Self-Driving Cars Will Make Organ Shortages Even Worse

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http://www.slate.com/articles/technology/future_tense/2016/12/self_driving_cars_will_exacerbate_organ_shortages.html

Self-Driving Cars Will Make Organ Shortages Even Worse
We need to prepare for that now.
By Ian Adams and Anne Hobson

Much has been said about the ways we expect our oncoming fleet of driverless cars to change the way we live—remaking us all into passengers, rewiring our economy, retooling our views of ownership, and reshaping our cities and roads.
They will also change the way we die. As technology takes the wheel, road deaths due to driver error will begin to diminish. It’s a transformative advancement, but one that comes with consequences in an unexpected place: organ donation.

Since the first successful recorded kidney transplant in 1954, organ transplant centers have been facing critical shortages. Roughly 6,500 Americans die waiting for an organ transplant each year, and another 4,000 are removed from the waiting list because they are deemed too sick for a transplant. Since 1999, the waiting list has nearly doubled from 65,313 to more than 123,000. Liver and kidney disease kill more people than breast cancer or prostate cancer, and the Centers for Disease Control and Prevention expects the incidence of these chronic diseases to rise along with the need for more organs.
It’s morbid, but the truth is that due to limitations on who can contribute transplants, among the most reliable sources for healthy organs and tissues are the more than 35,000 people killed each year on American roads (a number that, after years of falling mortality rates, has recently been trending upward). Currently, 1 in 5 organ donations comes from the victim of a vehicular accident. That’s why departments of motor vehicles ask drivers whether they want to be donors.

It’s not difficult to do the math on how driverless cars could change the equation. An estimated 94 percent of motor-vehicle accidents involve some kind of a driver error. As the number of vehicles with human operators falls, so too will the preventable fatalities. In June, Christopher A. Hart, the chairman of the National Transportation Safety Board, said, “Driverless cars could save many if not most of the 32,000 lives that are lost every year on our streets and highways.” Even if self-driving cars only realize a fraction of their projected safety benefits, a decline in the number of available organs could begin as soon as the first wave of autonomous and semiautonomous vehicles hits the road—threatening to compound our nation’s already serious shortages.
We’re all for saving lives—we aren’t saying that we should stop self-driving cars so we can preserve a source of organ donation. But we also need to start thinking now about how to address this coming problem.
Because they’re following the trajectory of transportation revolution, these further shortages won’t arrive all at once. We’re only starting the cautious rollout of the first wave of semiautonomous cars, which still require occasional operator input and, as we saw recently in San Francisco, further technical development. Sophisticated sensors and collision-avoidance systems will help reduce accidents, but the real change will come with well-engineered fully autonomous vehicles. The federal government has fast-tracked their adoption and sees them as a key part of a goal to get the nation to zero highway deaths in the next 30 years. Barring a monumental medical breakthrough in the field of organ replication, that means we need a national solution for our donation shortages—fast.

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http://www.thedrive.com/news/6740/think-tank-proposes-ebay-for-organ-shortage-created-by-autonomous-cars
 [/size]Think Tank Proposes eBay for Organ Shortage Created by Autonomous CarsNeed fast cash and have a spare liver? One group proposes an easy free-market solution now.BY LIANE YVKOFFAn often touted benefit of self-driving vehicles is that they are safer than human drivers, and cause fewer accidents. Fewer road accidents will mean fewer deaths. Fewer dead people means that there could be an even bigger shortage of donor organs in the near future. It may be morbid, opportunist, and callous, but a conservative think thank has identified this unintended consequence, and advocates a human market marketplace solution.Washington-based R Street published an article in Slate highlighting that 1 in 5 transplanted organs are a result of vehicle fatalities. Should the country achieve the government's targeted zero highway fatalities by 2030, there could a lot fewer bodies from which to harvest organs. The half-glass empty view of eliminating 38,000 annual deaths is to see an increased morbidity in other areas due to donor organ shortage.The authors have a good point. But rather than argue for increased funding for medical research or healthcare that could prevent or cure the many diseases that cause organ failure, or speed the development of artificial organs, the group proposes increasing supply. Increasing awareness would be the traditional strategy to achieve this outcome. However, a faster approach would be to change the organ donation system from the current "opt-in" system to one of "presumed consent," they argue. This means that rather than signing up to become an organ donor or declaring their intentions in their will, people would have to follow an "opt-out" process.Some countries, such as U.K. and Israel, have adopted this framework, and their statistics show an increase in organ transplantation following the changes. But this correlation doesn't necessarily mean causation, and the studies that R Street cites explicitly state this qualification. The researchers explain that just because organ supply goes up, it doesn't mean transplants go up.What R Street fails to point out is that organ transplants require a cohesive healthcare network to match patients with suitable organs. They also requires vast medical training, support, and access. Countries with nationalized healthcare systems are more effective at implementing and benefiting from a "presumed consent" framework because they can improve efficiencies, coordinate treatments, and all patients have equal access, and Spain demonstrates an effective model. However, privatized health insurance networks—even with Affordable Care Act in place—means uninsured individuals, who are disproportionately minorities and lower income, won't benefit as much as their wealthy and insured counterparts.The think tank also failed to mention that countries that have implemented "presumed consent" laws also had fewer organ donations from live individuals, which sometimes is the best way to find a suitable match.The most straightforward approach would be to incentivize the living to donate their organs in the way egg or sperm donors are, the insurance policy experts propose. Obviously this method introduces a lot of ethical concerns, such as exploiting the poor and treating people as junkyards for their body parts. But prohibiting organ trafficking in the U.S. or abroad hasn't fully prevented the practice, R Street points out, so if you can't beat 'em, join 'em, they propose.The sale of human organs has been banned in the U.S. since 1984 for good reason. It commoditizes individuals, takes advantage of dire financial situations, and could lead to a chain of expensive healthcare issues—even death—for live donors. The current system is flawed, and yes, the current egalitarian system can be gamed. But that doesn't mean moral principles should be scrapped.If we're lucky, autonomous technology will lead to fewer vehicle-related fatalities, but this potential benefit will unfortunately take time to achieve. That time shouldn't be used to fine tune an organ marketplace, as the authors suggest, but rather to prevent the need in the first place. The motivation for such ghoulish regulations aren't clear, but it's obvious who the individuals who benefits are.

[Clark]

https://www.fastcoexist.com/3066883/what-happens-if-driverless-cars-cause-a-drought-of-organ-donations

What Happens If Driverless Cars Cause A Drought Of Organ Donations?
There's already not enough organs for everyone on the transplant list, and one of the major sources is people who die in car accidents.

One of the main promises of driverless cars is that they'll save tens of thousands of lives that would otherwise die in car crashes caused by poor human driving. But could those saved lives actually mean more people die? While the roads will be safer without distracted humans behind car wheels, organ-donor waiting lists might grow as the supply of organs from auto-crash victims dries up.
According to figures sourced by Slate's Ian Adams and Anne Hobson, liver and kidney disease are bigger killers than breast or prostrate cancer. Over 10,000 people are removed from donor waiting lists each year either because they get too sick or they die, and the waiting list for transplants has doubled since 1999, it now stands at around 123,000 people.

One of the largest sources of organs for transplant is people killed in auto accidents. One-fifth of organ donations come from the 35,000 people who die on U.S. roads each year. These people would usually keep on living a healthy life, so their organs are perfect for re-use. When autonomous cars really take off, they're will be far fewer organs available. One estimate says that autonomous cars could save 300,000 lives over a decade. If that sounds dramatic, consider the effect of airbags and seatbelts. Since seat belts were made mandatory in the 1970s, road traffic deaths halved from 60,000 to just over 30,000.

One possible solution, Adams and Hobson argue, is to make the human organ market legal. A kidney transplant costs around $150,000. The average 4.5-year waiting period costs $350,000 for dialysis alone. That allows a lot of room, money-wise, to pay people to donate their organs. Economists Gary Becker and Julio Elias argue that paying people around $15,000 per kidney should be enough to get the market moving. And those are live prices. You'd be paid to have one of your kidneys taken out, not just to donate it after you're dead.
We already allow the sale of sperm, eggs, and blood, although none of those leaves the donor lacking a body part they may need to survive. There are already some countries that are moving in this direction. Israel, say Adams and Hobson, not only compensates donors with wage reimbursement and other benefits, it also puts the donor and their family on a priority list if they should require a donation in the future—a kind of pay-it-forward scheme that seems a lot more attractive, ethically, than straight-up cash-for-organs payments.
Would this lead to exploitation of the poor, in favor of the rich? Well, the rich already game the system anyway.
A wealthier liver-transplant candidate, for example, can afford to undergo analysis at numerous liver centers and, in doing so, get put on multiple transplant lists. Richer patients can also afford to travel to countries with more prevalent black markets for organs (which, unregulated, may have meant darker outcomes for their original owners).
The dilemma here is clearly an ethical one, because, financially, paid donations make so much sense if you want to improve supply. It's hard to conceive of anyone rich selling off an organ for that kind of money, so the majority of donors will surely be poor. This means that we need alternatives. The best option is medical advances: to prevent the need for organ transplants in the first place.