Saturday, April 18, 2015

Kidney exchange in Switzerland

Here's a paper reviewing kidney exchange around the world, from an Australian perspective (Paolo Ferrari has been one of the Australian pioneers), and advocating for a national kidney exchange program in Switzerland...

Kidney paired donation: a plea for a Swiss National Programme

Karine Hadayaa,b, Thomas Fehrc, Barbara RĂ¼sic, Sylvie Ferrari-Lacrazd, Jean Villardd, Paolo Ferrarie,f
a Service of Nephrology. Geneva University Hospital, Geneva, Switzerland
b Service of Transplantation, Geneva University Hospital, Geneva, Switzerland
c Service of Nephrology and Histocompatibility laboratory, Zurich University Hospital, Switzerland
d Transplant Immunology Unit and National Reference Laboratory for Histocompatibility (LNRH), Division of Immunology, Allergy and Laboratory Medicine, Geneva, Switzerland
e Department of Nephrology, Prince of Wales Hospital and Clincal School, University of New South Wales, Randwick, Sydney, Australia
f Organ and Tissue Authority, Australia


Growing incidence of end-stage renal disease, shortage of kidneys from deceased donors and a better outcome for recipients of kidneys from living donor have led many centres worldwide to favour living donor kidney transplantation programmes. Although criteria for living donation have greatly evolved in recent years with acceptance of related and unrelated donors, an immunological incompatibility, either due to ABO incompatibility and/or to positive cross-match, between a living donor and the intended recipient, could impede up to 40% of such procedures. To avoid refusal of willing and healthy living donors, a number of strategies have emerged to overcome immunological incompatibilities. Kidney paired donation is the safest way for such patients to undergo kidney transplantation. Implemented with success in many countries either as national or multiple regional independent programmes, it could include simple exchanges between any number of incompatible pairs, incorporate compatible pairs and non-directed donors (NDDs) to start a chain of compatible transplantations, lead to acceptance of ABO-incompatible matching, and integrate desensitising protocols. Incorporating all variations of kidney paired donation, the Australian programme has been able to facilitate kidney transplantation in 49% of registered incompatible pairs. This review is a plea for implementing a national kidney paired donation programme in Switzerland.
Swiss Med Wkly. 2015;145:w14083

Friday, April 17, 2015

Are firearms becoming a protected transaction on college campuses?

Inside Higher Ed has the story, on the clash when a transaction that some regard as repugnant is regarded as protected by others:  Momentum for Campus Carry

"At least 11 states are considering whether to allow concealed weapons on college campuses this year, the latest chapter in a now seemingly annual legislative debate between gun control advocates and gun rights supporters.

"Bills have been introduced, at least once, in almost half of the 50 states in the past few years. Despite slow success thus far -- just seven states have adopted versions of campus carry laws -- gun rights advocates have their eyes on two very large prizes this year: Florida and Texas.

"Right now, the odds are starting to stack up in their favor. The Texas bill has passed the Senate and is on its way to House. The version in Florida has passed through two Senate committees and is headed to the Judiciary Committee.
"Yet for all its familiarity, the idea of guns on campus is relatively novel. Campus carry was largely a nonissue a decade ago, when the University of Utah went to court to defend its autonomy and the related right to stay gun-free. A few years later, Oregon, Mississippi and Wisconsin began explicitly allowing guns on campus.

"In all, seven states have laws that allow concealed guns on campus, though the details vary on who can carry where. Twenty states still ban carrying a concealed weapon on a college campus, and 23 states leave the decision up to individual colleges."

Thursday, April 16, 2015

Uber and "safety by design"

I've written a lot about how marketplaces have to help markets become thick, deal with the congestion that can accompany thick markets, and make the market safe to participate in.  I just got a nice email from Uber illustrating how they are thinking about that third point, on the rider side of the market.

Drivers pass federal, multi-state, and county background checks before driving.
Extensive Screening
Uber prohibits drug or alcohol offenses, severe traffic violations, and sexual offenses.
From pick up to drop off, your ride is covered by a $1M commercial insurance policy.


Safe Pickups
The app pinpoints your location so you can request a ride from anywhere and wait safely.
Nobody’s A Stranger
Your driver's name, photo, and vehicle information appear in the app.
Disguised Phone Numbers
Communication between riders and drivers is anonymized to protect private phone numbers.


Always On The Map
The GPS-enabled map provides your driver's location and trip details in real-time.
Share My ETA
Share your ETA with friends and family to keep track of your ride and safe arrival.
Hassle-Free Payments
Your credit card is on file so you never need to carry cash or stop at an ATM.


Actionable Feedback
You rate your experience after every trip and drivers do the same.
Trip History
After each ride, you receive a detailed email receipt with trip route, driver name, and total fare.
24/7 Support
Lose something? Have questions? Contact our 24/7 customer support.

Wednesday, April 15, 2015

Food trucks trade assigned spaces in Washington DC

D.C. food trucks look to new platform to swap spaces assigned in lottery

"It didn’t take long after D.C. started doling out parking spaces to the city’s food trucks that the D.C., Maryland and Virginia Food Truck Association hit on one unfailing principal of economics: Where one market pops up, a secondary market will surely follow.
Food truckers, after getting their assigned spaces in the city's mobile roadway vending zones each month, were frantically hitting up the association’s message board with requests to trade days. It made for way too many emails, and not a lot of successful trades.
So the DMVFTA decided to find a better way. Now, a few months later, the association is about to launch its very own digital trading platform on its website.
"Hoffman had a group of masters students who needed a final project. With her guidance, those students developed a proof-of-concept program that took into account the truckers’ preferences for trades and automatically assigned new slots. In the end, the program spits out a new schedule for assigned spots that can be submitted to the D.C. Department of Consumer and Regulatory Affairs, so they are able to enforce the assignments."

HT: Paul Milgrom

Tuesday, April 14, 2015

Commerce and peer review: pay for speed?

Science has the story (and science is the story):
Editor quits journal over pay-for-expedited peer-review offer

"With a tweet yesterday, an editor of Scientific Reports, one of Nature Publishing Group’s (NPG’s) open-access journals, has resigned in a very public protest of NPG’s recent decision to allow authors to pay money to expedite peer review of their submitted papers. “My objections are that it sets up a two-tiered system and instead of the best science being published in a timely fashion it will further shift the balance to well-funded labs and groups,”
"The flap shines a light on a fledgling industry where several companies are now making millions of dollars by privatizing peer review. This niche is being exploited because journal peer review is usually a slow process. After all, it is typically an anonymous, volunteer effort for which scientists receive nothing more than thanks from journal editors and the good feeling of contributing to the scientific community. But for a price at some journals, authors now have the option of fast-tracking their submitted papers through an accelerated peer-review process.

NPG announced earlier this week that it was trying out the peer-review service, called Rubriq, provided by Research Square, a company based in Durham, North Carolina. For a $750 payment to NPG, authors are guaranteed a review within 3 weeks or they get their money back. NPG declined to say how much of that money goes to Research Square.

How does the company perform such quick reviews? “We have about 100 employees with Ph.D.s,” says Research Square’s CEO, Shashi Mudunuri. That small army of editors recruits scientists around the world as reviewers, guiding the papers through the review process. The reviewers get paid $100 for each completed review. The review process itself is also streamlined, using an online “scorecard” instead of the traditional approach of comments, questions, and suggestions. The company also offers services directly to authors, saying it can help them improve papers and find placement with a journal. Business is bustling for Research Square. So far, Mudunuri says, the company has about 1400 active reviewers who have scored 920 papers. The company pulled in $20 million in revenue last year. Mudunuri declined to name the other publishers with which the company has cut deals"

Monday, April 13, 2015

A problem for the NRMP that may be growing

I've had correspondence and conversations with a number of residency program directors, about a common problem that may interfere with how safe they feel about rank-ordering residency and fellowship applicants according to their true preferences.

I'll quote from some emails without identifying the senders.

"I oversee the xxx residency match ....

"There is a terrible game that is going on in some surgical fields, though.  Program directors feel that it is prestigious not to go down their lists very far.  A program director may boast to his/her Chair, "This year we only needed to go down to #6 on our list to fill our (3) positions."  This ambition to not go down far on a list, as evidence that a program is highly desirable, is often achieved by pressuring candidates in the following way, "If you want to come here, you really need to let us know," which translates to "tells us we are your #1 and then you will have a chance to match here."  These actual or implied quid pro quos are a shame and pervert the intent of the match and your good work.  I know the NRMP considers them illegal or at least poor practices, but they are common, unfortunately."


"I work in xxx [non-surgical specialty], which is a specialty that is very competitive for the match.  Although the system that you helped develop should match applicants and residency programs based on the rankings that applicants and programs provide according to their independent preferences, some prestigious residency programs in xxx (and likely other specialties) are being evaluated by hospital presidents or other administrative officials by how far down the rank list they must go to fill their complement of residents.  This in turn has created an environment where some programs are ranking applicants according to the likelihood that the applicant will rank the program in the top slot rather than if they believe that the applicant is truly the best applicant for their program.  While I believe that each residency  program should be able to use whatever criteria they want to for ranking applicants, the problem is that some residency program directors or department chairs are contacting applicants or faculty at which the medical students train to find out if their program is at the top of the applicant’s rank list.  This puts the applicants in an awkward position and in my opinion likely biases the match result to hurt some applicants.

In an ideal world, such behavior by residency programs could be prevented by explaining that it violates the principles of the match.  However, I am afraid that this approach will be unlikely to remove the cause of this problem: pressure that some departments feel from administrators and hospital presidents."

Perhaps the community (directors and NRMP) could be persuaded that residency directors shouldn’t show their rank order lists to their deans and chairs?  

Sunday, April 12, 2015

Organ donors increase in California, as undocumented residents become eligible for driver's licenses

Organ donors increase in California

"BAKERSFIELD, Calif. (KBAK/KBFX) - There has been a recent hike in people registering as organ donors in California.

"Reports show that the increase just might be linked to AB 60, the new law helping undocumented residents obtain driver's licenses. More than 60,000 people have been added to the California organ and tissue donor registry, bringing it up 29 percent from the same time last year.

"Lori Malkin is the founder of JJ's Legacy, a local nonprofit group aimed at educating the community about the importance of becoming an organ donor.

"If you are registered donor, you can save and heal lives through organ, eye, and tissue donations," said Malkin.

She launched JJ's Legacy in honor of her son, Jeffery Johns.

"I am a donor mother. My son was killed in an automobile accident and died from a head injury," said Malkin. "He had the opportunity to donate all of his organs and his corneas and tissue. He enhanced and saved eight lives through organ donation, and he also enhanced and saved 58 lives through tissue and cornea donation."

How the United States Stacks Up to Other Countries in Chronic Kidney Disease, by Elisa Gordon

How the United States Stacks Up to Other Countries in Chronic Kidney Disease by Elisa Gordon, is full of links to useful data sources