I agree that more refined metrics would allow a better comparison between deaths from malaria in Africa and deaths from kidney disease in America.
A typical story for the latter is “a Black man close to retirement suddenly develops the symptoms of end-stage kidney disease and is put on dialysis. If he receives a kidney, he lives until his late 70s-early 80s in health comparable to if he hadn’t experienced kidney failure. If not, he declines and dies a few years later.” Kidney transplants typically give about 15 years of extra life but only about a handful of extra QALYs compared to dialysis IIRC, and they are cheaper per QALY.
The tricky part is that GiveWell used their own idiosyncratic in-house version of “moral weights” to evaluate their charities, which precludes comparison using QALYs. Since some people do argue that “lives saved” is an appropriate way to compare interventions and critique QALYs/DALYs as ableist, I think it’s a relevant but not conclusive comparison.
You’re right to point out the carousel of ill-thought-out moral and practical objections to kidney sales that would have to be overcome (or put on firmer epistemic footing). Note that I don’t mean that all of these objections are wrong—just that their supporters have usually put in minimal real thought or research into them and tend to use them to justify a fundamentally emotional reaction. Janet Radcliffe Richards’ book “The Ethics of Transplants” is a great resource on this point (she’s an Oxford moral philosopher and EA). Overcoming with this feeling of repugnance—less widespread than you might think—to effect policy change is the main goal of the altruistic work I would be proposing.
Thanks for your thoughts!
I agree that more refined metrics would allow a better comparison between deaths from malaria in Africa and deaths from kidney disease in America.
A typical story for the latter is “a Black man close to retirement suddenly develops the symptoms of end-stage kidney disease and is put on dialysis. If he receives a kidney, he lives until his late 70s-early 80s in health comparable to if he hadn’t experienced kidney failure. If not, he declines and dies a few years later.” Kidney transplants typically give about 15 years of extra life but only about a handful of extra QALYs compared to dialysis IIRC, and they are cheaper per QALY.
The tricky part is that GiveWell used their own idiosyncratic in-house version of “moral weights” to evaluate their charities, which precludes comparison using QALYs. Since some people do argue that “lives saved” is an appropriate way to compare interventions and critique QALYs/DALYs as ableist, I think it’s a relevant but not conclusive comparison.
You’re right to point out the carousel of ill-thought-out moral and practical objections to kidney sales that would have to be overcome (or put on firmer epistemic footing). Note that I don’t mean that all of these objections are wrong—just that their supporters have usually put in minimal real thought or research into them and tend to use them to justify a fundamentally emotional reaction. Janet Radcliffe Richards’ book “The Ethics of Transplants” is a great resource on this point (she’s an Oxford moral philosopher and EA). Overcoming with this feeling of repugnance—less widespread than you might think—to effect policy change is the main goal of the altruistic work I would be proposing.