Should EA Groups Run Organ Donor Registration Drives?

post by Cullen_OKeefe · 2019-03-27T16:29:40.261Z · score: 9 (8 votes) · EA · GW · 16 comments

Contents

  Prima Facie Case
  Some Arguments Against This
  My Takeaway
16 comments

[Epistemic status: prima facie; exploratory]

Related content: Kidney [EA · GW] donation is a [EA · GW] reasonable choice for effective altruists and more should consider [EA · GW] it [EA · GW]; WaitList Zero Grant

Should EA groups run organ donor registration drives?

Prima Facie Case

Here are some reasons why I think this idea is worth trying (for American groups specifically):

1. There seems to be a significant gap between people's stated support for organ donation and actual registration ("95% of U.S. adults support organ donation but only 58% are actually signed up as donors." It's immediately unclear to me what "support" means in this context, though.). Registering is also extremely low-cost to donors; likely much less costly than donating money to effective charities. This suggests tractability.

2. Transplantation is constrained by the number of registered donors.

3. Donations can significantly improve the longevity of recipients.

4. There is some evidence that donation initiatives are cost-effective. ("In conclusion, initiatives to increase organ donation such as DA are likely to be cost‐effective under a variety of clinical scenarios. Aggressively implementing such programs could be an important step to generating long‐term savings and alleviating the worldwide organ shortage."). However, I have not compared this to other activities (the closest comparison point being fundraising for GiveWell charities).

5. Voluntary, uncompensated post-mortem organ donation is extremely popular (see 1. above) and uncontroversial; perhaps less controversial even than giving to the global poor.

6. For signaling and credibility reasons, I think it's generally good for EA groups to run activities that have very concrete, public, measurable impacts. This scores well on all of those (e.g., # of donors registered).

7. I intuitively expect similar activities (namely, fundraising for GiveWell charities) to have rapidly diminishing returns and to also be largely non-rivalrous with organ donor registration, such that switching time from GiveWell fundraising to organ donor registration might be sensible on the margin, especially if groups have underutilized volunteer capacity.

8. In my experience at two large universities, I recall only being asked to register as an organ donor one time, in a highly unusual setting, which anecdotally suggests that this is a neglected area.

9. I think it's generally good for EA groups to diversify their actions to attract more people and for reasons similar to 6. above.

10. Organ donation drives might emotionally resonate with people whose family members have lost QALYs due to waiting for a donation.

11. I suspect this would be easy to implement, since there are existing toolkits.

Some Arguments Against This

1. To credibly do this, this would require EAs to learn about a new cause area, which would take time.

2. Flow-through effects on farmed animals from extending Americans' lifespans might be significantly negative on average, possibly offsetting gains.

3. One should have a strong prior that actions aimed at improving Americans' lives are probably not cost-effective compared to actions aimed at improving the lives of the global poor.

4. It takes approximately 333 donor registrations to counterfactually increase the number of actual organ donors by 1, which suggests low tractability. ("[O]nly 3 in 1,000 people die in a way that allows for organ donation.")

5. Whereas charity pledge drives can drive longer-term commitments and changes in mindset, this doesn't seem like it can. H/T Ryan Carey [EA · GW].

6. This could promote memes about live kidney donation that are potentially harmful to EA productivity. H/T Ryan [EA · GW] Carey [EA · GW].

My Takeaway

Taking all of the above into consideration, my qualitative weighting of the evidence is that this is a worthwhile activity for EA groups to consider, especially if they have spare volunteer capacity and are reaching diminishing returns on GiveWell fundraising. However, I would also appreciate quantitative analysis of this proposal. (I don't have time to do this myself right now, unfortunately.) I would appreciate input from people who have run organ donor registration drives (or similar events like blood drives).

Even so, I think the arguments above are strong enough to warrant a local or school EA group experimenting with this right now.

16 comments

Comments sorted by top scores.

comment by RyanCarey · 2019-03-27T18:43:34.461Z · score: 18 (6 votes) · EA · GW

I agree that registering for organ donation after death helps but does no direct harm. But I think we need to have a high bar for including an activity in the typical cache of activities that EAs promote to others. We want the act to be similar to other acts that have near-maximal impact. Donation fits that bill because once you start donating anywhere, you can switch to other donation targets that have a big long term impact.

For organ donation, though, I don't think it really gives you ideas about anything that can be done that has any real long-term significance. If you go down the organ-donation vertical, you might end up with kidney donation, or with extreme ideas about self-sacrifice. This kind of ideology is really catchy --- It brought Zell Kravinsky mild fame, and was the main object of the book Strangers Drowning. But I don't think that's the main way that long-run good is done. I think doing long-run good requires mostly a more analytical or startup mindset. If you do things like live kidney donation, I actually think you might do less good than working for the week of your operation, and donating some of that to a top longtermist charity.

I get that my claim is that the second-order effects outweigh the first-order ones here, but I don't think that should be so surprising in the context of EA outreach --- we need to carve an overall package --- that gets people to do some good in the short-run, but most-importantly, that builds up a productivity mindset, and gets people to do a lot of good over the longer term.

comment by Cullen_OKeefe · 2019-03-27T19:16:53.119Z · score: 3 (2 votes) · EA · GW

That all seems quite plausible to me. It's definitely a one-off activity, which I agree drives down its EV. I also agree that there's a risk of this promoting potentially harmful ideas about e.g. live kidney donation. I've added those to the list of counterarguments and credited you :-)

I guess my main point is that this seems qualitatively competitive with pledge drives (e.g., GWWC, OFTW), so insofar as those are valuable things for a group to be doing (a common assumption), maybe this is too. But your points have updated me against this somewhat :-)

comment by Cullen_OKeefe · 2019-03-27T19:24:41.294Z · score: 5 (2 votes) · EA · GW

It's also worth clarifying that I doubt that any group that did this would derive a lot of their EV from this activity. Instead, I think this is a good top-of-the-funnel type activity to run for reasons 5.–11. above. More specifically, I think there's high community-building value in doing activities that:

1. Do a significant, easily quantifiable amount of good;

2. Address important problems;

3. Have some EA motivation; and

4. Give people a chance to talk about their EA worldview with non-EAs,

even if the good resulting from those activities might not, in themselves, account for a significant percentage of the good that EA group accomplishes. I think, e.g., GWWC/1FTW tabling is an example of this.

comment by Holly_Elmore · 2019-03-27T21:54:41.297Z · score: 4 (3 votes) · EA · GW
More specifically, I think there's high community-building value in doing activities that:
1. Do a significant, easily quantifiable amount of good;
2. Address important problems;
3. Have some EA motivation; and
4. Give people a chance to talk about their EA worldview with non-EAs

Strong upvote. I wrote something similar before seeing you had written this.

comment by jimrandomh · 2019-03-28T00:25:25.222Z · score: 15 (6 votes) · EA · GW

Post-mortem donation is fine, but being asked to sign up for kidney donation would be severely trust-destroying for me.

comment by aarongertler · 2019-03-28T00:03:02.931Z · score: 8 (4 votes) · EA · GW

Summary: Maybe groups should do this, but there are a lot of things groups should "maybe" do, and this doesn't seem like a clear best candidate.

4. It takes approximately 333 donor registrations to counterfactually increase the number of actual organ donors by 1, which suggests low tractability. ("[O]nly 3 in 1,000 people die in a way that allows for organ donation.")

I agree with others here that EA groups should try activities that:

1. Do a significant, easily quantifiable amount of good;
2. Address important problems;
3. Have some EA motivation; and
4. Give people a chance to talk about their EA worldview with non-EAs.

I think organ donor drives hit points 2 and 3 well, and aren't too bad on 1 or 4 (the impact isn't easy to quantify and organ donation isn't an EA cause area, but the topic is at least clearly positive/altruistic).

But even if a donor registration drive is a reasonable candidate for group activity, is it really better than other available options?

Examples:

  • Promoting some important piece of local legislation (there Open Phil-related ballot initiatives in at least three states before the 2016 election).
  • Any of the other opportunities mentioned in the EA Volunteering group (including research and assistance with writing projects).
  • Other "classic" forms of volunteering that seem tractable/neglected (e.g. helping at a local shelter, manning an emotional support hotline)
  • Learning skills that might help them make a bigger impact later (not just skills related to research or other "EA" pursuits, but also things like CPR or "how to administer Naloxone")

This is far from a complete list.

I don't know how good these things are compared to donor registration drives, but it seems like a group should examine a few different options before deciding to carry out an activity. Or, if they don't have confidence in their ability to estimate impact (or time to do so), they may just want to choose an activity based on other features (e.g. how well it will help the group bond, how convenient it is, how appealing it will be to new members, how well it ties into EA).

comment by Holly_Elmore · 2019-03-28T13:42:33.883Z · score: 2 (2 votes) · EA · GW

I think you're ignoring how much easier, more discrete, and more scalable an organ donation registration drive is than any of these examples.

Also, how many people have to learn CPR through a 4-hour certification for one of them to actually use it? I don't know how favorably it actually compares to the lifesaving potential of spending a few minutes per person registering them to donate their organs.

comment by aarongertler · 2019-03-29T04:11:55.501Z · score: 3 (2 votes) · EA · GW
I don't know how good these things are compared to donor registration drives.

As I mentioned before, I'm not claiming that any of these examples are necessarily better! I'm just trying to gesture to the number of other options groups might have, and the fact that it would be good to see even very rough cost-benefit analyses for different options.

For example, organ donation registration drives are indeed easy, discrete, and scalable, but even if promoting legislation isn't quite as good on those fronts, perhaps the expected impact is good enough to make it a better bet in some places and times.

CPR is rarely successful, especially when performed by non-professionals outside of a hospital, so I doubt it beats organ donation, but it's a plausible thing a group could look into. Other first-aid-ish interventions seem more promising, and EA groups could even consider expanding into other "social intervention" areas (e.g. a workshop on when it makes sense to call 911 if you see someone who looks to be very ill/unconscious).

All of that said, I'd have no objection whatsoever to a group running a well-organized donor registration drive, for the reasons I noted in my first post.

comment by Cullen_OKeefe · 2019-03-29T05:06:27.630Z · score: 1 (1 votes) · EA · GW

This perspective makes a lot of sense to me :-)

comment by toonalfrink · 2019-03-27T18:41:41.990Z · score: 7 (4 votes) · EA · GW

Meta: I'm concerned about the amount of downvotes I see that aren't accompanied with any justification. Consider that there is a lot of information value in a negative judgment. I imagine that the author would be very happy to hear about this, and more generally, I imagine that EA as a whole would skill up a *lot* faster if downvotes came with instructions.

comment by Cullen_OKeefe · 2019-03-27T19:22:50.962Z · score: 4 (3 votes) · EA · GW

Yeah, especially since this is an exploratory proposal, I'd love to have that criticism brought out into the open like Ryan does above [EA · GW]. Also (and this is not a complaint regarding those downvotes, but rather my own view of what good community norms are), to encourage promotion of new ideas, I think we should downvote exploratory proposals only if their prima facie justification is very flawed. Maybe mine is, but I can't tell whether unexplained downvotes are justified by some obvious, severe flaw in my prima facie argument or just a different weighing of the evidence.

comment by abiolvera · 2019-03-30T13:09:44.714Z · score: 2 (2 votes) · EA · GW

I agree that this has the potential to be highly impactful and it's definitely neglected. The fact that it can piggy-back on increasing exposure to non-EAs about EA topics makes this more persuasive, even if it the number of people helped might be small.

My only question would be whether that spare volunteer capacity could/would be used to persuade/train/target people within the DMV - since they are in a position to greatly increase the number of people who sign up by spending only an extra 2-3 seconds nudging people toward a yes, since it's a standard question for the driver's license application. I've read a study somewhere about how this was surprisingly effective - but I do realize this is a significant change in trajectory, but good to point out nonetheless.

I also see a potential upside of having more people wonder what other neglected topics can have outsized effects, thus a great lead-in to EA topics. If this were to become another cause area, it could garner some momentum, possibly enough to pressure some officials to contemplate an opt-out system, rather than the current opt-in system which would theoretically rid us of this shortage with only a nudge.

comment by G Gordon Worley III (gworley3) · 2019-03-28T19:21:07.340Z · score: 2 (2 votes) · EA · GW

I'm always of mixed opinion about organ donation. Yes, it seems straightforwardly beneficial, but it's also at odds with surprising things. For example, I'm signed up for cryonics, and this means it's very import I not be an organ donor both because my organs would be unusable after perfusion and because if I were an organ donor and was willing to accept a lower quality preservation by possibly not having my regularly circulatory system in place to help with cooling, it would still be a bad deal because doctors would hold on to my body for an unspecified amount of time in not necessarily ideal preservation conditions for my brain before maybe releasing me to the cryonics team hours or days later.

This would effectively mean pitting organ donation and life extension, at least in part, against each other within EA. Not necessarily a blocker if people think more organ donation among people who don't sign up for cryonics is worth it in expectation over, say, getting more people signed up for cryonics, but it's worth factoring into the calculation.

comment by Cullen_OKeefe · 2019-03-29T05:05:31.714Z · score: 1 (1 votes) · EA · GW

[I think there are strong arguments against cryonics as an altruistic intervention by Jeff Kaufman here.] But I thank you for pointing out the tension :-)

comment by Holly_Elmore · 2019-03-27T21:53:12.891Z · score: 2 (2 votes) · EA · GW
6. For signaling and credibility reasons, I think it's generally good for EA groups to run activities that have very concrete, public, measurable impacts. This scores well on all of those (e.g., # of donors registered).
[7] ...especially if groups have underutilized volunteer capacity.

I would say it's worth doing for this reason alone. One reason group volunteer activities are often so ineffective is that the real point is social bonding over a shared altruistic project. EA groups could use more of that feeling of camaraderie and discrete accomplishment that doesn't generally follow work on the most effective causes. Since I think it's worth finding more activities that new people or low-commitment people could do to get started or that would boost morale, I don't think it's necessary to justify something like this solely in terms of direct effectiveness. Activities like this can really strengthen ties in the group, which are a huge multiplier the group's and the individuals' effectiveness.

Also, this is just my observation, but I think getting people to do easy things like giving up their organs after death creates a sense of altruistic buy-in that leaves them more favorably disposed toward greater altruism later.

I second concerns about making organ donor registration drives an EA "thing," but I think it would probably be a nice idea for individual groups to do of their own iniative, especially if they think it would be good for them socially.