Sunday, July 15, 2018

Kidney exchange is fragmented in the U.S.


Market Failure in Kidney Exchange

Nikhil AgarwalItai AshlagiEduardo AzevedoClayton R. FeatherstoneÖmer Karaduman

NBER Working Paper No. 24775
Issued in June 2018

Abstract: "We show that kidney exchange markets suffer from traditional market failures that can be fixed to increase transplants by 25%-55%. First, we document that the market is fragmented and inefficient: most transplants are arranged by hospitals instead of national platforms. Second, we propose a model to show two sources of inefficiency: hospitals do not internalize their patients’ benefits from exchange, and current mechanisms sub-optimally reward hospitals for submitting patients and donors. Third, we estimate a production function and show that individual hospitals operate below efficient scale. Eliminating this inefficiency requires a combined approach using new mechanisms and solving agency problems."

Here's a key sentence:
"The three largest multi-hospital platforms together only account for a minority share of the kidney exchange market. 62% of kidney exchange transplants are within hospital transplants that are not facilitated by the NKR, APD or UNOS. Moreover, over 100 hospitals performed kidney exchanges outside these three platforms during this period."

Saturday, July 14, 2018

Jason Furman buys books when they're on sale

Here's a recent book review of my (2015) book that caught my eye, posted by Ismail Ali Manik, which begins with this tweet:
 Random Book recommendation — Who Gets What and Why: The New Economics of Matchmaking and Market Design

You might want to read the book yourself, and in any event there is an interesting selection of quotes, and then links to a bunch of videos, at the link above.

Friday, July 13, 2018

One kidney donor's journey

I recently heard the following story, by email from a recent kidney donor, who has given me permission to share it. It's lightly edited to preserve her privacy and mine, but I can't resist noting that her first name is Hope.

"Dear Professor Roth,

"Seven weeks ago today, I donated a kidney to a stranger in Minnesota.  Mayo Clinic sent me his email address this afternoon, just in case I want to contact him.  I'm not sure yet if I want to initiate communication but I certainly can't stop thinking about it.  It made me think about the Freakonomics episode I heard three years ago that started everything.  You know the one...

"When I heard the episode, I knew right away I wanted to become a living kidney donor.  I was 49 at the time. I never had children and my life felt incomplete.  Moreover, I lost my mother to cancer after a long battle, when I was just 14 years old.  I daydreamed about helping a child who had a sick parent so she doesn't have to go through what I went through. 

"My wife's cousin needed a kidney shortly after the episode aired.  I asked her if it was ok if I stepped up.  I played her the Freakonomics episode and she approved.  I reached out to her cousin Rick.  It turns out a few people volunteered and he got a direct match.  I felt defeated, which sounds selfish after such good news.  Then I heard a follow up episode that united a donor with his recipient.  Stephen Dubner was crying... I was crying... I called Mayo Clinic the next morning and signed up for testing.

"The rest is a long story and I know you are a busy man so I'll skip most of it.  I ended up being part of a pair, instead of an altruistic donor.  There was a man who worked with my wife that needed a kidney.  He once saved her life with the Heimlich maneuver so it was pretty poetic that I could save his.  He received his kidney from a bridge donor and I gave mine to someone on the diseased donor list.  So I got to save two lives!  I'm doing great.  I went back to work a couple of weeks ago.  I have no regrets and I hope I can inspire others to do something selfless and extraordinary in their lifetime. 

"I hope others have written to you.  I'm sure you see the statistics and know the impact of what you created with paired kidney donation.  I just wanted to make sure you hear some personal stories.  Life changing stories..."

A subsequent email exchange clarified some details:

"Hi Al!  I did all of my testing in May of 2016 to be a non-directed donor. I tested positive for Valley Fever and had to wait 90 days to be retested. The 2nd test was negative and I was approved but I was getting married in October so we put a hold on the donation. Mark came into the picture after that. He didn’t know about paired donation. We got him to switch to Mayo and we became a pair. He had lots of complications so I had to wait a long time. When he was finally approved, so much time had passed that I had to do most of the testing all over again. It took awhile to find me a match because I’m AB+. 

So a false positive Valley Fever test got Mark a kidney. 

I met Mark the day of his surgery. My wife and I were the first faces he saw. He was there the day of mine. He brought me flowers and a card from his kids. 

My team at Mayo Clinic were there for me the whole time. There was never any pressure and changing from non-directed to paired was seamless. They never discussed Mark. He had his own team. I was allowed to chicken out at any time. But I’ve never been so sure of anything in my life."
***********

And here are my posts linking to the Freakonomics shows that gave people so much of Hope.

Thursday, June 18, 2015

and this one (from huffingtonpost.com):

Saturday, May 6, 2017

Thursday, July 12, 2018

A television interview on kidney exchange in Mexico (video)

Here's a short video that ran on Mexican tv, with a one minute introduction in Spanish, and then 11 minutes in English with Spanish subtitles. Curiously, the recording ends abruptly just as I started to talk about the 1974 paper of Shapley and Scarf...:)





Here is an earlier post about my recent visit to Mexico:

Tuesday, May 22, 2018


Forbes Health Forum in Mexico City, May 23

Thursday, May 31, 2018

Kidney exchange takes another step forward in Mexico: Pro-Renal

Wednesday, July 11, 2018

The June issue of the newsletter of the ACM E-commerce group is devoted to market design. You can read them at the links below:

June, 2018



HT: Scott Kominers

Tuesday, July 10, 2018

Capitalisn't conversation on kidneys and repugnance with Luigi Zingales and Kate Waldock

Here's a podcast and transcript of a conversation I had recently  with Kate Waldock and Luigi Zingales on the Chicago Booth Capitalisn't show, about kidney exchange, repugnant transactions and more:  Capitalisn’t: Abdomenable Transactions





The closing interaction between Luigi and Kate seemed to me to capture something important about compensation for donors, and maybe about repugnance:

Luigi: Al is a great guy. His contribution is extremely important for economics but more importantly, is also very important for humankind. However, listening to his discussion and listening to how complicated it is to do these matches even with his algorithm and how many people are left out, the question arises: Why don’t we pay for people to donate an organ? Of course, not your heart because it means that you are killing yourself, but what about a kidney? People can very happily live without a kidney. If they’re willing to donate a kidney for money, why is it so wrong?
Kate: Luigi, how much money would you have to be paid to sell your kidney?
Luigi: Wow, that’s a good question because I would give a kidney to my wife and my kids, but I don’t think I would sell it for money.
Kate: All right. Fair enough. I’m not sure there’s a price that I would accept either. "

Monday, July 9, 2018

Explaining plasma donation

In recent posts I've commented on the repugnance (in Canada and elsewhere) to paid plasma donation, which is legal in the U.S.. (The U.S. consequently supplies much of the world's plasma needs.)  One question facing the plasma industry is how to defend against compensated plasma donation being seen as a repugnant transaction.

I think they are already very well equipped to communicate the need for plasma proteins, which provide treatments for a host of diseases, and which are used around the world.  But to the extent that (paid or unpaid) donation needs to be defended and encouraged, I would expect to see more stories like this one, from Australia.

This man's blood has saved 2.4 million babies
'I'd keep going if they let me,' says 81-year-old with magical plasma.


"The man with the golden arm
"Harrison's blood is valuable because he naturally produces Rh-negative blood, which contains Rh-positive antibodies. His blood has been used to create anti-D in Australia since 1967.

"Every ampule of Anti-D ever made in Australia has James in it," Robyn Barlow, the Rh program coordinator who recruited Harrison, told the Sydney Morning Herald. "Since the very first mother received her dose at Royal Prince Alfred Hospital in 1967."
Harrison was the program's first donor.

"It's an enormous thing ... He has saved millions of babies. I cry just thinking about it."
Since then, Harrison has donated between 500 and 800 milliliters of blood almost every week. He's made 1,162 donations from his right arm and 10 from his left.

...
Harrison's retirement is a blow to the Rh treatment program in Australia. Only 160 donors support the program, and finding new donors has proven to be difficult. Additionally, attempts to create a synthetic version of anti-D have failed."