10 ms·
How to stop losing 17,500 kidneys
- hinkley 3y agoOh good, we’re going to Let the Free Market Fix the Problem.
- throwup238 3y agoOur 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.
- throw10920 3y ago[flagged]
- justrealist 3y agoHow many decades of central planning organ-management failure would you like before concluding the experiment has failed?
- hinkley 3y ago[flagged]
- PaulHoule 3y agoWorst in some ways, best in others.
- Ma8ee 3y agoBest in which ways?
- itishappy 3y agoMedicine. We're really freakin' good at it. We make a lot of drugs, and our quality is high. We invent new drugs. Our doctors rank among the best in the world. We develop new treatments, techniques, and devices. It's access to care that we suck at, and our lifestyles aren't doing us any favors. People generally leave the country due to cost, not an expectation of better care.
- throw10920 3y ago[flagged]
- snakeyjake 3y agoIt 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.
- hinkley 3y ago[flagged]
- candiddevmike 3y agoPlaying 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?
- ceejayoz 3y ago> 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-resort-to-selling-kidneys-to-feed-families https://www.aljazeera.com/news/2022/2/28/desperate-afghans-r...
- avar 3y ago“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.
- candiddevmike 3y agoIf 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.
- bedobi 3y agothis 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
- soperj 3y ago> but not in the dystopian way you probably imagine How do you end up with any other way? (serious question)
- bedobi 3y agohttps://impact.stanford.edu/article/how-does-applied-economics-maximize-kidney-transplants https://impact.stanford.edu/article/how-does-applied-economi...
- ceejayoz 3y agoIt seems weird to describe this technique as a market.
- bedobi 3y agoand 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
- GartzenDeHaes 3y agoSoylent Red, the for profit recycling of corpses.
- rrr_oh_man 3y agoValued at $4.2T and currently losing less than $2B per year.
- dang 3y ago"Eschew flamebait. Avoid generic tangents." "Don't be snarky." https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
- dynm 3y agoFor a contrary view, this comment on Marginal Revolution is worth considering (https://marginalrevolution.com/marginalrevolution/2024/04/unos-kills.html?commentID=160742427 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
- jessriedel 3y ago> 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-transplant-go-missing-in-transit/ https://kffhealthnews.org/news/how-lifesaving-organs-for-tra...
- stevev 3y ago[flagged]
- behringer 3y agoIf you like eating, then you like pesticides. And you can thank the public at large for not eating all your pesticide-free foods before you get a chance to. Sorry but your pesticide-free lifestyle can't translate to billions of people. And anyway, there are all sorts of reasons why kidneys fail, a large reason in the US is sugar consumption/diabetes.
- clcaev 3y agopaired kidney exchange is a Market Design, see “Who Gets What and Why” by Alvin Roth
- renewiltord 3y agoThe 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.
- ceejayoz 3y agoFine, but you should be ineligible to receive, in that case.
- renewiltord 3y agoFine 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.
- ceejayoz 3y ago> 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.
- CobrastanJorji 3y agoBut 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?
- Jemaclus 3y agoAs an organ transplant recipient who would have died 20 years ago without one, I hope you reconsider.
- bee_rider 3y ago17,500 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.
- ceejayoz 3y ago> 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-transplant-prove-viable-study-shows 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/receiving-a-kidney/accepting-or-declining-an-offer-for-a-kidney/ 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.
- hinkley 3y agoWhen 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.
- soneil 3y ago
- Samuel_w 3y ago[flagged]
- anon291 3y agoNon 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.
- daedrdev 3y agoI 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-compensation.html https://www.nytimes.com/2024/04/02/opinion/kidney-donations-...
- tiagod 3y agoI 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.
- pyuser583 3y agoI’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.
- bombcar 3y agoI 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.
- astrange 3y agoThis 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.
- deleted 3y ago[deleted]
- 3y ago
- TheCowboy 3y agoSome 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://fedscoop.com/usds-organ-transplant-system-shakeup/ https://www.washingtonpost.com/health/2022/07/31/unos-transplants-kindeys-hearts-technology/ https://www.washingtonpost.com/health/2022/07/31/unos-transp...
- firejake308 3y ago> 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.
- TheCowboy 3y agoRight. 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".
- rdl 3y agoI was amazed we spend $38B/yr on kidney failure.
- DoreenMichele 3y agoThe 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.
- ifdefdebug 3y agoAlso 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.
- lazyasciiart 3y agoTurns 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.
- bookofjoe 3y ago>First pig kidney transplant in a person: what it means for the future https://www.nature.com/articles/d41586-024-00879-y https://www.nature.com/articles/d41586-024-00879-y
- natroniks 3y agoThere 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.html 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.