Sunday, September 24, 2017

Kidney exchange in Aussie TV

Pablo Guillen watches TV in Sydney, and sent me this link to a show featuring kidney exchange:
http://iview.abc.net.au/programs/pulse/DR1629H008S00


Saturday, September 23, 2017

Tributes to Ken Arrow


 
September 22, 2017

In Remembrance of Kenneth Arrow

Tributes in remembrance of Kenneth Arrow have been posted .
Kenneth J. Arrow, Elected 1951, President 1956

Kenneth Arrow's Contributions to Social Choice Theory by Eric Maskin

Kenneth Arrow's Contributions to General Equilibrium by John Geanakoplos

Kenneth Arrow's Work on Coping with Risk and Uncertainty by Menahem Yaari

Kenneth Arrow on Public Goods, Public Policy, and Environmental Economics by Partha Dasgupta

Friday, September 22, 2017

Broken Chains and Reneging: rare and not very consequential


By:Cowan, N ; Gritsch, HA; Nassiri, N; Sinacore, J; Veale, J
AMERICAN JOURNAL OF TRANSPLANTATION
Volume: 17   
Issue: 9   
Pages: 2451-2457
DOI: 10.1111/ajt.14343  Published: SEP 2017
Abstract
Concerns regarding the potential for broken chains and "reneges" within kidney paired donation (KPD) and its effect on chain length have been raised previously. Although these concerns have been tested in simulation studies, real- world data have yet to be evaluated. The purpose of this study was to evaluate the actual rate and causes of broken chains within a large KPD program. All patients undergoing renal transplantation through the National Kidney Registry from 2008 through May 2016 were included for analysis. Broken chains and loops were identified. A total of 344 chains and 78 loops were completed during the study period, yielding a total of 1748 transplants. Twenty broken chains and one broken loop were identified. The mean chain length (number of transplants) within broken chains was 4.8 compared with 4.6 of completed chains (p = 0.78). The most common causes of a broken chain were donor medical issues incurred while acting as a bridge donor (n = 8), donors electing not to proceed (n = 6), and kidneys being declined by the recipient surgeon (n = 4). All recipients involved in a broken chain subsequently received a transplant. Based on the results, broken chains are infrequent, are rarely due to lack of donor motivation, and have no significant impact on chain length.

Thursday, September 21, 2017

The private equity junior labor market continues to unravel

Eric Budish points me to the annual story, which seems to be published earlier each year, about the race for young talent in private equity:

Private Equity Prowls for Young Bankers Early in Frenetic Ritual
Job offers can ‘explode’ at midnight as buyout firms compete

"Junior analysts a few weeks on the job can now expect a flurry of emails from headhunters for some of the most prestigious private equity firms in the world. The jobs they’re being recruited for can pay more than $200,000 a year and won’t start until 2019. The battle to hire the best of them is fiercer, and more urgent, than ever.

"Buyout firms are tapping junior bankers earlier -- advancing the annual recruiting cycle, the industry’s biggest window of hiring, for the fifth consecutive year after an agreement to hold back fell apart.
...
"During the most recent cycle, formal interviews started in January...

"That was the earliest recruiting start ever -- about two weeks sooner than the previous year, and a full three months sooner than in 2013, when the major private equity firms stopped cooperating on timing after some broke out to recruit early.
...
"The majority of the mega-funds fill up their spots within 96 hours...
...
"Going forward, there’s no telling how much sooner the recruitment schedule will creep. But one effect is becoming permanent, said Grauer: candidates don’t have much work experience to discuss in their interviews anymore.

“I’d like to think we’ve gotten to a point where it doesn’t get earlier,” Grauer said, adding that interviewees today don’t often know what they want professionally in the long term. “The days when they were able to talk about all their transactions are gone.”

Wednesday, September 20, 2017

Hurricanes and price gouging (and watermelon)

Accusations of price gouging don't just concern food and water and plywood and gasoline: nowadays we evacuate by airplane as well. But last minute bookings are always expensive...

Airlines Face Criticism Amid Irma Price-Gouging Complaints
"Florida residents have been logging their compaints about unfair pricing of items like water and gasoline, along with airfares, with the office of Pam Bondi, the attorney general of Florida. There have been more than 7,000 since Monday, the attorney general said on Friday.
In their letter to Transportation Secretary Chao, Senators Blumenthal and Markey wrote:
“Airlines certainly have a right to a reasonable return for services rendered and vagaries in pricing are to be expected; but airlines have no right to impose exorbitant, unfair prices on Americans simply trying to get out of harm’s way.”
Florida Representative Charlie Crist also wrote a letter to Ms. Chao, calling for an investigation of United Airlines after receiving several complaints over airfare increases.
...
"“If there’s any gouge, it’s just the last minute walk-up airfares that are designed for desperate business fliers,” Mr. Hobica said. “It’s just the computer programs doing what they do when it’s last minute and seats are scarce.”
Delta, the target of the initial viral complaint, has denied changing its pricing structure leading up to Irma’s arrival and has capped its one-way fares out of South Florida at $399 through Sept. 13 (other airlines like JetBlue lowered one-way fares to as low as $99.) "
***********
I've never been able to track down if it's a true story, but I've heard over the years of some hurricane in which people both lined up to buy some essential good at a very high price, and then clapped when the police showed up to arrest the purveyors for price gouging and confiscate the goods.
Stephanie Wang points me to this second or third hand account, where the good in question is ice.

They Clapped: Can Price-Gouging Laws Prohibit Scarcity?

*********
Here are two recent articles, con and pro on raising prices in an emergency (they both have a picture of empty shelves...)

Memo to economists defending price gouging in a disaster: It's still wrong, morally and economically  by 

Price Gouging Can Be a Type of Hurricane Aid
Higher prices can help resources get to the people who need them most.
by Tyler Cowen

**********
Of course, not all accusations of price gouging arise from emergencies. Consider the watermelon. The Jordan Times has the story:
Petra diner closed temporarily for ‘overpricing melon’  Photo of fat bill goes viral, triggers anger, mockery

"AMMAN — The Petra Development and Tourism Region Authority (PDTRA) on Wednesday decided to extend the closure of a tourist restaurant over an over-priced bill of a watermelon.

"A photo of the bill went viral on social media sites, triggering both angry reactions and mockery.

"PDTRA President Mohammad Nawafleh told The Jordan Times on Thursday that the restaurant, whose rent contract had already expired on July 15, will be closed for two months for selling a water melon for an unreasonably high price and serving food items that are not listed on its menu.
...
"Commenting on the issue, Tourism Expert Sami Hasanat said that such overpricing would harm the “already deteriorating” sector in the Kingdom.

"Authorities have to ensure that prices are always within the “reasonable” levels, as prices would affect the turnout of tourists, added Hasanat, a former MP."

Tuesday, September 19, 2017

Marijuana in California: will the illegal market coexist with the legal market?

"California, which by one estimate produces seven times more marijuana than it consumes, will probably continue to be a major exporter — illegally — to other states. In part, that is because of the huge incentive to stay in the black market: marijuana on the East Coast sells for several times more than in California."

That's from the NY Times article
Legal Marijuana Is Almost Here. If Only Pot Farmers Were on Board

Monday, September 18, 2017

School choice in Chile (deferred acceptance algorithm)

There are new school choice systems being used this year in Chile, based on the deferred acceptance algorithm.

"La ciencia detrás del nuevo sistema--
Algoritmo promete terminar con filas y discriminación en la admisión escolar")

(Google Translate: The science behind the new system--
Algorithm promises to end rows and discrimination on school admission)


Here's a sentence that gives an indication of the old system the new school choice system replaces (courtesy of Google Translate):
"What is changing is the night and the long lines because it is a centralized postulation system that guarantees that all those who register in the agreed term do not have to queue and can apply from home."

Sunday, September 17, 2017

Yemenis selling kidneys in Egypt: Al Jazeera

Al Jazeera has the (nuanced) story:
Desperate Yemenis sell organs to survive
Victims of trafficking rings say the networks operate anonymously in shisha bars and coffee shops in Yemen and Egypt.

"Ali - who is unemployed, divorced and in his early thirties - recently found himself facing a stark choice. He could either sign up to fight with the Houthi rebels on the front lines of the war in Yemen, seek work in neighbouring Saudi Arabia, or sell his organs.

"There are no jobs, and my wife left me for another man," Ali said despondently from his postoperative bed in Yemen's Bani Matar district, southwest of the capital Sanaa.

"After more than two years of war, many working-class Yemenis have turned to selling grocery items and khat - a mild, chewable narcotic - to make a meagre living. Others have opted to sell their organs to survive.
...
"Ali said that the doctor who performed his operation did not warn him of the potential consequences and there was no postoperative care. Patients are compelled to sign a contract that states, "It is not our responsibility if complications arise after the surgery," he added.

"Once the surgery was done, and I received the money, I was on my own," Ali said.
...
"A few operations are done in big hospitals with proper medical care; the majority are done in unlicensed or makeshift operation theatres with inadequate equipment or staff, Maqtari added. Only 45 percent of the healthcare facilities in Yemen are fully functional.
...
"As Yemen's war drags on, the future is anything but certain. But for Adnan Ali, who will soon enter his second marriage with the woman of his dreams and launch a taxi service, there are signs of a brighter future.

"Arrangements are under way for the wedding," he said, "and I am planning to buy a car to run a taxi."

Saturday, September 16, 2017

Sven Seuken appointed Chief Economist of BandwidthX

Here's the press release:

BandwidthX Appoints Sven Seuken as Chief Economist
Prof. Seuken’s appointment underlines the importance of market design in BxMarket

"BandwidthX, the operator of the cloud-based mobile data market, today announces Prof. Sven Seuken as its Chief Economist. Professor Seuken is one of the world's experts in electronic market design. He is a tenured Associate Professor of Computation and Economics at the University of Zurich in Switzerland where he supervises a team of seven PhD students and Postdocs, conducting research on market design topics. At BandwidthX, Professor Seuken enjoys a broad mandate including the design and analysis of market mechanisms and trading rules to drive new efficiencies in BxMarket. The appointment comes at an exciting moment as BandwidthX is expanding its platform across various data networks and global offerings.

"Professor Seuken holds a PhD in Computer Science from Harvard University. Since 2006, he has been conducting research on electronic market design. His main focus lies on designing marketplaces with complex combinatorial constraints. Applications he has worked on include peer-to-peer backup markets, electricity markets, matching markets, spectrum auctions, data markets, financial markets, cloud computing markets, and bandwidth markets.  Prof. Seuken has received several awards, including a Google Faculty Research Award, a Microsoft Research PhD Fellowship, and a Fulbright Fellowship."
...
"BandwidthX operates an advanced connection management service and a cloud-based marketplace where both Mobile Operators and Network Service Providers can define their value for data capacity in real time and are automatically matched when their values align. BxMarket gives the Mobile Operators incremental data capacity at lower cost, while allowing the Network Service Providers to profit from new revenue streams from their underutilized data networks. With this new form of micro-commerce, everyone in the mobile data ecosystem wins: from Mobile Operators and Network Service Providers to equipment and software vendors, aggregators and financial clearing companies and, of course, the end user of the device. Learn more about BandwidthX at http://www.bandwidthx.com.

Friday, September 15, 2017

An optimistic view of transplants in China from the Washington Post

I've written a number of posts linking to optimistic stories about China's move away from using executed prisoners as sources of organs for transplants, and others expressing some skepticism. The Washington Post has some elements of reporting that indicates that they explored and discounted some of the reasons for skepticism, so I think this is the most credibly optimistic assessment I've seen to date.

Here's the Washington Post story:
China used to harvest organs from prisoners. Under pressure, that practice is finally ending.

"China had more than 600 organ transplant centers in a sprawling, unregulated system. That number was whittled down to about 160 registered and approved centers in 2007, when legislation was also introduced to outlaw organ trafficking and ban foreigners from coming to the country to receive Chinese organs.
...
"Chinese law does not explicitly rule out using organs of prisoners condemned to death by the criminal courts, and Huang himself was quoted in Chinese media in late 2014 and early 2015 as saying prisoners could “voluntarily” donate organs.
Huang now disavows those comments, insisting there is “zero tolerance” for using any prisoners’ organs in the hospital system. But in a country of 1.3 billion people, he said at a Vatican conference in February, “I am sure, definitely, there is some violation of the law.”
Lawyer Yu Wensheng said that one of his clients had shared a Beijing prison cell with a man facing the death penalty last November and that the condemned man was given a form to sign to “voluntarily” donate his organs.
Death-row prisoners, he said, were “given the choice not to sign the forms, but they would receive much more mistreatment and suffer much more. If they sign, their last days of life would pass more easily.”
Yet the supply of organs from executed prisoners seems to have been drying up because the number of death sentences appears to have fallen dramatically after a 2007 mandate requiring the Supreme Court to review all capital cases."
...
"Transplant patients must take immunosuppressant drugs for life to prevent their bodies from rejecting their transplanted organs. Data compiled by Quintiles IMS, an American health-care-information company, and supplied to The Post, shows China’s share of global demand for immunosuppressants is roughly in line with the proportion of the world’s transplants China says it carries out.
Xu Jiapeng, an account manager at Quintiles IMS in Beijing, said the data included Chinese generic drugs. It was “unthinkable,” he said, that China was operating a clandestine system that the data did not pick up.
Critics counter that China may also be secretly serving large numbers of foreign transplant tourists, whose use of immunosuppressant drugs would not appear in Chinese data. But this assertion does not stand up to scrutiny.
Jose Nuñez, head of the transplantation program at the World Health Organization, which collects information on transplants worldwide, says that in 2015 the number of foreigners going to China for transplants was “really very low,” compared with the traffic to India, Pakistan or the United States, or in comparison with transplant-visitor numbers in China’s past.
Chapman and Millis say it is “not plausible” that China could be doing many times more transplants than, for instance, the United States, where about 24,000 transplants take place every year, without that information leaking out as it did when China used condemned prisoners’ organs.
And lawyers who have defended Falun Gong practitioners also reject allegations that those prisoners’ organs are being harvested.
“I have never heard of organs being taken from live prisoners,” said Liang Xiaojun, who said he had defended 300 to 400 Falun Gong practitioners in civil cases and knew of only three or four deaths in prison.
In China, despite state repression, family members can be determined in speaking out and seeking justice when relatives vanish.
If tens of thousands of Falun Gong practitioners were being executed every year, that information would emerge, experts say.
A U.S. congressional commission on China, the State Department and the Falun Gong community website have separately tried to estimate the number of political prisoners in China, and the figures range from 1,397 to “tens of thousands” — and even that upper number is significantly lower than the 500,000 to 1 million claimed by Gutmann and others."

Thursday, September 14, 2017

An Invitation to Market Design by Kominers, Teytelboym and Crawford

Scott, Alex and Vince have written an introduction to what I gather is a special issue of the Oxford Review of Economic Policy devoted to market design.  It is also a concise and easy to read introduction to the field, with some guesses about where we're going.

An Invitation to Market Design
Scott Duke Kominers, Alexander Teytelboym, Vincent P. Crawford
 September 4, 2017

Abstract: Market design seeks to translate economic theory and analysis into practical solutions to real-world problems. By redesigning both the rules that guide market transactions and the infrastructure that enables those transactions to take place, market designers can address a broad range of market failures. In this paper, we illustrate the process and power of market design through three examples: the design of medical residency matching programs; a scrip system to allocate food donations to food banks; and the recent “Incentive Auction” that reallocated wireless spectrum from television broadcasters to telecoms. Our lead examples show how effective market design can encourage participation, reduce gaming, and aggregate information, in order to improve liquidity, efficiency, and equity in markets. We also discuss a number of fruitful applications of market design in other areas of economic and public policy

Wednesday, September 13, 2017

Kidney exchange proposed for Qatar

Here's a story from the Gulf Times.

Kidney donation: Qatar study reveals incompatibility

"Kidney Paired Donation (KPD) has emerged as an attractive option for donor-recipient pairs who are not immunologically compatible with each other.
The study 'Safe and ethical living kidney donation in Qatar: A national health system’s approach', recently appeared on Qatar Medical Journal which is part of the publications on QScience.com, an online publishing platform from Hamad Bin Khalifa University Press.
The study was conducted by three Hamad Medical Corporation (HMC) officials, Mohamed Asim, Yousuf al-Maslamani, and Hassan al-Malki.
The study suggests that establishment of a national KPD registry and perhaps a unified registry in the Gulf region will have the potential to maximise living donor transplant rates. Collaboration with international societies such as Transplantation Society, International Society of Nephrology, and European Society for Organ Transplantation would facilitate the establishment of desensitisation and KPD programmes to optimise living kidney transplantation in Qatar.
Successful implementation of these programmes will invariably require resources and expertise and in return, it will ensure that maximum number of LKDs achieve their noble ambition.
The study highlights that LKDs are a unique group of people who should be carefully and respectfully evaluated to determine their suitability for donation.
As per the study, HMC offers a culturally and linguistically tailored living kidney transplant programme that focuses on protecting the rights and best interests of the LKDs. The programme’s legal and policy framework prohibits organ commercialism while providing a safe, supportive, and compassionate environment for those who come forward.
The study also points out that incidence of dialysis therapy for end-stage renal disease in Qatar has increased from 82 per million population in 2013 to 104 in 2016. The increasing incidence of end-stage kidney disease in Qatar has led to growing demand for donor kidneys.
The deceased donor kidney programme has yet to achieve its full potential. Although many of the barriers to deceased donor transplantation related to legislation and infrastructure have been overcome, unfavourable public attitudes toward deceased organ donation still prevail, leading to desperately low consent rates for organ donation.
Hence, living kidney donation has been widely adopted as an appropriate alternative. The reliance on living kidney donors however, raises a number of social, ethical, and legal concerns surrounding informed consent, voluntarism, psychosocial evaluation, perioperative care, and long-term follow-up of the donors. Many of these concerns become heightened in a multicultural, multilingual society such as Qatar, the study says."

Tuesday, September 12, 2017

Global kidney exchange and repugnance in the AJT: comments and replies

The forthcoming issue of the American Journal of Transplantation is going to have a number of conflicting views about Global Kidney Exchange (GKE).  Just as yesterday's post showed how Kidney Exchange faced some repugnance at the turn of this century, these interactions show that GKE will have to overcome some repugnance too. (I just returned from Geneva where I talked about GKE among other things, in an attempt to start bridging this divide.)


It all started with our article proposing GKE and reporting the case of a Philippine patient-donor pair, which came out in March, along with an accompanying editorial suggesting that maybe the whole idea is repugnant.

Here's the original article:

Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation
by M. A. Rees, T. B. Dunn, C. S. Kuhr, C. L. Marsh, J. Rogers, S. E. Rees, A. Cicero, L. J. Reece, A. E. Roth, O. Ekwenna, D. E. Fumo, K. D. Krawiec, J. E. Kopke, S. Jain, M. Tan, S. R. Paloyo
American Journal of Transplantation, Volume 17, Issue 3 March 2017, Pages 782–790

And here's the accompanying editorial:
Walking a Tightrope or Blazing a Trail?
by A. C. Wiseman, J. S. Gill


Here is our forthcoming reply to the editorial
Global kidney exchange: Financially incompatible pairs are not transplantable compatible pairs
M. A. Rees, S. R. Paloyo, A. E. Roth, K. D. Krawiec, O. Ekwenna, C. L. Marsh, A. J. Wenig and T. B. Dunn
Version of Record online: 1 SEP 2017 | DOI: 10.1111/








And here is a letter saying that GKE is essentially organ trafficking…

Francis L. Delmonico and Nancy L. Ascher
Accepted manuscript online: 21 AUG 2017 09:05AM EST | DOI: 10.1111/ajt.14473
·        Abstract  Article  PDF(63K)

And our replies:

You have free access to this content
People should not be banned from transplantation only because of their country of origin
Alvin E. Roth, Kimberly D. Krawiec, Siegfredo Paloyo, Obi Ekwenna, Christopher L. Marsh, Alexandra J. Wenig, Ty B. Dunn and Michael A. Rees
Accepted manuscript online: 1 SEP 2017 09:25AM EST | DOI: 10.1111/ajt.14485

  1. You have free access to this content
    Open dialogue between professionals with different opinions builds the best policy
    Ignazio R. Marino, Alvin E. Roth, Michael A. Rees and Cataldo Doria
    Version of Record online: 11 SEP 2017 | DOI: 10.1111/ajt.14484
  2. Here's the text of the Roth et al. letter:

"Previously [1,2], we described how a Filipino husband-and-wife patient–donor pair were included in an American kidney exchange.1,2 Delmonico and Ascher object in the strongest terms.3 They write that ethical Global Kidney Exchange (GKE) with patient–donor pairs from the developing world “is not feasible when the culture is so experienced with organ sales.”

Among the proposers of GKE are experienced surgeons and clinicians, a senior lawyer, and a veteran market designer. We take black markets with the utmost seriousness. That’s why the first GKE pair was started with a husband and wife. We think the right course of action is to proceed carefully, slowly at first, and with constant monitoring. The second GKE pair from Mexico were cousins cared for by Dr. Ricardo Correa-Rotter, a world-renowned nephrologist and signatory of the Declaration of Istanbul.4,5

We also take seriously long-term postoperative care for both patients and donors. That’s why we propose GKE in partnership with developing countries that already have some first-rate hospitals that perform living donor transplantation. Rees et al. describe how we coordinated care with the Philippine General Hospital and St. Luke’s Medical Center in Manila.2 We also provided an escrow fund for long-term continuing care. Ivan Carrillo describes our care of the donor and recipient in the second GKE and it is clearly celebrated by Mexican media as a beautiful way to help citizens of both Mexico and the United States.4,5

Kidney exchange (KE) itself is a relatively new “matching market,” of a kind that does not involve any payments to donors. It has been successfully launched in many countries, and proposals for international cooperation are underway.6 What makes KE special is that two or more patient–donor pairs help each other. What makes GKE special is that helping first-world patients get transplants saves money, because dialysis is so expensive, and these savings can benefit poor patients and donors in poor countries who would otherwise be unable to help themselves, but can participate in GKE for free.

Delmonico and Ascher propose that poor people with ESRD in poor countries, and the donors who love them, must all be regarded as potential criminals who would inevitably corrupt first-world medicine by being included in it. In the current political climate this is a bit like proposing a blanket ban on granting asylum to refugees from some countries. We do not adopt this point of view. On the contrary, GKE is a proposal that says there are many deserving patients who need our help, who we can help, and who can help us—if we invite them carefully and take care of them attentively.

Fear is not the path forward. Bold, careful innovation has led transplantation to where it is today, and remains our best collective future.

Disclosure The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

References
1. Rees MA, Paloyo S, Roth AE, et al. Global Kidney Exchange: Financially Incompatible Pairs Are Not Transplantable Compatible Pairs. Am J Transplant. 2017;17:782-90.
2. Rees MA, Dunn TB, Kuhr CS, et al. Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation. Am J Transplant 2017;17:782-90.
3. Delmonico FL, Ascher NL. Opposition to Irresponsible Global Kidney Exchange. Am J Transplant 2017;17:IN PRESS THIS ISSUE.
4. A bridge of life: Global kidney exchange between Mexico and the U.S. (Accessed 8/23/2017, at http://marketdesigner.blogspot.com/2017/04/a-bridge-of-life-global-kidney-exchange.html.)
5. Carrillo I. Un puente de vida (English Translation: A bridge of life). Newsweek en Español 2017 April 14, 2017:16-25.
6. Biró P, Burnapp L, Haase B, et al. Kidney Exchange Practices in Europe, First Handbook of the COST Action CA15210: European Network for Collaboration on Kidney Exchange Programmes (ENCKEP)2017.
**********

Today I'm in D.C. at a meeting of NLDAC, the National Living Donor Assistance Center.







Monday, September 11, 2017

Kidney exchange in Switzerland in 1999, and some early repugnant reaction

Kidney exchange is well established and growing in Europe today, but the first exchange was greeted in some quarters as a repugnant transaction.

The first kidney exchange in Europe was actually an international exchange, involving a German couple and a Swiss couple. It was conducted in Basel on May 23rd 1999, and reported in

G. Thiel, P. Vogelbach, L. Guerke, T. Gasser, K. Lehmann, T. Voegele, A. Kiss, and G. Kirste  ”Crossover renal transplantation: hurdles to be cleared!”, Transplant Proc , 2001

They report that
"The Swiss Health Insurance paid the hospital bill without hesitation. The German insurance, however, refused to pay, despite the fact that the cost (including donor nephrectomy) was lower in Basel than cadaveric transplantation alone would have been in Germany and despite huge savings for the German insurance by being released from further payments for dialysis treatment. The insurance agency argued that crossover transplantation is not allowed in Germany, and that they would not pay for an illegal procedure. …Crossover transplantation is legal in Switzerland”

Following the publication of the paper, press coverage reflected a good deal of repugnance for kidney exchange and criticized the German surgeon Prof Dr. Gunter Kirste (with whom I have discussed these matters prior to my recent talk in Geneva). Muriel Niederle pointed me to this story from Der Spiegel 12.02.2001: “[Opening the] Door to Commerce”



Here's another, from the Suddeutsche Zeitung, also in 2001, kindly supplied by Dr. Kirste, which compares kidney exchange to organ trafficking: "Organs of a Travelling Salesman"



Sunday, September 10, 2017

Why don't museums sell art (except to buy more art)?

Brian Frye over at the Faculty Lounge published three nice posts about the professional repugnance that art museums have about selling art.

Here's the first:
Are Deaccessioning Norms Ethical?

It's about the rules that associations of art museums have to prevent museums from selling art. It's a professionally repugnant transaction.
 He argues that it's a way to make sure that capital gains on the secondary market accrue only to private collectors...

And here's the second:
Watching the Deaccessioning Police
"One of the biggest stories in the art world this week is the Berkshire Museum's plan to "deaccession" (read "sell") 40 artworks from its "permanent collection" worth about $50 million, in order to pay for renovations and shore up its endowment. The museum plans to auction at Sotheby's works by Norman Rockwell, Frederic Church, Albert Bierstadt, Alexander Calder, and Charles Wilson Peale, among other artists."
...
"Predictably, the deaccessioning police went ballistic. The American Alliance of Museums (AAM) and the Association of Art Museum Directors (AAMD) issued a joint statement saying they are “deeply opposed to the Berkshire Museum’s plans to sell works from its collection to provide funds for its endowment, to make capital investments, and to pay for daily operations.” The AAM and AAMD also noted that their "ethical" codes prohibit museums from selling artworks in order to cover operating costs. And their art world allies piled on, with perennial deaccessioning critics like Lee Rosenbaum lamenting the museum's decision."


And the third:
Deaccessioning Police Redux
"Predictably on cue, the "deaccessioning police" have raised their usual hue and cry. One of loudest voices in the claque is Christopher Knight of the LA Times, who has now gone "full nihilist" on deaccessioning. As Donn Zaretsky of the Art Law Blog observed, Knight's most recent column takes the anti-deaccessioning position to its inevitable reductio ad absurdumendpoint:
Here’s an idea: Don’t sell the art. Do close the museum. Start behaving like the charitable institution you are supposed to be. Spend the next several years responsibly overseeing the dispersal of the collection.
To paraphrase: "We had to destroy the museum in order to save it." 
***********
See this earlier post of mine, concerning university museums:

Tuesday, August 9, 2016



Saturday, September 9, 2017

The Nephrology fellowship match

Nephrology is a subspecialty that has required fellowship programs to participate in the match ("All In")

Perspectives on the Nephrology Match for Fellowship Applicants

  1. for the ASN Match Committee
    1. "
    2. In recent years, there has been a marked decline in applicants to United States nephrology programs (1). Although a multipronged approach is clearly needed to increase interest in nephrology, it is important that we ensure that our applicants/future colleagues are treated in the most fair and equitable manner possible, and we believe that 100% participation in the National Residency Matching Program (NRMP) is vitally important to achieving that goal. In this perspectives article, we will briefly review the evolution of the Match since it was implemented for appointment year (AY) 2009, the successes achieved, and the challenges ahead."

Friday, September 8, 2017

The Medical Physics Residency Match

Kristi R. G. Hendrickson, Titania Juang, Anna Rodrigues, Jay W. Burmeister
Journal of Applied Clinical Medical Physics
First published: 20 August 2017 DOI: 10.1002/acm2.12135   

"Thirteen percent of 2015 respondents and 20% of 2016 respondents were asked by at least one program how highly they planned to rank them or which program they would rank first. Thirty-seven percent of 2015 and 40% of 2016 program directors indicated that candidates communicated to the program their rank intent, with 22.0% in 2015 and 12.5% in 2016 being told that their program would be ranked first. Twenty-three percent of 2015 respondents indicated being asked by at least one program during the interview about children or plans to have children; including 19% of males and 33% of females. In 2016, these values were 28% overall, 22% male, and 36% female. Fifty-seven percent of 2015 respondents who were asked this question indicated being uncomfortable or very uncomfortable answering, including 27.3% of males and 88.9% of females. In 2016, 42.9% of all respondents indicated being uncomfortable or very uncomfortable answering, including 10.0% of males and 80.0% of females.
***********
See also the editorial in the same journal: The Dark Side of the MedPhys Match
by John A. Antolak PhD, Timothy D. Solberg PhD

**********

Here are earlier posts on the medphysics fellowship match, and radiation oncology.

Thursday, September 7, 2017

U.S. transplant patients from overseas

Here's a paper presented at the ISODP meeting in Geneva, concerning which foreign patients receive deceased-donor organs in the U.S.   Bottom line, there are fewer than 1% of transplants going to foreign patients.  Half of them go to patients from Saudi Arabia and Kuwait.
Abstract
Transplant Tourism into the United States
Francis L. Delmonico1, Timothy Pruett2, Gabriel M. Danovitch3, Nancy L. Ascher4.
1Chief Medical Officer, New England Donor Services, Waltham, MA, United States; 2Chief Division of Transplantation, University of Minnesota, Minneapolis, MN, United States; 3Department of Nephrology, University of California Los Angeles, Los Angeles, CA, United States; 4Division of Transplant Surgery, University of California San Francisco, San Francisco, CA, United States
Introduction: Since 2012, the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) has required transplant centers to record the country residence of every patient undergoing transplantation in the United States. This policy replaced the quota 5% limit of non-US citizen/non-residents (NC/NR) traveling to the US for the purpose of transplantation.
Methods: Since April 1, 2015 the country of residence for the NC/NR on the wait list has also been recorded. The citizenship data of the candidate listed for transplantation was obtained from the Transplant Center Registrations (TCR) forms. These data excluded registrations of patients removed the wait list following living donor transplantation.
Results: Between April 1, 2015 and May 31, 2016, there were 42,754 waitlist additions for kidney transplantation, 551 of whom were NC/NR. Of the 14,394 waitlist additions for liver transplantation there were 191 NC/NR. The most NC/NR registrations for kidney and liver combined were from Saudi Arabia (70 total, 15 kidney and 55 liver) and Kuwait (37 total, 15 kidney and 22 liver).
Of the 14,798 kidney transplants performed from deceased organ donors there were 163 NC/NR. Of the 8168 liver transplants performed from deceased organ donors there were 124 NC/NR. 49% of the NC/NR patients undergoing liver and kidney transplantation were from Saudi Arabia and Kuwait. 7% of the kidney and 20% of the liver allografts from deceased donors were allocated to NC/NR children. There were 44 NC/NR that were removed from the list because of death or severity of illness (21 kidney and 23 liver).
A tabulation of the wait list duration, MELD score, UNOS Regions, and transplant centers that performed NC/NR transplants will be presented. The severity of illness of the wait listed candidates and the mortality rate of patients awaiting transplants in the specific UNOS region should be addressed.
Conclusions: Since the adoption of the transparency policy, < 1% of waitlist additions and < 1% of transplants have been NC/NR recipients. However, there is a disproportionate representation from 2 Middle East Countries. Review of NC/NR data is intended to promote public trust and the US to be model for the WHO principle of transparency.
References:
[1] Organ transplantation for nonresidents of the United States: a policy for transparency. Glazier AK, Danovitch GM, Delmonico FL. Am J Transplant. 2014 Aug;14(8):1740-3.

Wednesday, September 6, 2017

Organ Donation in Geneva

I'll be attending the 2017 Organ Donation Congress of the International Society for Organ Donation and Procurement, September 6-7 in Geneva.

Here's the program and the list of plenary and keynote speakers.

I'll be speaking on Thursday,September 7, on the ongoing design of kidney exchange.

Tuesday, September 5, 2017

UNOS proposal: Allowing Deceased Donor-Initiated Kidney Paired Donation (KPD) Chains

Earlier I posted about our 2016 paper proposing that some kidney exchange nondirected donor chains be started with deceased donor kidneys.
Melcher, Marc L., John P. Roberts, Alan B. Leichtman, Alvin E. Roth, and Michael A. Rees, “Utilization of Deceased Donor Kidneys to Initiate Living Donor Chains,” American Journal of Transplantation, 16, 5, May 2016, 1367–1370. http://onlinelibrary.wiley.com/doi/10.1111/ajt.13740/full

Now UNOS has put out a proposal for public comment.  Here's the proposal

Allowing Deceased Donor-Initiated Kidney Paired Donation (KPD) Chains

Here's the request for comments:
Deceased donor initiated KPD chains      Public Comment  

Monday, September 4, 2017

Scott Kominers' Market design course at Harvard

http://scottkom.com/courses/Market-Design_2017-2018/index.html
DateTopicGuest(s)
September 5, 2017Introduction/Overview
September 12, 2017The Market Designer's Toolbox
September 19, 2017Food Supply, Scrip Systems,
and Pseudo-Markets
September 26, 2017School ChoiceParag Pathak
October 3, 2017Signaling in Matching Markets
October 10, 2017Internet MarketsBen Edelman, Andrey Fradkin
October 17, 2017Auction TheoryShengwu Li
October 24, 2017The US Spectrum Incentive Auction
October 31, 2017Organ AllocationCarmen Wang
November 7, 2017Refugees, Immigration, and
Economic Development
Ilya Vidrin
November 14, 2017Markets for Intellectual Property
November 21, 2017New HorizonsRavi Jagadeesan, David Parkes,
Ben Roth, Utku Ünver
November 28, 2017Student Talks/Course Wrap
Internal Harvard Website:
https://canvas.harvard.edu/courses/29888/.

Sunday, September 3, 2017

The Iranian kidney market--Associated Press

The Associated Press has a nice story on the Iranian market in which donors can be compensated for kidneys. Here's the version in the Denver Post

In Iran, unique system allows payments for kidney donors

Some interesting paragraphs:

"Iran started kidney transplants in 1967 but surgeries slowed after the 1979 Islamic Revolution and the storming of the U.S. Embassy in Tehran, in part due to sanctions. Iran allowed patients to travel abroad through much of the 1980s for transplants — including to America. But high costs, an ever-growing waiting list of patients and Iran’s grinding eight-year war with Iraq forced the country to abandon the travel-abroad program.

"In 1988, Iran created the program it has today. A person needing a kidney is referred to the Dialysis and Transplant Patients Association, which matches those needing a kidney with a potential healthy adult donor. The government pays for the surgeries, while the donor gets health coverage for at least a year and reduced rates on health insurance for years after that from government hospitals.

"Those who broker the connection receive no payment. They help negotiate whatever financial compensation the donor receives, usually the equivalent of $4,500. They also help determine when Iranian charities or wealthy individuals cover the costs for those who cannot afford to pay for a kidney.

"Today, more than 1,480 people receive a kidney transplant from a living donor in Iran each year, about 55 percent of the total of 2,700 transplants annually, according to government figures. Some 25,000 people undergo dialysis each year, but most don’t seek transplants because they suffer other major health problems or are too old.

"Some 8 to 10 percent of those who do apply are rejected due to poor health and other concerns. The average survival rate of those receiving a new kidney is between seven to 10 years, though some live longer, according to Iranian reports.
...

"Poverty around the world drives black market kidney sales, a lucrative business the World Health Organization estimated represented at least 5 percent of all transplants in 2005, though it acknowledges that figure is only a guess. The U.N. health agency’s guiding principles on organ transplantation call for banning organ sales, though it allows for “reimbursing reasonable and verifiable expenses,” including the loss of income by a living donor."