
Amit Gupta Could Have Marrow Transplant by End of Year - sbashyal
http://www.wired.com/epicenter/2011/12/amit-gupta-marrow-transplant/
======
patio11
You guys may be interested in Flynn vs. Holder, which is a court case
attempting to strike down the federal prohibition on selling bone marrow.

If you could buy and sell bone marrow, all parties agree that that would
happen more frequently than bone marrow donation. The side that believes that
would be bad won.

(A brief sketch of the concern: if you allow money into the equation, either
a) people who won the marrow lottery could extort money from folks who are
dying or b) poor people would be hooked up to machines and have their vital
juices sucked out so that rich people could live. A brief sketch of the
argument for allowing bone marrow sales: the present law guarantees persistent
market undersupply of bone marrow, which, with certainty, kills people.)

~~~
uptown
I'll admit I haven't read the case you references, but once you build a
financial marketplace around something, it will get controlled, manipulated
and exploited. Why stop at bone marrow? Everybody's got a couple kidneys ...
why not let people sell one? What about the donors who regularly give blood
donations today? Would they stop doing so without being paid? I believe it's
an oversimplification to just say that the current system kills people by
design and that adding money will make it operate more effectively.

~~~
ars
> Why stop at bone marrow?

I would draw a very clear line: Renewable tissue and organs can be sold, non
renewable ones can't.

Blood, sperm, marrow: All sellable.

Kidneys: Nope, donation only.

Liver, skin: On the fence. (They renew, but only with scarring, and can be
taken only a limited number of times.)

~~~
carbocation
Liver is renewable, but living donation is extremely risky to the liver donor.

~~~
ars
I'm not worried about risk, that's for the donor/seller to decide. Higher
risk, higher money. It's no different than hazard pay for dangerous jobs.

But my understanding is that someone can only donate a liver once, even though
it regenerates. Perhaps that just because doctors are uncomfortable with the
risk of a second donation?

~~~
carbocation
I don't agree that tissue renewability is the correct sole factor in
determining whether said tissue should be for sale. I think that donor risk is
much more important. I consider this to be a bioethical issue but I think it's
also pretty political so I'll probably refrain from making much of an argument
here.

I don't do liver transplant so I'm at the limit of my knowledge re: number of
liver donations, but I would guess that it has to do with the fact that the
donated segments do not regrow; the liver regains function, but not form.

~~~
ars
> I think that donor risk is much more important.

It would be important to me certainly, if I was considering donating.

But at the end of the day each person much decide for themself. Just like
people decide on a level of risk when accepting a job.

If people are allowed to risk their life on a job to make money, they should
be allowed to risk their life to donate tissue to make money.

For donations though, any significant risk is probably not acceptable, which
is the current situation.

------
kens
One interesting thing about Amit Gupta's efforts to get people to register
their bone marrow is he's actually helping other people much more than he's
helping himself. The key point is that everyone who needs bone marrow is more
likely to find a match because of the additional registrants.

Serious question: is there a game-theoretic name for this? It's kind of the
opposite of tragedy of the commons or free-rider. Amit's actions actually
seems structurally similar to contributing to open-source software: he's
trying to solve his own problem, but at the same time helping thousands of
other people.

In any case, you should sign up - wouldn't it be great to save someone's life
in this way?

~~~
gajomi
>Serious question: is there a game-theoretic name for this?

From the view of evolutionary game theory he might be called a "neutrally fit
cooperator" or "nearly-neutrally fit cooperator".

In public goods games cooperators increase the amount of public goods
available to everyone, but if there is some cost to producing the good they
can be subject to invasion by defectors. Amit's campaign definitely benefits
everyone in the community more or less equally, but the cost to him
(determined by the additional opportunities he might have had to find a donor
for himself through some other means) are presumably quite low to the point
where we can consider them to be zero. Since both cooperators and defectors
pay nothing but receive the same benefit, they are equally fit and no relative
fraction of strategies employed by the population is preferred (although
having more cooperators should contribute to a higher overall payoff).

The interesting little twist to the story, if we are thinking in terms of
evolutionary game theory, is that players that reach a certain payoff (e.g.,
by getting there transplant), leave the game with some probability! This is
the opposite of what usually happens in games in evolutionary biology, since
higher absolute payoff is typically associated with larger population sizes.

------
callmevlad
"But we’re sort of in wait-and-pray mode because historically, only half of
South Asians who are tested actually agree to donate."

Not only is the chance of finding South Asians to get a DNA test very low, but
that chance is further sliced by half because a matched donor can get cold
feet.

I really hope that those people who were identified as a match come through
for Amit (or others in need).

~~~
tdoggette
Look, if you sign up, you sign up to actually give marrow if there's a match.
Period. Unless you're not healthy enough, there's no excuse for welching on a
deal that involves someone's life.

~~~
naz
How wrong it is to flake is irrelevant. You can't really force someone to
undergo surgery.

~~~
leddt
It's basically a 6 hours long blood donation. Hardly what most people think as
surgery.

I agree you can't force them to go through with it, but the effort needed
versus the outcome if successful are not even comparable.

~~~
preamble
No it's not like a blood donation. It's misinformation like this that cause
people to sign up to donate, and then back out when they find out what they
really have to do. Bone marrow donation is a surgery. PBSC donation requires
you to get injected with a drug for 5 days, and then have your blood drawn out
from one arm, go through a machine, and passed back to you through the other
arm. If you have thin veins it'll even require a central line (tube in your
neck).

~~~
maxharris
Thanks for explaining this!

This is why Flynn vs. Holder is so damn important.

If the goal is to actually save human lives, more people need to _choose_ to
let doctors invade their bodies to take the cells they need, take the time off
of work, away from their goals, etc. The only way that most people could do
this for a stranger is to be compensated. I predict great things to come!

~~~
khafra
I'm trying to think of a dollar amount high enough to let somebody stick a
tube into my jugular and extend my circulatory system outside my body for
hours. I don't think I can count that high; unless I needed the money for
fairly immediate survival.

~~~
akuchling
It's not as bad as it sounds, though 6 hours is quite a while. Platelet
donation is done this way ([http://www.redcrossblood.org/donating-blood/types-
donations/...](http://www.redcrossblood.org/donating-blood/types-
donations/platelet-donation)), taking an hour or two each time, and there are
donors who make a platelet donation every two weeks. The blood cools while
it's being run through the machine so you get chilly, but donors generally
just sit under a blanket and read or watch a DVD for the duration.

------
herbdean
Mike makes a good comment - The one thing that the article does not explain is
that all swabs go into a national database. If you give a sample in a drive to
save somebody that you know, you could end up getting a call 10 years later
saying that you match somebody else on the other side of the country

------
suivix
Why should I care about this person, and how is it relevant to startups,
hacking, technology, etc.?

"On-Topic: Anything that good hackers would find interesting. That includes
more than hacking and startups. If you had to reduce it to a sentence, the
answer might be: anything that gratifies one's intellectual curiosity."

~~~
SandB0x
Ignoring your horrific lack of tact and sensitivity: From
<http://amitgupta.com/>

> In the past... I started Jelly, worked with Seth Godin to start ChangeThis,
> brought BarCamp to NYC, started a co-op called House 2.0, contributed to a
> WSJ best-seller with Malcolm Gladwell, Guy Kawasaki and others, and started
> a venture-backed company called The Daily Jolt while in college. I enjoy
> camping.

~~~
ineedtosleep
He actually brings a point I've been wondering since the entire thing started:
Why is he somehow more "important" than all the other people on the bone
marrow transplant list?

Downvote me to oblivion if necessary, but this really is a genuine question
which, by the looks of things, has the answer of: His life is more important
than everyone else on the transplant list.

~~~
oz
_"Why is he somehow more "important" than all the other people on the bone
marrow transplant list?"_

He is _not_ more important in an _objective_ sense. Most people would agree in
an abstract sense that all lives are equally valuable, but would readily save
their child rather than another if it came down to it. Why? Because they value
the life of their child more than the life of another's child, and there's
absolutely nothing wrong with that.

Amit, as a member of the startup community, is our child, as it were. Due to
this commonality, we feel closer to him than 'faceless' people on the list. So
your last sentence might read: "His life is more important than everyone else
on the transplant list _to us._ "

~~~
daenz
Anyone else see the irony of a community fighting to save a person's life,
while ignoring all the other "faceless" sufferers, when the life that they're
fighting for probably depends on the good will of a "faceless", anonymous
person? Serious question.

~~~
homosaur
I'm not sure you know what "irony" means.

~~~
daenz
Sad time when HN doesn't downvote your non-contributing comment out of spite
for my comment.

