Wednesday, October 2, 2019

Repeal of motorcycle helmet laws increases deceased donor transplants: Dickert-Conlin, Elder and Teltser in AEJ:Applied

I imagine that a law that anyone who dies while riding a motorcycle without a helmet is automatically considered to be registered as a willing deceased organ donor would increase the voluntary use of helmets.  Here's a paper that investigates the relationship between helmet laws and transplants under current laws, which vary by state and over time.

Allocating Scarce Organs: How a Change in Supply Affects Transplant Waiting Lists and Transplant Recipients
By Stacy  Dickert-Conlin, Todd Elder, and Keith Teltser
American Economic Journal: Applied Economics 2019, 11(4): 210–239 https://doi.org/10.1257/app.20170476

Abstract: "Vast  organ  shortages  motivated  recent  efforts  to  increase  the  sup-ply  of  transplantable  organs,  but  we  know  little  about  the  demand  side  of  the  market.  We  test  the  implications  of  a  model  of  organ  demand using the universe of US transplant data from 1987 to 2013. Exploiting variation in supply induced by state-level motorcycle helmet  laws,  we  demonstrate  that  each  organ  that  becomes  available  from a deceased donor in a particular region induces five transplant candidates to join that region’s transplant wait list, while crowding out    living-donor  transplants.  Even  with  the  corresponding  demand  increase,  positive  supply  shocks  increase    post-transplant  survival  rates."


"We find that transplant candidates respond strongly to local supply shocks, along two  dimensions.  First,  for  each  new  organ  that  becomes  available  in  a  market,  roughly five new candidates join the local wait list. With detailed zip code data, we demonstrate that candidates listed in multiple locations and candidates living out-side of the local market disproportionately drive demand responses. Second, kidney transplant recipients substitute away from  living-donor transplants. We estimate the largest crowd out of potential transplants from living donors who are neither blood relatives  nor  spouses,  suggesting  that  these  are  the  marginal  cases  in  which  the  relative  costs  of  living-donor  and    deceased-donor  transplants  are  most  influential.  Taken together, these findings show that increases in the supply of organs generate demand behavior that at least partially offsets a shock’s direct effects. Presumably as  a  result  of  this  offset,  the  average  waiting  time  for  an  organ  does  not  measurably  decrease  in  response  to  a  positive  supply  shock.  However,  for  livers,  hearts,  lungs, and pancreases, we find evidence that an increase in the supply of deceased organs increases the probability that a transplant is successful, defined as graft survival. Among kidney transplant recipients, we hypothesize that living donor crowd out mitigates any health outcome gains resulting from increases in  deceased-donor transplants.
...
"The  SRTR  data  show  that  multi-listing  is  not  common,  with  only  6  percent  of  all  candidates  choosing  to  do  so  at  a  point  in  time  (online Appendix A describes how we identify multi-listed candidates and spells in the data). However, those who multi-list are systematically different from those who do not, with higher probabili-ties of having attended some college (46 percent versus 36 percent), higher rates of employment (44 percent versus 33 percent), and lower rates of insurance coverage via Medicaid (5 percent versus 11.5 percent). Not surprisingly, they are also more likely to register outside their own or a bordering DSA (12 percent) than candidates with a single listing (4 percent).
...
"the  percentage  of  liver candidates who receive a transplant within 5 years of listing ranged from 30.5 percent in New York to 86.1 percent in Arkansas (Israni, et al. 2012, 70). Similarly, “a striking (but not new) observation is the tremendous difference ... in the percent-age  of    wait-listed  patients  who  undergo  deceased  donor  kidney  transplant  within  5  years,”  varying  from  roughly  25  percent  in  California  DSAs  to  67  percent  in  Wisconsin (Israni, et al. 2012, 13).
...
"in  the  early  1970s  most  states  had  universal  helmet  laws  because  the  federal  government  tied  state  highway  construction  funds  to  such  laws  (Insurance Institute for Highway Safety (IIHS) 2018). By the  mid-1970s, states successfully lob-bied  Congress  to  break  that  link,  and  states  began  repealing  their  universal  helmet  laws (IIHS 2018).
...
"Using    state-level  OPTN  data  from  1994  to  2007,    Dickert-Conlin,  Elder  and  Moore (2011)—henceforth, DCEM—uses 6  state-level repeals and 1 enactment of a universal helmet law to estimate that repealing universal helmet laws increases the supply of organ donors who die in motor vehicle accidents by roughly 10 percent."
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This paper is part of an exciting line of work that I've blogged about earlier:

Thursday, August 1, 2019  How much do Kidney Exchanges Improve Patient Outcomes? Keith Teltser in AEJ-Policy


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