Wednesday, January 10, 2018

Do organ donors have a right to donate?

Here's a case that makes clear that some donors really wish to become donors, in this case deceased donors. The story is from the Canadian Broadcasting Service news:
Organ donation changes dying for those getting medically assisted death
People who have chosen to die with medical assistance are often the best candidates for donation

"When ALS diminished Brian Wadsworth's quality of life, he asked for medical assistance in dying. Organ donation was the natural next choice. And while the decision came with logistical challenges and ethical concerns, his loved ones say he never looked back."

1 comment:

Prior_Analytics said...

Hi Alvin,

I just listened to a rebroadcasted interview of you on Freakconomics.

I too enjoy market design; So here goes;

From the podcast, I inducted the following;

1) There is a great need for kidney donation
2) There is an even higher need for kidney classification, as not every kidney is a match
3) There is a high surplus of kidneys in any given population
4) The larger the population, the higher the likelihood that an unused kidney exists when a need arises
5).Donors take on some risk/cost as a result of donation. As they lose their redundant kidney
6) Much of the motivation for donors currently centers around asterism, (say for a loved one)
7) Current kidney exchange, relies heavily on temporal coincidence, in that not only do kidneys need to be matched, but timing needs to match too
8) Delays in finding matches, increase the overall health cost of the population

From there, rightly or wrongly, I deduced the following;

1) For most people that need a donation, there probably exists at least one match to a surplus kidney in the population
2) There is an information problem in identifying all of the potential matches in a given population
3) Many potential donors value personal risk mitigation and perceived reciprocity
4) People trust the 3rd party escrow system in place
5) Speeding up donations would decrease the overall cost of the need for donation

And from there I drew the following design assumptions;

Transactions would increase by;
1) Adding risk mitigation as a motivator for donors
2) Removing the temporal requirement as a prerequisite to matching
3) Incentivising testing
4) Incentivising donation
5) designing a system that increases reciprocity

Market Design; tokenized privileges exchanged through an escrow system.

Two tokens;
- Token B: earned when a potential donor is tested for kidney classification. Time stamped when created.
- Token A: earned when donor donates a kidney to needed recipient.
- Tokens are held in escrow system.
- Potential donors earn Token B, upon testing. And a separate Token A upon donation, thus earning 2 tokens for one donation.
- Potential donors (token B holders), and donors (token A holders) may transfer their tokens to a family member, or friend in need for donation, through the escrow system.

Tokenized Exchange;

When a new kidney becomes available; a list of potential recipients is generated.

Priory is given in the following order;
1) Token A holders first, with the timestamp of the token deciding when more than 1 token A holder is a match
2) Token B holders second, with the timestamp of the token deciding when more than 1 token B holder is a match
3) non-token holders

Expected results;
1) Tokens allow exchanges to happen without direct matching

2) Potential Donors can greatly decrease their risk of not having a kidney available when they need it by just getting tested. The sooner the testing, the higher the timestamp priority at time of need

3) Donors can further decrease their own personal risk (of not having a kidney when needed) by donating a surplus kidney, thus receiving one token A and one token B in the process. The sooner the donation, the higher their timestamp priority at time of need

4) Tokens resolve the temporal match requirement, while maintaining high levels of reciprocity

5) Existing escrow system maintains trust in the market

So at it’s core, a donor gets one token B and one token A in return for their single kidney. And the timestamp priority gives the needed incentive (increased value) to encourage quicker action. Two high priorities, (one token B and one token A) in return for one donation then maintains reciprocity and risk mitigation desires that the donor has.

I could go on, but I think you get the idea....

And back to this article, the donation of two kidneys, would result in the creation of one B token, plus an additional A token for each successful donation. And these timestamped tokens could be assigned to the trustee of choice through the escrow system.