if we take the odds of success of cryonics as less than 100%, the equation changes. It now depends on both RomeoStevens current non-cryonics life expectancy and the odds of success of the cryonics program. If, for example, the cryonics program has odds of success of merely 10%, then at a 0.1% discount rate, the indefinite lifespan is comparable to 100 QALYs at present. That means a risk as high as 10% in exchange for a certain 10 QALYs would be reasonable.

I think I can safely conclude that either RomeoStevens thinks cryonics has a higher chance of working than I do, or that he is using a very small discount rate for long lifespans.

(EDIT: fixed r vs 1-r confusion. A discount rate of 1% implies that a QALY (or $) n years in the future is valued at 0.99^n times its present value. IOW, discount rate r -> discount function (1-r)^n. I believe the post now uses all such terms in an internally consistent fashion.)

Comment author: shminux 18 June 2012 04:45:55AM 3 points [-]

Excellent analysis!

Comment author: RomeoStevens 18 June 2012 05:06:11PM 2 points [-]

good stuff, but I was in fact being selfish and arrogant. I should have been more specific and said I'd risk my life to save an AI researcher, upload researcher, or radical life extension researcher whom I feel significantly increases my odds of continuing to exist longer more so than the risk of dying immediately. I would do this even if they weren't signed up for cryonics, but this seems somewhat unlikely for anyone sufficiently awesome enough to meet my criteria.

Comment author: gwern 18 June 2012 03:27:17AM 0 points [-]

Well, one would start with discounting a cryonicsers's life to infinity to the net present value, and then see how many mayfly lives that translates to...

Comment author: philh 18 June 2012 12:17:14AM 2 points [-]

Presumably that depends on whether the risk precludes getting frozen. If you die of donating-a-kidney, I assume you're most likely to die in a hospital. I also assume that a hospital is one of the best possible places to die, provided they know you're signed up for cryonics and they have the appropriate equipment. (I can think of plausible worlds in which both of these assumptions are false.)

Comment author: saturn 18 June 2012 03:32:38AM 1 point [-]

With the combination of bureaucratic inertia and the medical establishment's prejudice against cryonics, I'd expect a hospital is actually one of the worst places for a prompt suspension. This is without looking at any data, though.

Comment author: [deleted] 18 June 2012 10:59:09PM 0 points [-]

What would better places be?

Comment author: saturn 19 June 2012 04:27:54AM 0 points [-]

Alcor recommends a hospice that has a track record of cooperating with cryonics arrangements. Otherwise, generally anywhere that you can be monitored by a standby team and taken directly to the cryonics facility without delay.

Comment author: MixedNuts 19 June 2012 12:43:13PM 1 point [-]

Not a fair point. I can't sell my kidney and buy mosquito nets with the proceeds, thus saving more lives than if I donate the kidney. It's illegal, I'm likely to get conned, and there are knock-on effects that end up costing more lives overall. Donating a kidney isn't displacing any charitable donation (except for pay cuts while I'm in the hospital, maybe?).

Comment author: juliawise 20 June 2012 12:52:17PM 3 points [-]

Except that people think about doing their good deed for the day. I bet if you asked someone who'd just undergone major surgery to save someone's life if they now wanted to donate money as well, they'd say, "Look, I've sacrificed enough."

This is part of why I try to make my help as hassle-free for myself as possible (writing a check). I probably end up helping more in the long run the easier it is for me. Surgery does not sound easy.

Comment author: AlexanderB 23 June 2012 08:32:34PM 3 points [-]

I tried to respond to this issue above: http://lesswrong.com/lw/d4v/altruistic_kidney_donation/6w9j

Comment author: mwengler 18 June 2012 04:50:53PM 1 point [-]

I would need a lot more than $400 of value in return for giving up a kidney. Even the discomfort would be worth more than $400 to me.

I was wondering what a Kidney would costs so I looked it up and summarized my results here. The best price I found (in a few minutes of looking) is $3613 (Why the precision? I don't know.) So it looks like malaria nets are the loss-leader in saving people's lives, at least in a market of nothing but malaria nets and kidney transplants.

Comment author: jkaufman 19 June 2012 05:39:41AM *  0 points [-]

If there were a functioning and safe market for kidneys in which all costs of transplant were borne by the buyer, how much would you need to give up your kidney?

For me it's probably between $10K and $100K.

Comment author: welf 09 March 2016 09:15:42PM 0 points [-]

Excellent discussion. This certainly made me think more about donation; however, I believe you are wrong to include the effects of chains in your analysis, for two reasons.

Firstly, I don't see how you can count the benefit of all donations in a chain within the donation of the first donor. Sure, those down the chain may not have been able to donate without the original donor, but it is still them that is having a kidney removed, and they should rightly be able to count that within their own 'charity equivalent' value. Double counting this donation value for two different donors doesn't seem correct.

Secondly, I personally wouldn't want to donate into a chain, as to me it feels like adding additional conditions to the donation - 'I will donate you this kidney, as long as you have a friend who is willing to donate to someone else'. I believe that patients on the waiting list for a kidney should have equal rights to donated kidneys, regardless of whether they have anyone willing to donate for them.

I like to think that those friends or family that were willing to donate, but were not a match, would still be moved to donate altruistically if their loved one received a living donor kidney. Although this then puts the choice of when and how to donate on their own terms. (I'm not aware of any stats or studies on whether this is actually the case or not.)

Finally, as other comments have mentioned, I don't see kidneys and cash as fungible in the same way you do. Whilst most would probably donate the equivalent cost of saving a life to charity rather than undergo major surgery, there is nothing stopping you from doing both, particularly if you employer will cover your time off work at full pay. I think AlexanderB has previously made this point quite well.

Comment author: jkaufman 17 March 2016 02:19:53AM 0 points [-]

I don't see how you can count the benefit of all donations in a chain within the donation of the first donor.

If you're trying to compare actions, you should say "how will the world be if I do A instead of B". If you think the chain truly wouldn't have happened if you hadn't decided to donate your kidney then the benefit of all of those people receiving kidneys happens in the world where you donate, and not in the world where you keep your kidney.

Comment author: [deleted] 09 January 2016 11:05:09PM 0 points [-]

Incredible analyses in the comments here.

Somebody That I'll Never Know (Gotye parody) Organ Donation

Comment author: jkaufman 11 January 2016 03:53:40PM 0 points [-]

Which of the youtube comments are you referring to? There are a bunch of them (and none of them jumped out as an incredible analysis to me? But I was just skimming.)