Monday, July 20, 2015

Organ Donor Safety Exemptions

The following question was posted on the EA Policy Facebook page:

General idea: should exemptions be granted to certain safety laws if you sign up to be an organ donor?

Would such policies likely be a positive or negative for organ donation and safety compliance?

My response turned into a full blog post:

The biggest possible failure is that it discredits the idea of voluntary organ donation, resulting in less organ donation from other sources. I have no idea how big this effect might be.

Concrete examples help analysis, so I will consider this by looking at motorcycle helmet laws:

It is possible that telling people 'We will allow you to ride a motorcycle without a helmet if and only if you agree to become an organ donor, so we can harvest your organs after you crash and become brain-dead.' might shock them into wearing their helmet voluntarily, which seems like a simple good thing with no side effects aside from the possible organ donation discrediting.

Assuming that people are rational agents, some of whom experience large amounts of utility from riding without a helmet, we can expect the following:

1) People take the deal and ride without a helmet (good effect, social utility increases).
2) Motorcycle crashes decrease due to risk compensation (good effect).
3) The crashes that happen are more likely to cause death or brain injuries to motorcycle riders (bad effect).
4) More organs are available for use, both from the crash victims and people who take the deal and die from other causes (good effect).

I expect effects 3 and 4 to be the largest. More riders will die, or become disabled and require a lifetime of expensive medical care, and lives of people waiting for organ transplants will be saved.

Fatal motorcycle crashes tend to be an excellent source of donor organs, but I am fairly sure that most of them will cause a net decrease in QALYs, even the ones that result in many useful organs. Organ recipients tend to be old and unhealthy, so the organ does not give them that many QALYs. If the rider was young and healthy, they likely lose more QALYs than all the combined recipients of the organs would gain. If the rider was middle-aged and unhealthy, the organs are not likely to be as useful.

However, organ donation makes the QALY loss from those fatalities significantly less than most fatalities. (A nonfatal crash resulting in permanent disability will cause a larger QALY loss than a fatal crash.) If the rate of motorcycle crashes among people who take the deal is small enough, then the good effects of all of their organ donation will outweigh the bad effects of their crashes, and the policy is good.

I suspect that the crash rate is low enough that the policy of offering these exemptions is good. I think the breakeven would be something like ten new organ donors for every lethal or disabling crash, and I am almost sure that the lifetime risk of such a crash for motorcycle riders is significantly less than 10%.

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