Columbia University Professor turned President of the Coalition to Modify NOTA & Executive Director of Waitlist Zero advocating for the passage of the End Kidney Deaths Act (H.R. 2687).
Elaine Perlman
Karma: 21
That’s a fair critique, and I agree that EA and the U.S. government are obviously distinct actors.
My argument wasn’t meant to conflate them. It was meant to highlight a broader lesson that I think is relevant to both.
The U.S. kidney system is an example of a domain where enormous resources already exist, Medicare spends billions on dialysis annually, yet poor institutional design prevents those resources from translating into optimal outcomes.
My broader point is that EA may face analogous problems if funding grows dramatically. The central constraint may increasingly shift from, “How do we raise more money?” to “How do we build mechanisms that reliably convert money into public good?”
The kidney shortage feels like a useful case study because it demonstrates that abundance of capital alone doesn’t solve coordination failures, incentive failures, or policy failures.
In other words: the government example is illustrative, not identical.
And I’d argue that this lesson becomes even more important in a world where EA capital scales rapidly.
Please consider signing our petition to help get the End Kidney Deaths Act to the finish line. 100,000 Americans (the total number that will be saved over the ten year pilot program) are relying on us to save their lives. https://forms.gle/rVmseMDioZmazLQXA
25 people in the USA will die today because the kidney shortage denied them a transplant.
Congress must act.
Tell them to PASS the End Kidney Deaths Act and save thousands of lives every year.Sign & share: https://forms.gle/NtQqCcNCJMzDXSnR7
Thanks, Mihkel! I spoke with the leader of transplant in Egypt who told me that “Egypt needs the End Kidney Deaths Act.” A doctor from Nigeria said the same thing about Africa where in all but SA, there is not deceased donation program. Once the End Kidney Deaths Act passes here, we can provide support for all countries to pass similar laws.
Low-income Americans are three times more likely to die from kidney failure. The single best way to change that is to ensure an abundance of kidney transplants. The way to get there is by passing the End Kidney Deaths Act.
Big thanks Rebecca!
You are right. Fixed the issue. Thanks, Arepo!
Thanks for reading and for considering ways to expand the impact of this effort! I’d greatly appreciate feedback.
Thanks for the fair critiques.
On the writing style: I did use ChatGPT as an editorial tool for structure and phrasing.
On the second point: I agree that EA absolutely talks about talent, coordination, and institutional bottlenecks not just money. My argument was narrower than perhaps the opening suggests.
I was responding explicitly about navigating a potential influx of capital, and trying to argue that even in a world with much more funding, mechanism design may matter more than additional grant-making in some domains.
The kidney shortage (that we are working hard to end) presents a case study because it’s a place where enormous resources already exist (billions spent on dialysis), but poor institutional design prevents those resources from producing better outcomes.
So I agree the opening could have been more precise. The stronger version of the claim is probably:
“Even when funding is abundant, poorly designed systems can still produce scarcity.”
This is relevant both to kidney policy and to EA more broadly.
Please consider signing our petition to help get the End Kidney Deaths Act to the finish line. 100,000 Americans (the total number that will be saved over the ten year pilot program) are relying on us to save their lives. https://forms.gle/rVmseMDioZmazLQXA