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Natural direct and indirect effects decompose the effect of a treatment intothe part that is mediated by a covariate (the mediator) and the part that isnot. Their definitions rely on the concept of outcomes under treatment with themediator "set" to its value without treatment. Typically, the mechanism throughwhich the mediator is set to this value is left unspecified, and in manyapplications it may be challenging to fix the mediator to particular values foreach unit or individual. Moreover, how one sets the mediator may affect thedistribution of the outcome. This article introduces "organic" direct andindirect effects, which can be defined and estimated without relying on settingthe mediator to specific values. Organic direct and indirect effects can beapplied for example to estimate how much of the effect of some treatments forHIV/AIDS on mother-to-child transmission of HIV-infection is mediated by theeffect of the treatment on the HIV viral load in the blood of the mother.

Defining and estimating causal direct and indirect effects when setting the mediator to specific values is not feasible