Firstly I would challenge your assumptions in using “lives saved” as currency in your very brief final estimate. Depending on your moral basis, the lives of people in need of a kidney transplant are probably less valuable than those typically saved by malaria interventions:
they probably gain less extra lifetime
they are probably more likely to have health problems that diminish their quality of life
they probably have less productivity and more healthcare costs ahead of them for the previous two reasons
Consider using DALYs instead.
I think you are right to think about considering government funding. It seems plausible that transplants would save govt money compared to dialysis. But transplant recipients also live longer (that’s the point of this) and will incur healthcare costs for a longer time.
If you do come up with a figure for “costs saved” you could try to convert govt spending into DALYs or similar. Some countries’ healthcare systems evaluate treatments based on the cost per QALY (in the UK publicly-funded drugs are supposed to cost less than £30,000 per QALY). If you assume that any money the system saves is invested in DALYs at the threshold rate, converting is simple. I don’t think this applies in the US, where costs are split between private and public sources in a confusing way.
All of this brings me back to broad agreement with your instinct to count the health gains as “free”, because it’s quite complicated to do otherwise. But I would caution about complexity. Objections to the buying/selling of organs are partly based on notions of sanctity that we might see as stupid (much like the fear of GM crops that is blocking Golden Rice) but also partly on valid concerns about the hard-to-predict secondary effects of an organ trade (exploitation, decreased concern for the poor who “can always sell a kidney if they are truly struggling”).
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.
Nice question!
Firstly I would challenge your assumptions in using “lives saved” as currency in your very brief final estimate. Depending on your moral basis, the lives of people in need of a kidney transplant are probably less valuable than those typically saved by malaria interventions:
they probably gain less extra lifetime
they are probably more likely to have health problems that diminish their quality of life
they probably have less productivity and more healthcare costs ahead of them for the previous two reasons
Consider using DALYs instead.
I think you are right to think about considering government funding. It seems plausible that transplants would save govt money compared to dialysis. But transplant recipients also live longer (that’s the point of this) and will incur healthcare costs for a longer time.
If you do come up with a figure for “costs saved” you could try to convert govt spending into DALYs or similar. Some countries’ healthcare systems evaluate treatments based on the cost per QALY (in the UK publicly-funded drugs are supposed to cost less than £30,000 per QALY). If you assume that any money the system saves is invested in DALYs at the threshold rate, converting is simple. I don’t think this applies in the US, where costs are split between private and public sources in a confusing way.
All of this brings me back to broad agreement with your instinct to count the health gains as “free”, because it’s quite complicated to do otherwise. But I would caution about complexity. Objections to the buying/selling of organs are partly based on notions of sanctity that we might see as stupid (much like the fear of GM crops that is blocking Golden Rice) but also partly on valid concerns about the hard-to-predict secondary effects of an organ trade (exploitation, decreased concern for the poor who “can always sell a kidney if they are truly struggling”).
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.