Should I be an organ donor? Should I tell others to be donors? Should you be a donor?

Two studies report on the QALY impact of organ donation in the Cost Effectiveness Analysis Registry. Whiting et al (2004) Canadian study reports that kidney transplantation alone results in a gain of 1.99 QALYs over a 20-year time compared with waiting on dialysis. Kontodimopoulos and Niakis's (2008) Greek study reports a 16.11-4.37=11.74 and 16.11-3.94=12.17 for the Lifelong QALY difference for hemiodialysis and peritoneal dialysis respectively against renal replacement therapy.

By inference, kidney transplantion alone raises recipient QALY’s by between 1.99 and 12.17. Accorinding to DonateLife: ‘Less than 1% of people die in hospital in the specific circumstances where organ donation is possible. The circumstances in which you can become a tissue donor are less limited.’ Assuming a 1% successful registration to transplantion rate, one donor registration aggregates to between 0.19 and 1.2 QALY’s for kidney’s alone. Assuming excess resources exist for transplantation aside donor registration, these QALYs can be directly attributable to additional donor registration. Additional donor registration can be attributed to organ donation advocacy if we assume accurate self report and adjust for selection of people who are already interested in organ donation in pre-and-post persuasion surveys for a group being targeted for increased donation.

The mechanism of action for behaviour change in prospective organ donor advocacy is believed to be family education and facilitating informed consent cccording to DonateLife. They say that ‘The majority of Australians are generally willing to become organ and tissue donors (69%).’ and ‘'In Australia approximately 60% of families give consent for organ and tissue donation to proceed.The majority of Australians (60%) have now discussed their donation decision with their family.'’

It seems like there is not enough information on the assembly of outreach operations to actually cost it per QALY. But it’s free to tell people that they should support their families decisions and to get your learn on so you can talk authoritatively and provide ‘informed consent’ to prospective donors.

The Open Philanthropy Project estimates that:

clearing the kidney waiting list could (naively) save billions of dollars and hundreds of thousands of QALYs.

They refer to clearing the waitlist with incentive based organ trading (no price ceiling of $0 for donors)

It seems like policy change roughly occurs in an altruistic direction over the long term. The literature suggests switching to an opt-out system doesn’t increase donation rates, even though countries that have those systems tend to have higher donation rates. But why donate organs if I can wait to the Open Philanthropy Projects' policy change interventions manage to get incentive based systems set up? In fact, could motivating individuals to donate their organs, thus giving them less incentive to advocate selfishly for a licit organ trade be ineffective?

tl;dr: America’s Matas and Schniztler (2003), in a highly cited paper, report a gain of 3.5 QALY’s and health care system cost savings of 100,000USD for every new donor. Assuming, the American health care system is costed at the same rate at the time of publication as today (unlikely, figure is extremely conservative), will save the government 1million USD for just 10 new organ donors (35 QALY’s)

My country, Australia, underperforms international for organ donation rates :/

References

• DonateLife http://www.donatelife.gov.au/discover/facts-and-statistics#sthash.uidw6ohC.dpuf

• *Kontodimopoulos and Niakis's (2008) * An estimate of lifelong costs and QALYs in renal replacement therapy based on patients' life expectancy: www.ncbi.nlm.nih.gov/pubmed/17996975

• Whiting et al (2004) Cost-effectiveness of organ donation: evaluating investment into donor action and other donor initiatives: www.ncbi.nlm.nih.gov/pubmed/15023149

• Matas and Schniztler (2003) Payment for Living Donor (Vendor) Kidneys: A Cost-Effectiveness Analysis: onlinelibrary.wiley.com/doi/10.1046/j.1600-6143.2003.00290.x/full