Income inequality, risk, and repugnance by Hauge, Kverndokk, and Lange

Two recent papers by  Karen Hauge, Snorre Kverndokk, and Andreas Lange report on the roles played by inequality and risk in causing repugnance to markets.

First, an experiment, motivated by a hypothetical market in kidneys (expressed in abstract terms), that finds that income inequality boosts repugnance to trade.

Hauge, Karen E., Snorre Kverndokk, and Andreas Lange. "Opposition to markets: Experimental evidence." Journal of Economic Behavior & Organization 227 (2024): 106743.

Abstract: We experimentally investigate reasons for opposing market institutions. The experiment shows that opposition to implementing market institutions varies by background characteristics and shows that distributional concerns are a reason for opposing trade institutions. We find no evidence that the opposition to trade is due to risk preferences or paternalistic motives. A main driver of the opposition to trade is the information about background conditions: veils of uncertainty increase the support for the trade institution.

"This paper reports experimental evidence to better understand potential opposition to market institutions, i.e. for allowing people to trade. For this, we abstract from repugnancy concerns that relate to the specific characteristics of the good or service in question, and rather reduces the setting to the payoff dimension and thus the involved risks and distributional concerns. While we use a neutral framing, organ trade, in particular, trade in kidneys, inspires the set-up of the experiment. Trading kidneys for payment is illegal worldwide, apart from in Iran.1 While it is obvious that persons with kidney issues would substantially benefit from a transplant, healthy donors expose themselves to risk (e.g., Lentine and Patel 2012). Currently, there is not a large income gap between donors and recipients in the US (Gill et al., 2012). Nevertheless, studies suggest that - at a given price - the poor would have larger incentives to donate and therefore, are more exposed to potential risks (Moniruzzaman, 2012; Parada-Contzen and Vásquez-Lavín, 2019) and thus potentially more vulnerable in terms of Satz (2010).2 To illustrate this in the experiment, we vary both the initial income of players (rich/poor) as well as their condition (healthy/sick) which combined affect their potential prospects with and without trade. 

...

"In our experiment, a share of 20 % of respondents across all treatments oppose the trade institution although it is constructed such that personal expected payoff is unaffected or improved. We find that the major reasons individuals vote against trade are the unfair distributions of gains from trade. Importantly, the opposition towards trade is partly self-serving: opposition is lower among those that benefit the most from implementing a market institution. Specifically, we find a significantly smaller opposition to trade institutions when participants are behind the veil of ignorance and do not know their income level, their (abstractly defined) health condition, and thus, how trade affects their payoff. Similarly, we find that distributing gains from trade more evenly, thus benefiting the poor to a larger extent, reduces opposition to trade among the poor."

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And here's a related survey study:

Hauge, Karen Evelyn, Snorre Kverndokk, and Andreas Lange. "On the opposition to market institutions on moral grounds." Humanities and Social Sciences Communications 11, no. 1 (2024): 1-8.

Abstract

"From a liberal viewpoint, voluntary trade appears to be something that should meet universal approval. If no one is obliged to trade, establishing a market institution could only make all better off. Nonetheless, specific market institutions meet substantial skepticism and criticism. This paper extends the extant literature by surveying the moral opposition towards trade in multiple dimensions and linking this to policy support measures. We provide survey results on moral opposition to trade in organs, sex services, surrogate mothers, trade in carbon permits, goods produced in poor countries, and food from countries where people suffer from hunger. These cover the potential reasons for opposing trade institutions: moral concerns, paternalism regarding risk-taking, and distributional concerns. Beyond this, we measure support for policies on unemployment benefits, risk prevention, equality goals within society, and redistribution. The survey of Amazon Mechanical Turk workers from the U.S. reveals significant moral opposition to trade in diverse dimensions. About a third of the participants strongly oppose trade in body items, sex services, and food imports from countries where a large proportion of the population suffers from hunger and malnutrition. Fewer participants strongly oppose trading CO2 permits, importing from developing countries, or allowing surrogate mothership. Besides other correlates (e.g., gender, education, being conservative), individuals’ attitudes towards imposing risks on others are identified as an important correlate of the opposition to trade for all the contexts of trade: those who are averse to exposing others to risk for their own advantage are more likely to oppose trading institutions. This measure of social preferences also relates to support for policies on risk prevention, equality goals within society, and redistribution. We discuss potential mechanisms behind this explanatory power of the newly identified measure."

Arguments against paying for plasma and other Substances of Human Origin (SoHO)

 Substances of Human Origin (SoHO) have a growing, often lifesaving role in modern medicine, from breast milk for premature babies, to kidneys for transplant, to blood and blood plasma, which the World Health Organization categorizes as an essential medicine for a wide variety of ailments and injuries.  However concern for protecting the donors of SoHO from exploitation has led to a considerable debate about whether donation must always be uncompensated, and motivated purely by altruism.
 

Two important cases are donation of kidneys and of blood plasma. Payment to donors of kidneys for transplant is banned almost everywhere, but a few countries (among which the U.S. is prominent) allow payment to plasma donors. Kidneys are in short supply, so patients with kidney failure very often die prematurely without receiving a transplant, but among high and middle income countries almost no one is today dying from a shortage of plasma and plasma products.  That isn’t because countries that don’t pay plasma donors generate sufficient supply for their domestic needs, it is because they can import plasma pharmaceuticals from countries that do pay donors, chiefly the U.S. which exports tens of billions of dollars of plasma products annually.
 

Here's an article arguing that payment for plasma and other SoHOs is always and everywhere wrong and should be stopped. (The  authors seem to agree with the WHO that countries should raise enough plasma domestically from unpaid donors, although no country has yet managed to do this.)  Furthermore, they suggest that companies that collect and process plasma must be nonprofits.

Prevention of Trafficking in Organs, Tissues, and Cells by Martin, Dominique E. PhD1; Capron, Alexander M. LLB2; Fadhil, Riadh A. S. MD3; Forsythe, John L. R. MD4; Padilla, Benita MD5; Pérez-Blanco, Alicia PhD6; Van Assche, Kristof PhD7; Bengochea, Milka MD8; Cervantes, Lilia MD9; Forsberg, Anna PhD10; Gracious, Noble MD11,12; Herson, Marisa R. PhD1; Kazancioğlu, Rümeyza MD13; Müller, Thomas PhD14; Noël, Luc MD15; Trias, Esteve MD16; López-Fraga, Marta PhD17 Transplantation, October 22, 2024. | DOI: 10.1097/TP.0000000000005212
 

“It is essential that all national laws “concerning the donation and human application” of human organs, tissues, and cells, as well as all derived therapies, conform to the principle of financial neutrality, prohibiting financial gain in the human body or its parts.9,70 Healthcare professionals, service providers, and organ, cell, and tissue procurement organizations, as well as other industry stakeholders involved in processing, manufacture, storage, and distribution of SoHOs and SoHO-based therapies, are all entitled to “reasonable remuneration” for their work and coverage of the costs associated with various sector activities.66,71 However, what may be considered a reasonable and proportionate remuneration in this context is ill defined. There have been reports of service providers and professionals generating disproportionate profits from such activities, creating potential financial conflicts of interest in service provision and potentially violating ethical norms and legal standards prohibiting trade in SoHOs.30
 

“Development of innovative therapies using human cells and tissues has increased, with the potential therapeutic value of these resources spurring commercial interests that, in some cases, has led to practices in which donated SoHOs are treated as commodities.30,72–75 Furthermore, some SoHOs may undergo substantial processing, resulting in these therapies being regulated outside the regulatory framework governing the transplantation of organs, tissues, and cells as such, and rather being considered as medicines, where commercial profits are expected and guide the production and distribution activities.74,75
 

“Mechanisms should be developed to ensure that strategies used in donor recruitment, which may involve actual or perceived financial incentives, are routinely disclosed and open to scrutiny.70 Transparency of practice is also required to enable scrutiny of the fees charged to cover costs of procuring, processing, storing, manufacturing, and distributing cells, tissues, and SoHO-based therapies and to assess the potential influence of financial interests on decision-making about the use of SoHOs in particular SoHO-based therapies, or distribution of SoHO-based therapies.74 These measures would furthermore help to facilitate equitable access to treatments for all patients.21
…
Box 1, first recommendation
“Recommendations for action to prevent trafficking in SoHOs
•    1. All countries should establish laws that prohibit payment for donation of SoHOs, trafficking in SoHOs, and trafficking in human beings to obtain SoHOs.
o    a. Legislation should prohibit activities that make the human body or its parts a source of financial gain exceeding the recovery of the costs of obtaining, processing, storing, and distributing those parts or the products made from them and of ensuring the sustainability, safety, and quality of donation and transplantation systems.”

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They also suggest that there is widespread human trafficking in SoHO, although they acknowledge that there isn’t a lot of data to support this:

“since 2010, there have been few empirical studies of organ trafficking, with more recent studies often consisting of qualitative interviews or surveys with individuals who participated in organ trafficking or were victims of human trafficking for organ removal several years earlier.7,32,52 Legal case analyses have focused primarily on seminal cases that detail activities that occurred in the early 2000s.33,38 Much of what is known about current trafficking activities is gleaned from sporadic media reports, which make clear the global prevalence of organ trafficking.”

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Earlier:

Wednesday, August 28, 2024  WHO Says Countries Should Be Self-Sufficient In (Unremunerated) Organs And Blood, by Krawiec and Roth

Monday, April 22, 2024 Plasma donation in the EU: compensated and uncompensated

Saturday, November 4, 2023  The EU proposes strengthening bans on compensating donors of Substances of Human Origin (SoHOs)--op-ed in VoxEU by Ockenfels and Roth

Payments for election-related actions

 Buying votes is illegal, but other election related offers may seem odd but are legal.  

The Guardian has the story.

‘There are certain things that we don’t allow to be sold’: why vote buying in the US is illegal. by George Chidi

"Last week, Tesla CEO Elon Musk offered a $47 payment to people who refer registered voters in swing states to sign a petition supporting free speech and gun rights. The billionaire’s political action committee is using the petition to gather contact information in a last push for support of Donald Trump’s campaign.

"Responding to that offer, card game company Cards Against Humanity, long a Musk foe, announced it will pay up to $100 to each person who didn’t vote in 2020, who apologizes for that, makes a plan to vote and posts in public the phrase “Donald Trump is a human toilet.” Residents of swing states can earn the most money.

"The card game company told the New York Times that more than 1,150 people had been paid through the program as of Wednesday afternoon.

"Vote buying in illegal under US law, but Cards Against Humanity’s site claims that it is “exploiting a legal loophole to pay America’s blue-leaning non-voters”.

"The Guardian talked with Richard Hasen, a professor specializing in election law and director of the Safeguarding Democracy Project at the UCLA School of Law, about the legality – if not the propriety – of these offers.

Q:"I want to get a sense from you about where the line is. What’s legal and what’s not? What are we looking at with Trump buying $100 worth of groceries for somebody at the store, or Musk with this $47 thing, or the reaction by Cards Against Humanity to that? How much of this is legal, and how much isn’t?

A: "It’s all legal. The Cards Against Humanity one comes closest, but there’s a pretty bright line. You cannot pay someone to vote, to register to vote, to vote in a particular way in a federal election. Elon Musk is not paying anyone to vote. He’s paying for leads. I mean, if he’s actually going to pay people to vote, that’s a different question.

Getting more transplants,, two recent articles

 Frank McCormick, and Martha Gershon point me to two articles about increasing kidney transplants.

The first one is by Dylan Matthews in Vox Future Perfect. Here are its first paragraphs and last sentence (the middle is well worth reading too if you're new to this debate..)

The moral case for paying kidney donors.
Kidney donors save lives. Why aren’t we compensated for it?

"A few months ago, I wrote about a proposal called the End Kidney Deaths Act, which seeks to make sure that every one of the more than 135,000 Americans who get diagnosed with kidney failure every year has access to a kidney transplant.

"Its method is simple: a federal tax credit worth $10,000 a year for five years, paid to anyone who donates a kidney to a stranger. It’s the kind of thing that would’ve helped a lot when I donated a kidney back in 2016. Elaine Perlman, a fellow kidney donor who leads the Coalition to Modify NOTA, which is advocating for the act, estimates the measure will save 100,000 lives over the first decade it’s enacted, based on conversations with transplant centers on how many surgeries they can perform with their current resources. Polling has shown this kind of measure has overwhelming public support, with at least 64 percent of Americans supporting a system where a government agency compensates donors.

...

"Not enough nurses? Pay nurses more. Not enough waiters? Pay your waiters more. Not enough kidney donors? Here’s a crazy idea: Pay us."

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And here's an article in Healthcare Brew, by Caroline Catherman:

From pigs to payouts, weighing solutions for the US kidney shortage.  About one out of every 20 people waiting for a kidney transplant die each year, according to the United Network for Organ Sharing. Scientists, policymakers, and other experts are scrambling to find a solution.

It also talks about the End Kidney Deaths Act, and pig kidneys and more effective deceased donation as well.

Incentives matter for getting participation in clinical trials by low income households

 Here's a study that casts some light (via a randomized experiment) on the importance of incentives to get representative participation in clinical trials.

Nonrepresentativeness in Population Health Research: Evidence from a COVID-19 Antibody Study By Deniz Dutz, Michael Greenstone, Ali Hortaçsu, Santiago Lacouture, Magne Mogstad, Azeem M. Shaikh, Alexander Torgovitsky, and Winnie van Dijk, AER: Insights 2024, 6(3): 313–323, https://doi.org/10.1257/aeri.20230195

Abstract: "We analyze representativeness in a COVID-19 serological study with randomized participation incentives. We find large participation gaps by race and income when incentives are lower. High incentives increase participation rates for all groups but increase them more among underrepresented groups. High incentives restore representativeness on race and income and also on health variables likely to be correlated with seropositivity, such as the uninsured rate, hospitalization rates, and an aggregate COVID-19 risk index."

"We analyze representativeness in a unique COVID-19 serological study. Unlike most studies, the Representative Community Survey Project (RECOVER)COVID-19 serological study experimentally varied financial incentives for participation. The study was conducted on households in Chicago (the target population). Randomly sampled households were sent a package that contained a self-administered blood sample collection kit and were asked to return the sample by mail to be tested for the presence of COVID-19 antibodies (“seropositivity”). Households in the sample were randomly assigned one of three levels of financial compensation for participating in the study: $0, $100, or $500.

"We find that households in neighborhoods with high shares of minority and poor households are grossly underrepresented at lower incentive levels. High incentives increase participation rates for all groups but increase them more among underrepresented groups. A $500 incentive restores representativeness in terms of neighborhood-level race and poverty status. Representativeness is also restored in health variables likely to be correlated with seropositivity, such as the uninsured rate, hospitalization rates, and an aggregate COVID-19 risk index. Since incentives were randomly assigned and only revealed after the household was contacted, the noncontact rates at $0 and $100 should be the same as at $500, implying that differential hesitancy to participate is responsible for much of the nonrepresentativeness that we find at lower incentives.

"We are not aware of studies that randomize financial incentives in population health studies. It is well appreciated that racial minorities and lower-income households participate in health research at lower rates.1  The impact of incentives on survey participation rates conditional on demographic characteristics has been studied in the survey methodology literature (see Groves et al. 2009; Singer and Ye 2013, and references therein). The incentives used in this literature are typically an order of magnitude smaller than the incentives in the RECOVER study."

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Some earlier related posts:

Monday, February 22, 2021

Ethical Payment in Human Infection Challenge Studies in the American Journal of Bioethics

Monday, March 1, 2021

Compensating challenge vaccine trial participants: further discussion in the American Journal of Bioethics

Thursday, October 29, 2020

Paying participants in challenge trials of Covid-19 vaccines, by Ambuehl, Ockenfels, and Roth

"we note that increasing hourly pay by a risk-compensation percentage as proposed in the target article provides compensation proportional to risk only if the risk increases proportionally with the number of hours worked. (Some risky tasks take little time; imagine challenge trials to test bulletproof vests.) "

Sunday, November 1, 2020

What do we know about the effects of payments to participants in challenge trials for vaccines, and other public spirited activities?

Compensating plasma donors, or buying plasma from the U.S.? Europe clutches its pearls (The Economist)

 The Economist summarizes the plasma situation well.

The plasma trade is becoming ever-more hypocritical. Reliance on America grows, as other countries clutch their pearls

"Last year American blood-product exports accounted for 1.8% of the country’s total goods exports, up from just 0.5% a decade ago—and were worth $37bn. That makes blood the country’s ninth-largest goods export, ahead of coal and gold. All told, America now supplies 70% or so of the plasma used to make medicine.

...

"America’s booming blood trade is not an unmitigated success story, however, since it reflects problems elsewhere. The trade is mostly driven by two factors. The first is greater demand for plasma products: doctors have found ever more uses for the medicines, especially intravenous immunoglobulin. According to Marketing Research Bureau, a data firm, the market for immunoglobulin has grown by 5-7% a year for the past quarter of a century.

"The second reason is restrictions on plasma collection in other countries, owing to a combination of misplaced worries about safety and concerns about the morality of rewarding people for their bodily fluids. It is, for instance, illegal to pay for plasma donation in Britain, although the National Health Service does offer gifts and acknowledgments when donors reach certain milestones. In June the European Parliament approved new regulations that allow compensation to be offered for donations, but ban it from being mentioned in advertising and cap payments to an amount proportionate to the value of time spent donating. 

...

"Such qualms do not stop countries from importing American blood. Britain and Canada are almost entirely dependent on the country’s plasma; Europe brings in lots, too. China, a great rival of America in other areas of trade, is also more than happy to take advantage of America’s supply. Some 43% of Chinese imports of blood products now come from its geopolitical rival, up from just 14% a decade ago, according to figures from the UN. Chinese policymakers ban imports of plasma—a legacy of an attempt to prevent the spread of HIV in the 1980s—with the exception of a single protein, known as albumin. That alone is driving the trade.

"Some countries are even more flagrant in their double standards. France lobbied against the European Union’s recent regulatory changes, arguing that they risked making the human body a commodity, as is “already a reality in the United States”. At the same time, the French government is the sole shareholder in a company that owns six plasma centres in America, which pay donors, with the fluid collected available for use in France."

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Here are all my posts about plasma.

WHO Says Countries Should Be Self-Sufficient In (Unremunerated) Organs And Blood, by Krawiec and Roth

 Requiring national self sufficiency in blood and plasma supplies is particularly hard on low and middle income countries, as is limiting the possibility of participating in active kidney exchange programs.

WHO Says Countries Should Be Self-Sufficient In (Unremunerated) Organs And Blood by Kimberly D. Krawiec and Alvin E. Roth : August 24, 2024,   Available at SSRN: https://ssrn.com/abstract=4935827

Abstract: This chapter critiques the twin World Health Organization (WHO) principles of self-sufficiency and nonremuneration in organs and blood, urging a more sensible approach to the scarce resources of blood products and transplantable organs. WHO and other experts have failed to acknowledge the tension between self-sufficiency and nonremuneration in blood products--no country that fails to pay plasma donors is self-sufficient. Furthermore, international cooperation and cross-border transplantation provide numerous benefits, especially in smaller countries and those without well-developed domestic exchange programs. The combination of these twin principles denies to health care many of the benefits that trade has brought to so many other human endeavors and the effects are particularly damaging to low and middle income countries. Substances of human origin are special, but not so special that we prohibit plasma or organ donation. We should be open to exploring and experimenting with ways to bring to health care some of the benefits that trade has brought to so many other human endeavors, such as the production and distribution of food and lifesaving vaccines and other medicines.

Here's the concluding paragraph:

"We close by noting that the combination of the nonremuneration principle and the self-sufficiency principle deny to health care many of the benefits that trade has brought to so many other human endeavors. Substances of human origin are special, but not so special that we prohibit plasma or organ donation. So we should be open to exploring and experimenting with ways to bring to health care some of the benefits that trade has brought to so many other human endeavors, such as the production and distribution of food and lifesaving vaccines and other medicines."

Incentives for blood donation in China

 College students have serious (and competitive) incentives to donate blood in China.  This is from Ariana Tang's blog

blood donation bonus points for scholarship credits

"Incentives and Care for Blood Donating Students and Faculty at Shanghai University of Finance and Economics

"Students and faculty who participate in voluntary blood donation will receive a blood donation care package. This package includes a blood donation care card loaded with a nutrition subsidy of 220 RMB (previously, a 20 RMB meal subsidy was added to the care card). This card can be used at various campus restaurants and supermarkets.

"Additionally, the package contains a snack worth 40 RMB. Students who participate in voluntary blood donation will also receive an extra 0.5 points towards their scholarship.

"[translated excerpts from the official call-to-donation announcement, original file (in Chinese) archived here]

"scholarship system mechanics

"Key points: (1) scholarships are awarded by ranking of a score, and blood donation bonus is often a tie-breaker (2) scholarships are very important, and competitive.

"The major scholarship that students compete for—the ‘People’s Scholarship’ issued by the National Bureau of Education—quota is allocated to each class according to a designated ratio. For example, I compete among the pilot class with a total of 18 students for the following quota:

First-place: 18*2% = 0.36 -> 1 person.

Second-place 18*6% = 1.08 -> 1 person.

Third-place: 18*12% = 2.16 -> 2 person.

Students are ranked by their ‘comprehensive evaluation score’ which is mainly a weighted sum of their grades, physical exercises, adding a ‘bonus points’ which includes the aforementioned blood donation incentive:

...

"Notably, students can earn up to 0.5 points for each voluntary blood donation, with the potential to accumulate 1 point for two donations within a year.

...

competitions

The bonus from blood donations can decisively influence scholarship outcomes"

...

"the donation rush

"Scholarship is not only about money. The mental value that it carries, and more importantly, winning the ‘People’s Scholarship’ is a necessary for applying for further honors. Because of this huge incentive, students rush to get their blood donated.

"Given the scarcity of blood donation opportunities—only five to six campus visits yearly by the Shanghai blood center, each time offering around 150-200 quotas—students often queue from as early as 6 a.m. to secure a donation form. Latecomers, even those arriving slightly past 7 a.m., risk missing out due to the limited number of forms available.

"I’ve been there. Only got a form the second time."

End Kidney Deaths Act intoduced in Congress

 Here's the press release from the Congressional sponsors:

Malliotakis Introduces Bipartisan End Kidney Deaths Act, August 12, 2024

"(WASHINGTON, DC) - Today Congresswoman Nicole Malliotakis (NY-11) joined Reps. Don Bacon (NE-02), Josh Harder (CA-09) and Joe Neguse (CO-02) in introducing the End Kidney Deaths Act, bipartisan legislation that would provide a refundable tax credit to living kidney donors who donate kidneys to strangers, specifically those waiting the longest on the kidney waitlist.

"Specifically, the End Kidney Deaths Act will provide a $10,000 refundable tax credit per year for five years ($50,000 total) to living kidney donors who donate kidneys. If enacted, this legislation is expected to save up to 100,000 Americans currently on the waitlist and save taxpayers an estimated $10 to $37 billion."

...

VIEW THE BILL TEXT HERE

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And here's the Coalition to Modify NOTA 's press release(which includes quotes from some of their long list of supporters...)

LIFE-SAVING END KIDNEY DEATHS ACT INTRODUCED TO CONGRESS; PROJECTED TO SAVE 100K LIVES AND $37 BILLION OVER 10 YEARS

Washington DC – The End Kidney Deaths Act (H.R. 9275) has just been introduced by Congressional Representative Malliotakis (R-NY) and Representative Harder (D-CA). This bill will save up to 100,000 American lives and $37 billion tax dollars over the next decade by offering refundable tax credits to encourage living kidney donation in this ten-year pilot program. The End Kidney Deaths Act will provide all Americans who donate kidneys to strangers at the top of the kidney waitlist with a refundable tax credit of $10,000 each year for five years, totaling $50,000."

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Earlier:

Saturday, July 22, 2023

Modify NOTA: a new effort

How Do Financial Obstacles Affect Decision-Making Among Potential Living Organ Donors?

 Here's a report on the effects of helping living organ donors with their expenses.

Mandell, Rebecca J., Abigail R. Smith, Kimberly A. Gifford, Barry A. Hong, Nathan P. Goodrich, Amit K. Mathur, Melissa A. Fava, Akinlolu O. Ojo, and Robert M. Merion. "How Do Financial Obstacles Affect Decision-Making Among Potential Living Organ Donors?" Progress in Transplantation (2024): 15269248241268679.

Abstract: Introduction: Living donation increases the organ supply, but associated non-medical expenses can disincentivize donation. Programs aimed at increasing living donation need to better understand how financial obstacles, including lost wages, impact the decision to pursue donation. Methods/Approach: Forty-eight interviews were conducted and analyzed using a grounded theory approach. Findings: Three key themes were identified that influenced decision-making: emotional attachment, temporal flexibility, and job security. These themes emerged when dividing interview participants into 3 groups: close relationship donors, broader network donors, and non-directed donors, representing donation to a family member or friend, a specific person they do not know well or at all, or a non-specified individual, respectively. Most close relationship donors wanted to donate regardless of personal financial cost, based on emotional attachment to the recipient. Wage reimbursement did not typically affect their decision-making but could reduce stress. Since non-directed donors did not donate to a specific individual, they could wait to achieve financial stability before donating, if needed. While wage reimbursement might create more proximate stability, non-directed donors had the flexibility to postpone donations until they could independently achieve financial stability. Lacking emotional attachment and temporal flexibility, broader network donors were particularly active decision-makers and most influenced by wage reimbursement. Across all groups, donors with job security were more resolute about donating. Conclusion: The findings underscore the importance of lost wage reimbursement to facilitate donation and reduce stress, and policies to protect donor job security."

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Related posts:

Thursday, March 31, 2022

National Living Donor Assistance Center (NLDAC) support for lost wages and dependent care

Saturday, September 17, 2022

Non-directed organ donors and NLDAC financial support

The End Kidneys Death Act has growing support

I've earlier blogged about the Coalition to Modify NOTA (the National Organ Transplant Act of 1984).

Here is a summary of their proposed legislation

The End Kidney Deaths Act Summary

It begins this way:

"The End Kidney Deaths Act is a ten year pilot program to provide a refundable tax credit of $10,000 each year for five years ($50,000 total) to living kidney donors who donate a kidney to a stranger, which will go to those who have been waiting longest on the kidney waitlist. By the 10th year after the passage of the End Kidney Deaths Act, up to 100,000 Americans who were dying on the waitlist will instead have healthy kidneys, and taxpayers will have saved $10-$37 billion. Deceased donor kidneys last half as long as living donor kidneys, the gold standard of kidney care.

"One author of the National Organ Transplant Act, Representative Al Gore, said 40 years ago in 1984 that if transplant centers conclude efforts to improve voluntary donation are unsuccessful, incentives including tax credits, should be provided to donors."  

Their list of supporters is growing, and includes many transplant professionals as well as many people who have already donated or received kidneys.

A proposal to assess public opinion in Europe on compensation for organ donors

 Here's a paper that proposes doing an experiment. Concerning compensation for organ donors. In Europe.  With the hope of influencing policy and reducing the shortage of transplants.  (A very worthy cause, that brings to mind Titian's painting of Sisyphus...)

Ambagtsheer, Frederike, Eline Bunnik, Liset HM Pengel, Marlies EJ Reinders, Julio J. Elias, Nicola Lacetera, and Mario Macis. "Public Opinions on Removing Disincentives and Introducing Incentives for Organ Donation: Proposing a European Research Agenda." Transplant International 37 (2024): 12483.

Abstract: The shortage of organs for transplantations is increasing in Europe as well as globally. Many initiatives to the organ shortage, such as opt-out systems for deceased donation and expanding living donation, have been insufficient to meet the rising demand for organs. In recurrent discussions on how to reduce organ shortage, financial incentives and removal of disincentives, have been proposed to stimulate living organ donation and increase the pool of available donor organs. It is important to understand not only the ethical acceptability of (dis)incentives for organ donation, but also its societal acceptance. In this review, we propose a research agenda to help guide future empirical studies on public preferences in Europe towards the removal of disincentives and introduction of incentives for organ donation. We first present a systematic literature review on public opinions concerning (financial) (dis)incentives for organ donation in European countries. Next, we describe the results of a randomized survey experiment conducted in the United States. This experiment is crucial because it suggests that societal support for incentivizing organ donation depends on the specific features and institutional design of the proposed incentive scheme. We conclude by proposing this experiment’s framework as a blueprint for European research on this topic.

Kidney transplants for cats

 Kidney transplants for cats are a thing, and they all take the form of kidney exchange with a very short chain, in which the lives of two cats are saved. The donor cat is either an unadopted cat from a 'kill shelter,' or a veteran of a medical research trial, who (as the story below says) would otherwise face a "bleak future." But when such a cat becomes a living kidney donor, it is adopted into the family of the cat who receives the transplant (and I guess it goes without saying that they love cats..)

The Washington Post has the story

.Cat kidney transplants: For some, the pricey procedure is well worth it. The surgery can cost up to $25,000. “I just spent $17,000 on my roof, and I love my cat a lot more than my roof,” one person said.  By Marlene Cimons

"Segal, then living in the Boston area, drove his cat to the University of Pennsylvania School of Veterinary Medicine in Philadelphia where Despy underwent a kidney transplant in 2018. Today, Despy is thriving. So is Stevie, the kidney donor cat from a local shelter that Segal agreed to adopt as part of the renal transplant.

...

"Chronic kidney disease is one of the most common conditions in aging cats and a leading cause of death. The disease can be heritable, afflicting young cats such as Despy, and can result from toxin exposure, such as eating lilies.

...

"Like humans, cats have two kidneys, which filter waste from the body, and can live with just one if that kidney is healthy.

"Kidney transplants in cats began more than 25 years ago, although they still are rare, and only three facilities perform them: Penn Vet, the University of Wisconsin School of Veterinary Medicine and the University of Georgia College of Veterinary Medicine.

"Penn Vet has performed 185 transplants since 1998, the Georgia school more than 40 since 2009, and Wisconsin 87 since 1996.

...

"Many pet health insurance companies will cover some of the costs for the recipient, but usually not for the donor because “the donor is not the insured pet,” according to the North American Pet Health Insurance Association. The cost for the donor surgery to harvest the kidney is about 25 percent of the $25,000 total, Aronson says.

...

"Matching is easier for cats than it is for humans needing a transplant because there are only two blood types among all cats.

"Donors come from cat research breeding facilities or shelters, where they might otherwise have a bleak future, and families whose cats undergo transplants must adopt the donors. “For the cost of a kidney, [the donor cats] get to move in with a cat-loving household and are universally loved by their new adoptive families,” Schmiedt says.

...

"Transplants other than kidneys in pets aren’t viable because most require the death of the donor. Kidney transplants in dogs can be challenging because, unlike cats, they often suffer problems with immunosuppression, says Aronson, who has performed three. (The dogs survived but did not do as well long-term as cats, she says.)

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Earlier

Monday, November 23, 2020

Colin Sullivan on organ transplant policy (and on the job market this year)

His job market paper is an experiment with an exceptionally creative design. (Spoiler: it involves a cat actually getting a kidney transplant.) 

Eliciting Preferences Over Life And Death: Experimental Evidence From Organ Transplantation by Colin by D. Sullivan