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Social Costs and Benefits of Transplants

in The Global Organ Shortage: Economic Causes, Human Consequences, Policy Responses

This chapter makes the medical and financial case for large increases in transplant activity. It reviews studies that examine in detail the social costs and benefits of various transplants, and ... More

This chapter makes the medical and financial case for large increases in transplant activity. It reviews studies that examine in detail the social costs and benefits of various transplants, and finds, consistent with overwhelming medical opinion, that transplantation is the best and most cost-effective treatment for a number of serious disorders. In the case of kidney transplants and end-stage renal disease, one can justify paying very large compensation to donors (or their families) based solely on savings to public health funds. Many billions of dollars or euros are lost every year through continued reliance on the current system of organ procurement. In contrast, it is more difficult to rationalize large increases in certain other transplant procedures purely based on direct medical cost effects. It is unlikely, given current technological constraints and life expectancies, that large expansions in heart-lung transplants will “pay for themselves” in this sense.Less

Reforms Short of Open Donor Compensation

in The Global Organ Shortage: Economic Causes, Human Consequences, Policy Responses

This chapter reviews proposed reforms for the organ procurement system that fall short of donor compensation. In general, policies to reduce waiting lists within the existing procurement framework ... More

This chapter reviews proposed reforms for the organ procurement system that fall short of donor compensation. In general, policies to reduce waiting lists within the existing procurement framework fall into three categories. First, many efforts are aimed at influencing the behavior of potential or actual organ donors. Public service advertising, appeals to people's moral decency, and propaganda efforts fall into this category. A second type of program aims to increase the extent to which the existing pool of potential organ donors is realized. These programs, such as the Organ Donation Breakthrough Collaborative in the United States and the “Spanish model,” provide hospitals with both incentives to actively pursue donations and additional resources to support such efforts. A third category of possible reforms has received little attention so far: the effort to reduce the need for transplants—what economists might term “demand-side management.” For example, many individuals needing kidney transplants suffer either from poorly managed diabetes or untreated hypertension that can lead to organ damage. Programs that effectively treat these preconditions would almost surely be economically efficient when the costs of ongoing dialysis and transplantation are considered.Less

The Role of Repugnance in the Development of Markets: The Case of the Market for Transplantable Kidneys

Julio Jorge Elias

in Social Economics: Current and Emerging Avenues

Economic efficiency is a criterion commonly used in economic analyses to establish an order of preference between different policy alternatives. However, in many societal situations where decisions ... More

Economic efficiency is a criterion commonly used in economic analyses to establish an order of preference between different policy alternatives. However, in many societal situations where decisions on policy are made it would seem that this criterion is not the one most often prevails. This paper examines a disgust or repugnance factor, and examines how this factor operates as a restriction on certain transactions in the market and the consequences of these restrictions. This repugnance concept, developed by Al Roth (2007), suggests that some transactions, such as the purchase and sale of kidneys for transplants are illegal simply because a sufficient number of people find it repugnant. This paper demonstrates that the level of the repugnant reaction depends on circumstances and is closely associated with the social cost imposed by the development, prohibition or regulation of a kidney transplant market.Less

Organ Transplant

K. Kannan

in Medicine and the Law

Prolongation of life and improvement of quality of health assumed immense possibilities with organ transplants from live and deceased donors. When a person can be treated as dead in order for organs ... More

Prolongation of life and improvement of quality of health assumed immense possibilities with organ transplants from live and deceased donors. When a person can be treated as dead in order for organs to be harvested for transplant and when life support can be withdrawn from a critically ill patient requires close monitoring and the Organ Transplantation Act contains empowering provisions to mitigate the dilemma. Issues of consent are vital to proper implementation of the Act and since they are emotive, often arising during the time of critical care of the patient, advance directives and the surrogate decisions of near relatives assume significance. Statutory controls have not quelled either the organ trade or manipulation of authorization committees’ recommendations. Prices for organs to check the scourge of black market trade in organs may seem an attractive proposition but in a country of countless indigent persons, they are bound to result in exploitation of the poor.Less

Racial Equity in Kidney Transplants

Michael D. Stein and Sandro Galea

in Pained: Uncomfortable Conversations about the Public's Health

This chapter examines disparities between the health outcomes of white people and minorities in organ transplant allocation. Prior to 2015, kidney transplants went to white patients at a much higher ... More

This chapter examines disparities between the health outcomes of white people and minorities in organ transplant allocation. Prior to 2015, kidney transplants went to white patients at a much higher rate. A new allocation system was devised in order to change that. The simple, yet ingenious solution attacked the structural cause of the inequity. It kept time on the donation list as the main selection criteria, but the fix by the United Network for Organ Sharing (UNOS) acknowledged that because of underlying health care disparities, black and Hispanic persons spend more time on dialysis before being put on the list. The new system places the starting point at the earliest date a patient was either put on the list for kidney transplants or started regular dialysis treatments. Work in Health Affairs shows that the new UNOS system worked as intended, and that the racial disparities in transplantation have been largely addressed. Transplants are the go-to treatment option for those with end-stage renal disease, increasing the likelihood of survival and better quality of life, while costing one third as much as long-term dialysis.Less

Neurocognitive Effects of Solid Organ Transplantation

Nataliya Zelikovsky and Debra S. Lefkowitz

in Cognitive and Behavioral Abnormalities of Pediatric Diseases

The first successful organ transplant was a kidney transplant performed between identical twins in 1954. Since that time, major medical advances have been ... More

The first successful organ transplant was a kidney transplant performed between identical twins in 1954. Since that time, major medical advances have been made to help improve survival rates for transplant recipients. In 2008, there were 1,964 solid organ transplants performed for children under age 18 (2007 Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients [OPTN/SRTR] Annual Report 1997–2006). Currently, approximately 1,830 pediatric patients are awaiting some type of solid organ transplant (2007 OPTN/SRTR Annual Report 1997–2006). Organ transplantation in children is relatively recent compared to other treatments for children with chronic illnesses. The focus over the first few decades has been on medical advances and improving survival rates for transplant patients. In the recent years, increasing attention has been given to the developmental, neurocognitive, and psychosocial outcomes prior to transplant and in the short-term period post transplant. Most chronic illnesses and acute traumatic medical events have implications for neurocognitive outcomes. End-stage disease of the liver, kidney, heart, and lung are all believed to affect intellectual, academic, and neurocognitive functions. Gross neurodevelopmental deficits have become less common due to early medical intervention (e.g., improved nutrition, surgical intervention, reduced exposure to aluminum (Warady 2002). Organ transplantation is believed to ameliorate the deleterious long-term developmental and neurocognitive effects, but this topic has received little attention in the literature, and the available results with regard to intellectual, academic, and neurodevelopmental results have been mixed. In a combined sample of solid organ transplant patients, 40% had clinically significant cognitive delays (Brosig et al. 2006). Examining the impact of different underlying disease processes and transplantation of each solid organ separately is critical. Thus, we discuss the neurocognitive outcomes of each organ group separately in this chapter. Neurocognitive outcomes can be assessed in a variety of ways depending upon the age of the child. Among infants and toddlers, neurocognitive functioning is measured by an assessment of motor function, social and environmental interaction, and language development. Assessment of older children may involve the evaluation of intelligence, academic achievement, emotional and behavioral functioning, and adaptive skills. Less

The Moral Psychology of AI and the Ethical Opt-Out Problem

Jean-François Bonnefon, Azim Shariff, and Iyad Rahwan

in Ethics of Artificial Intelligence

This chapter discusses the limits of normative ethics in new moral domains linked to the development of AI. In these new domains, people have the possibility to opt out of using a machine if they do ... More

This chapter discusses the limits of normative ethics in new moral domains linked to the development of AI. In these new domains, people have the possibility to opt out of using a machine if they do not approve of the ethics that the machine is programmed to follow. In other words, even if normative ethics could determine the best moral programs, these programs would not be adopted (and thus have no positive impact) if they clashed with users’ preferences—a phenomenon that can be called “ethical opt-out.” The chapter then explores various ways in which the field of moral psychology can illuminate public perception of moral AI and inform the regulations of such AI. The chapter’s main focus is on self-driving cars, but it also explores the role of psychological science for the study of other moral algorithms.Less

Medical disability

M.T. Hosey and R. Welbury

in Paediatric Dentistry

There are many general medical conditions that can directly affect the provision of dental care and some where the consequences of dental disease, or even dental ... More

There are many general medical conditions that can directly affect the provision of dental care and some where the consequences of dental disease, or even dental treatment, can be life-threatening. The increasing number of children who now survive with complex medical problems because of improvements in medical care present difficulties in oral management. Dental disease can have grave consequences and so rigorous prevention is paramount. The decline in childhood mortality has led to increasing emphasis on maintaining and enhancing the quality of the child’s life and ensuring that children reach adult life as physically, intellectually, and emotionally healthy as possible. Dental care can play an important part in enhancing this quality of life. Indeed, management within the primary dental services helps to ‘normalize’ life for these children who appreciate attending along with their family, even though sometimes they might still require specialist expertise. Although infant mortality rates (deaths under 1 year of age) have declined dramatically in the UK, death rates are still higher in the first year of life than in any other single year below the ages of 55 in males and 60 in females. The rates are highest for the very young. The main causes of death in the neonatal period (the first 4 weeks of life) are associated with prematurity (over 40%) and congenital malformations (30%). However, in the remainder of the first year the main causes of death occur at home and often nothing abnormal or suspicious is found (SUDI (sudden unexpected death in infancy) and SIDS (sudden infant death syndrome). Although the unexpected death of a child over 1 year of age is rare, a few infants still succumb to respiratory and other infective diseases (e.g. meningitis), congenital malformations, and accidents. (See Key Points 17.1.) All patients should have an accurate medical history taken before any dental treatment is undertaken. This is important for several reasons. 1. To identify any medical problems that might require modification of dental treatment. 2. To prioritize children who require intensive preventive dental care. 3. To identify children requiring prophylactic antibiotic cover for potentially septic dental procedures. Less