Successful birth in Brazil to a woman who received a uterus transplanted from a deceased donor

The Lancet reports the first known case of a live birth to a woman born without a uterus who received a transplanted uterus from a deceased donor.

Livebirth after uterus transplantation from a deceased donor in a recipient with uterine infertility

December 04, 2018 DOI:https://doi.org/10.1016/S0140-6736(18)31766-5

Background

Uterus transplantation from live donors became a reality to treat infertility following a successful Swedish 2014 series, inspiring uterus transplantation centres and programmes worldwide. However, no case of livebirth via deceased donor uterus has, to our knowledge, been successfully achieved, raising doubts about its feasibility and viability, including whether the womb remains viable after prolonged ischaemia.

Methods

In September, 2016, a 32-year-old woman with congenital uterine absence (Mayer-Rokitansky-Küster-Hauser [MRKH] syndrome) underwent uterine transplantation in Hospital das Clínicas, University of São Paulo, Brazil, from a donor who died of subarachnoid haemorrhage. The donor was 45 years old and had three previous vaginal deliveries. The recipient had one in-vitro fertilisation cycle 4 months before transplant, which yielded eight cryopreserved blastocysts.

Findings

The recipient showed satisfactory postoperative recovery and was discharged after 8 days' observation in hospital. 

...

The female baby weighed 2550 g at birth, appropriate for gestational age, with Apgar scores of 9 at 1 min, 10 at 5 min, and 10 at 10 min, and along with the mother remains healthy and developing normally 7 months post partum. The uterus was removed in the same surgical procedure as the livebirth and immunosuppressive therapy was suspended.

*************

In Brazil (where commercial surrogacy is apparently illegal, and legal surrogates must be family members of the intended mother), the urge to have one's own baby is nevertheless strong. 

See earlier post:

Wednesday, January 15, 2014

Womb transplants in Sweden (where surrogacy is illegal)

Kidney exchange looks imminent in Sweden

Dagens Medicin (Today's Medicine) has the story:

Nytt koncept ska ge fler en ny njure
Snart startar ett nytt utbytesprogram av njurar som sträcker sig över hela Sverige. 
(GT: New concept will give more a new kidney
Soon a new kidney replacement program will start all over Sweden.)

"The exchange program has shown good results in other countries, so expectations are high, says Per Lindnér, Senior Assistant and Operations Manager at Transplant Center at Sahlgrenska University Hospital in Gothenburg.

"He is one of the initiators of the first Swedish renal exchange program. It can easily be described as a database matching system that couples potential donors and recipients within renal donation.
...
"Today, all of the country's centers for kidney transplants participate, that is, Sahlgrenska University Hospital, Karolinska University Hospital, Academic Hospital and Skåne University Hospital.

- Even hospitals in Norway and Denmark want to connect. But the idea is to start nationally and expand over time, "says Per Lindnér.
...
"The idea of ​​a national exchange program was born three years ago when Per Lindnér visited a seminar with Tommy Andersson, professor of discreet mathematics at Lund University.

Tommy Andersson talked about the mathematical background of an American renal exchange program created by Alvin Roth, former winner of Sveriges Riksbank's award in economics, to Alfred Nobel's memory.

When Per Lindnér wanted to introduce the same concept in Sweden, Tommy Andersson contributed with his knowledge, which forms the basis for the program."

MD4SG Colloquium: (Market Design for Social Good): tomorrow (updated with a video)

I'll be speaking in the MD4SG Colloquium Series, online, tomorrow, Thursday, December 13th, 12-1:30 PM EST. 

Date: Thursday, December 13th, 12:00-1:30 PM EST
Link: https://www.youtube.com/watch?v=ku-ZRSB82SU. 

Market design is more complicated than mechanism design. And so is achieving good social outcomes.

Marketplaces are often small parts of large markets, and so potential marketplace participants may have large strategy sets, that include actions taken outside of the marketplace. And markets require social support, so the behavior of people who do not intend to participate in the market may nevertheless be important for market design. This talk will illustrate these points with some examples, drawing on experience from the design of school choice systems and kidney exchange clearinghouses.

*********

Update: here it is

The (private equity) market for dermatologists

Dermatology is a lucrative part of medicine, and private equity firms are buying medical practices, which has led to an unusual quarrel in the Journal of the American Academy of Dermatology, involving corporate interests.

The NY Times has the story:
Why Private Equity Is Furious Over a Paper in a Dermatology Journal

"Early this month, a respected medical journal published a research paper on its website that analyzed the effects of a business trend roiling the field of dermatology: the rapid entrance of private equity firms into the specialty by buying and running practices around the country.

"Eight days later, after an outcry from private equity executives and dermatologists associated with private equity firms, the editor of the publication removed the paper from the site.
...
"Dermatologists account for one percent of physicians in the United States, but 15 percent of recent private equity acquisitions of medical practices have involved dermatology practices. Other specialties that have attracted private equity investment include orthopedics, radiology, cardiology, urgent care, anesthesiology and ophthalmology.
...
"This week a lawyer for Advanced Dermatology and Cosmetic Surgery, which is backed by private equity and is the largest dermatology practice in the United States, called the general counsel at the University of Florida, where two of the authors are employed, demanding specific changes to the paper."

Self regulation of black markets on the dark web?

Here's an interesting story from the Guardian, about some dark-web black markets in the U.K. banning fentanyl, as too deadly and (hence) too likely to attract vigorous police attention:

Dark web dealers voluntarily ban deadly fentanyl
Suppliers, fearing police crackdown, decide opioid is too high-risk to trade

"Major dark web drug suppliers have started to voluntarily ban the synthetic opioid fentanyl because it is too dangerous, the National Crime Agency has said.

"They are “delisting” the high-strength painkiller, effectively classifying it alongside mass-casualty firearms and explosives as commodities that are considered too high-risk to trade.
...
"Vince O’Brien, one of the NCA’s leads on drugs, told the Observer that dark web marketplace operators appeared to have made a commercial decision, because selling a drug that could lead to fatalities was more likely to prompt attention from police.

"It is the first known instance of these types of operators moving to effectively ban a drug.
...
"O’Brien said that the NCA is working with US law enforcement agencies to prevent the UK from having a similar fentanyl epidemic, though the number of people dependent on opioids in the UK compared to America means it has a much smaller market."

Gabriel Weintraub's class on online marketplaces at Stanford GSB (winter quarter)

Gabriel Weintraub writes:

I am sharing this information in case some of you are interested on this new half-quarter PhD course I will be teaching this coming Winter:

OIT 648: Empirics of Online Markets
In this course we cover current research on the empirics of platforms and online marketplaces. We will study diverse topics relevant to the design of these markets such as search and matching, review and reputation systems, demand estimation, and pricing. We will do so in the context of different application domains such as rentals, sharing, e-commerce, labor markets, and advertising. The course will be eclectic in terms of approaches, using reduced-form and structural econometrics, machine learning, and experimentation. The course will mostly consist of recent papers presented by the instructor, guests, and students. Some background knowledge required to understand current work will be provided as needed.

The course will meet on the following Mondays between 3:30 and 6:20PM: 

- Mon. Feb 4

- Mon. Feb. 11

- Mon. Feb. 25
- Mon, Mar 4
- Mon. Mar 11
- Fri. Mar. 15

School choice, an overview by the Center for American Progress

The Center for American Progress, a DC think tank, reviews school choice:
Expanding Access to High-Quality Schools
Implementing School Choice Algorithms

From the introduction:

"According to a 2017 analysis by the Brookings Institution, the proportion of large school districts that offered school choice doubled from 2000 through 2016.1 As a result, of the more than 50.1 million students nationwide who attended public schools over the 2015-16 school year, more than 2.8 million students attended public charter schools, and more than 2.6 million students attended magnet schools. Additional students attended other types of public schools of choice, such as those with specialty or thematic programs.
...
"A centralized system can simplify enrollment for both families and schools. Students apply through a single application, ranking a list of schools that they would like to attend and receiving a single offer to one of their preferred schools. However, system design matters when it comes to centralized enrollment. Depending on how a district assigns an offer for each student, some families can unfairly manipulate the system to make it more likely that their child secures a seat at a more in-demand, usually better-performing school.

To reduce this risk of strategic manipulation in centralized enrollment systems, Atila Abdulkadiroglu, Parag Pathak, Alvin E. Roth and Tayfun Sönmez—economists with expertise in game theory and market design—proposed a solution. They designed two fair and efficient matching algorithms—or a set of rules and calculations—to ensure that, given the preferences of all other students and schools in the system, each student receives a single offer with his or her best possible school match. Specifically, the economists designed two matching algorithms suitable for centralized assignment: deferred acceptance (DA) and top trading cycles (TTC)."