Thursday, March 31, 2011

Boston Globe on school choice

The Boston Globe has a series of articles and videos on the Boston School choice system, and the experience of getting in, or not, to your first choice schools: GETTING IN: INSIDE BOSTON’S SCHOOL ASSIGNMENT MAZE.

Part of the message is that there aren't enough pre-K seats to fill the demand. And, as one parent points out, "the lottery is not the problem, the problem is that there are bad schools."

 Here are the articles so far, in reverse order of appearance (I make a 45 second appearance in the video in the "Relief..." story, starting just about minute 1:15...and then again for a moment right at the end, at 5:20):

Wednesday, March 30, 2011

Kim Krawiec reflects on organ donation

I recently gave a talk at Duke U. Law School, on my paper with Judd Kessler (who will be a professor at Wharton next year). In the law school manner, I didn't present the paper, but responded briefly to two discussants, Kim Krawiec and Kieran Healy, and then answered questions. It was a novel experience for me, and great fun. Both Kim and Kieran are well informed about organ donation and related matters, and gracious hosts.

Now Kim has posted some of her comments on The Faculty Lounge: Al Roth: The Pied Piper of Repugnance?

Tuesday, March 29, 2011

Report from the front on the war for talent

From a recent NY Times article on recruiting in Silicon Valley:

"Two executives at a small start-up who spoke on the condition of anonymity said it recently lost an intern when one of the biggest start-ups offered the candidate a 40 percent bump in stock options, potentially worth hundreds of thousands of dollars — but only if the candidate accepted the job before hanging up the phone.

“The atmosphere is brutally competitive,” said Keith Rabois, a Silicon Valley veteran and chief operating officer at Square, where Mr. Firestone works. “Recruiting in Silicon Valley is more competitive and intense and furious than college football recruiting of high school athletes.”
"Tech recruiters have also expanded their searches. They still scout college campuses, particularly Stanford’s computer science department, where this year it was common for seniors to receive half a dozen offers by the end of first semester. But since college degrees are not mandatory, recruiters are also going to computer coding competitions and parties, in search of talent that is reminiscent of the dot-com mania."

Does anyone know some talented high school PHP, Ruby and Python programmers? (Or maybe they are already teaching those things in kindergarten?)

Monday, March 28, 2011

Same sex marriage still a repugnant transaction in Maryland

Same-Sex Marriage Bill Falls Short in Maryland

"The speaker of Maryland’s Democratic-controlled House of Delegates, Michael E. Busch, said that the bill, the Civil Marriage Protection Act, had fallen short of the 71 votes required for passage and that Democrats had decided to withdraw it instead of holding a vote that would fail.

“This is a distance run, not a sprint,” Mr. Busch said. “We’ll come back next year and take a strong look at it.”

"The withdrawal capped a tumultuous few weeks, which began with the bill’s sponsors saying that its passage was all but assured and that Maryland would soon become the sixth state to legalize same-sex marriage.
"Two national groups that oppose same-sex marriage, the National Organization for Marriage and the Family Research Council, both highlighted African-American and religious opponents of the bill as central to its defeat.

Particular thanks must go to the African-American pastors, church members and delegates who spoke out against the attempted hijacking of the concept of ‘civil rights,’ ” the Family Research Council said in a statement.

"Democrats hold 98 of the House’s 141 seats, more than enough to overcome near-total Republican opposition, but ultimately about a third of all Democrats opposed it.
"The bill’s supporters would settle for no less than full marriage rights, as are legal in Connecticut, Iowa, Massachusetts, New Hampshire, Vermont and the District of Columbia. A Democrat’s proposal to make the bill about civil unions instead of marriage failed.

The law walks. It doesn’t run,” said Michael A. McDermott, a Republican who supported the civil union alternatiPost Optionsve. “You need to take it a step at a time.”

Sunday, March 27, 2011

Misc. kidney transplantation

In Texas, where everything is the biggest, the Texas Transplant Physician Group says they are the biggest "in Texas AND the United States."
"Our Living Paired Donor Kidney Transplant team made history in November, 2010, with the world's largest paired donor kidney transplant donor chain--with 16 transplants completed over three days. The 17th donor's "bridge" kidney was used to start another chain in December--extending the record-breaking chain to 23--still the largest single center kidney donor chain in the world! The kidney recipients ranged in age from 17 to 69 and all were transplanted with fully matched kidneys without the need for desensitization therapy. Dr. Adam Bingaman, Kidney and Pancreas Transplant Surgeon and Director of the Live Donor Kidney Transplant Program with Texas Transplant Physician Group is planning to extend the chain further in January, 2011.

"Read the local and national coverage this donor chain generated in our Kidney News section."


A story in the LA Times about a procedural error gives some insight into transplant procedures: Wrong patient got kidney at USC
"USC University Hospital halted kidney transplants last month after a kidney was accidentally transplanted into the wrong patient, according to a spokesman for the program that coordinates organ transplants in Los Angeles.

"The patient who received the wrong kidney escaped harm, apparently because the kidney happened to be an acceptable match, said Bryan Stewart, spokesman for the program, OneLegacy, which was notified of the error by the hospital.

"The hospital, which performs about two transplants a week, confirmed in a statement that it had voluntarily halted transplants Jan. 29 after a "process error" was discovered. The hospital did not detail the nature of the error and declined to answer questions. It said no patients were harmed.
"In general, immediately after a kidney is removed from a donor, it is placed in a plastic container with a screw-on lid. That container, labeled with an identification number, is then placed inside three sterile plastic bags, which are placed on ice in another container.

"The nurses in the operating room and the surgeon must check for the ID number on the kidney and compare that with the patient ID number," Klintmalm said.

"It is the operating room surgeon's responsibility to make sure the numbers match," he said. "You sign forms before you start the surgery."

Flip Klijn writes: "Recently, several towns in the Netherlands started discussing the possibility to ask citizens directly whether they are willing to sign a donor form (i.e., to give permission for organ transplants at the time of decease) when they visit the city hall to pick up a driver's license or a passport. In Amsterdam, both left-wing and right-wing political parties seem to agree that this is a good idea:!QfBmXR4HMGY/

(There are already similar proposals in Rotterdam and The Hague. And probably for the US this is not something new.) In another city (Breda) they stopped asking "because citizens apparently did not like to be asked" (according to the city hall):

Saturday, March 26, 2011

Marijuana in Montana and shark-fin soup in California

Two NY Times stories about repugnant markets caught my eye:

Soup Without Fins? Some Californians Simmer


In Montana, an Economic Boon Faces Repeal Effort

On Montana marijuana:

"Questions about who really benefits from medical marijuana are now gripping Montana. In the Legislature, a resurgent Republican majority elected last fall is leading a drive to repeal the six-year-old voter-approved statute permitting the use of marijuana for medical purposes, which opponents argue is promoting recreational use and crime.

"If repeal forces succeed — the House last month voted strongly for repeal, and the Senate is now considering it — Montana would be the first to recant among the 15 states and the District of Columbia that have such laws.
"Bozeman’s mayor, Jeff Krauss, a Republican, said he thought there was an element of economic fairness to be considered in the debate about medical marijuana’s future. “I don’t think anybody passed it thinking we were creating an industry,” he said, referring to the 2004 voter referendum. But like it or not, he said, it has become one, and legal investments in the millions of dollars have been made."
"One owner of a gardening supply company in the Bozeman area estimated that a person could essentially buy a job for $15,000, beginning a small growing operation with 100 plants. Especially for construction trade workers who were used to being self-employed before the recession, the owner said, the rhythms of the new industry feel familiar.

“Forty to 50 percent of customers come from construction,” said the owner, who spoke on the condition of anonymity because her national suppliers threatened to stop doing business with her if their products were openly associated with marijuana. “Plumbers, electricians, the whole genre of working-class, blue-collar Montana.”

On shark-fin soup, there are environmental and animal-rights issues, as well as cultural ones:
" a move that has infuriated Mrs. Li and others in this community, a bill recently introduced in the California Legislature would ban the sale and possession of shark fins, including the serving of shark’s fin soup. Down the rickety alleyways and produce-laden byways of San Francisco’s Chinatown, some see the proposed law as a cultural assault — a sort of Chinese Exclusion Act in a bowl.

"Similar to a measure passed in Hawaii, the bill seeks to curtail shark finning, a brutal, bloody practice of the global trade in which the fins are typically hacked off a live shark, leaving it to die slowly as it sinks to the bottom of the sea.

"In Hawaii, restaurants have until June 30 to cook or dispose of their fin inventories, and penalties for possession will be severe, with fines of $5,000 to $15,000 for a first offense. Similar bills were introduced in Oregon and Washington State.

"Scientists cite a growing international demand for shark’s fin soup, especially popular with China’s expanding middle class. As the once-ceremonial dish becomes more accessible, up to 73 million sharks are being killed a year.

"The bill is attracting a motley group of supporters, including the state’s sport and commercial fishermen’s associations, aquariums, chefs, scientists and numerous environmental groups.

"But in a city where food and the environment are perhaps equal obsessions, the politics of soup has also highlighted a generational divide between eco-conscious children and their tradition-bound elders. "

Friday, March 25, 2011

AMMA 2011 The Second Conference on Auctions, Market Mechanisms and Their Applications

 AMMA 2011: The Second Conference on Auctions, Market Mechanisms and Their Applications  New York, NY August 22-23, 2011  Call for papers.

The conference seeks papers devoted to issues that arise in all stages of deploying a market mechanism to solve a problem. This includes, but is not limited to, theoretical and empirical examination of questions such as:
  • Is a market the right mechanism for the problem? What are the externalities involved? What are the issues with central planning?
  • How should novel markets be organized? What is the "right" micro-structure for a given problem?
  • What is the best way to provide incentives? Is (real) money necessary?
  • Will the use of markets lead to the creation of artificial economies and what can we say about these economies?
  • What new problems arise because of the special nature of these markets (e.g., from everyone wanting to use a cluster around the time of a conference deadline)?
  • What protocols need to be in place for agents to participate in such markets (including everything from practical matters like integrating bidding protocols into the system to theoretical questions like incentive compatibility)?
  • Is there a need for new mechanisms for specific applications (e.g., auctions used in sponsored search were never used in other settings)? If so, what properties of applications warrant such mechanisms?
In addition to more traditional academic papers, we are especially interested in experiences from the real world (case studies and new applications). Below are some potential areas, but the list is simply illustrative rather than exhaustive -- we welcome papers in all areas of market design.
Sample areas include:

  • Content delivery networks
  • Resource allocation in networks and distributed computing
  • Sponsored search auctions
  • Prediction markets
  • Allocation of landing slots in congested airports
  • Road pricing
  • Student-school matching
  • Kidney exchanges
  • Combinatorial auctions

Submission Deadline
April 15, 2011
Notification of acceptance/rejection
May 27, 2011
Final versions of archival papers due
June 15, 20

Thursday, March 24, 2011

Unraveling of NBA (and college) basketball

The NY Times Magazine writes about the Baylor freshman basketball player who is already an NBA draft prospect: Is it Dunk and Done for Perry Jones?

"In eighth grade, Jones was invited to attend a Baylor University basketball game on the campus in Waco, Tex. He was still a raw player, not widely known and in some ways perfect for the Baylor program, which was not attracting the best of the seasoned prospects.
"Jones declared on the ride home that he had found his school, and soon after, he committed to Baylor, meaning that the team’s coach, Scott Drew, offered him a scholarship and he accepted. It was only a verbal bond, one that could not be officially sealed until he reached his senior year of high school and signed an N.C.A.A. letter of intent, but he never wavered, even as coaches from more-traditional college-basketball powers, including Kansas and U.C.L.A., sent letters to his home.
"But just about everyone assumes that he will be a one-and-done player at Baylor, a pure rental who stays for a single season. That has become the norm for top college players. In fact, in some projections, as many as six of the top 10 picks in this spring’s N.B.A. draft are college freshmen."...
...(Players can no longer enter the N.B.A. straight out of high school, as Kobe Bryant, LeBron James and many others did.)
"You might assume that if Jones left school after just one season for the N.B.A., it would be a terrible disappointment to the coaches who recruited him when he was in his early teens — then had to keep in constant contact to make sure no one poached him. (Such vigilance is known as baby-sitting.) But that is not the case. If Jones leaves, it will further validate Baylor’s program and show everyone — the media, potential recruits, influential summer-league coaches who control players and sometimes broker them to colleges — that Baylor is a place that attracts top talent and produces N.B.A. millionaires. It will make it easier for Drew to recruit more players like Jones, who then, of course, also might also leave after one season. "

See my earlier posts Unraveling and uncertainty: The NBA draft, and Another step in the unraveling of the baskeball market about how the rule that players have to be 19 years old and a year out of high school before being drafted by the NBA has caused some players to play a year for European teams.

HT: Scott Cunningham

Wednesday, March 23, 2011

The surrogacy supermarket in India

This graphic, about the thriving pregnancy-for-hire market in India, is from the article Moms market, by Namita Kohli, in the Hindustan Times.

HT: Amol Agrawal

Tuesday, March 22, 2011

2011 job market scramble for new economics Ph.D.s

The AEA's Economics job market scramble web page opens for registration tomorrow.

2011 Job Market Scramble Important Dates:

March 23: Registration Opens
March 30: Registration Closes

April 1-12: Scramble Website will be open for viewing by registered participants only
April 12: Scramble Viewing will close.
See the Scramble Guide for more detailed information.

And good luck to all still on the market.

Monday, March 21, 2011

Are college places in the U.K. like Japanese medical internships?

That's the question raised in this Times Higher Education story by Simon Baker: Could Japanese hospital doctors offer a remedy to student place dilemma?

"Ministers still scratching their heads over how to release individual English universities from controls on student numbers while keeping a lid on the cost to the taxpayer have been urged to look at work by leading economists in the US.

"Research by academics at the universities of Stanford and Harvard on the placing of doctors in Japanese hospitals could contain the solution to a conundrum that is perplexing policymakers.

"The suggestion comes as David Willetts, the universities and science minister, reiterated in a speech last week that finding a solution to freeing up student places was the "big prize" that the government needed to drive competition in the sector.

"However, apart from putting forward short-term proposals to allow a proportion of overall places to be contested through a "core and margin model", all he said was that he would "welcome a debate" on a more permanent settlement.

"A radical solution could lie in the kind of research led in the US by Alvin Roth, George Gund professor of economics and business administration at Harvard University, an expert in how to design markets under public sector constraints.

"He said the problem faced by the English university system was "somewhat similar" in character to attempts by the Japanese government to allocate enough junior doctors to hospitals in rural areas by using regional "caps" that hold down numbers in cities.

"The issue was investigated by Fuhito Kojima, an assistant professor in economics at Stanford University, and Yuichiro Kamada, a graduate student at Harvard. They designed an algorithm to find the most efficient way to solve the problem.

"Dr Kojima said their analysis could be applied to the English university system - given that institutions were in effect operating under one large "regional cap" on numbers - by designing an algorithm to "transfer" places between institutions according to their popularity among students.

"Often, the problem is that these kinds of adjustments go through bureaucratic processes that firstly can take a lot of time and secondly do not result in the correct or efficient outcome. Once you use an algorithm, this kind of adjustment can be automatic," he said.

HT: Nick Feltovich


Sunday, March 20, 2011

Match Day 2011

This past Thursday, medical school seniors found out where they are matched to residencies. Ishani Ganguli, one of the newest in the fine tradition of doctor/writers reflects briefly on her experience: Matched!

"For medical students, Match Day can be exhilarating or deeply disappointing. Some schools create pageantry around the event, asking students to come up to the mike in front of an amphitheater of classmates to receive and read aloud their results. Others, like Harvard, simply pass out the envelopes and serve lunch."

Saturday, March 19, 2011

Experimental economics and philosophy in the Basque country

XIV Summer School on Economics and Philosophy (2011), Experiments in Economics, Experiments in Philosophy

Since 1998 the Urrutia Elejalde Foundation has annually organized a Summer School on frontier topics between philosophy and economics and other social sciences, bringing together scholars from all these fields to explore them. The aim of this year Summer School is to explore the potential avenues for collaboration between the growing disciplines of experimental economics and experimental philosophy. Experimental economics has evolved into a thriving subfield, as attested by the number of experimental papers published in leading general economics journals. This growing enthusiasm for experiments in economics has coincided with the revival of philosophical and methodological analyses of causality, which view the controlled experiment as the privileged gate to causal inference. But more importantly, in the last years, a new field known as experimental philosophy has set out to complement or even substitute for pre-theoretical intuitions regarding philosophical themes such as moral dilemmas or rationality. At a moment in which experimental economics is already well-established and experimental philosophy is emerging, this meeting compares their main themes and results.
2. Preliminary list of speakers
Nicholas BARDSLEY (University of Reading), Giorgio CORICELLI (CNRS, Institut des Sciences Cognitives, Lyon), Francesco GUALA (Univ. di Milano), Nagore IRIBERRI (U. Pompeu Fabra), Joshua KNOBE (Yale University), Daniel ZIZZO (University of East Anglia), Cristina BICCHIERI (UPenn), Jason DANA (UPenn)
3. Call for papers
We encourage submission of papers that cover one or more of the above areas. The scientific committee will consider a number of submissions by young scholars at graduate or postgraduate level. The Foundation will cover the registration fees and accommodation expenses of the authors. Please send a pdf abstract of no more than 500 words before April 1st. A decision will be made by April 15th.

Friday, March 18, 2011

Market for adultery revisited

Cheating, Incorporated At Ashley Madison's website for "dating," the infidelity economy is alive, well, and profitable By Sheelah Kolhatkar

Lots of interesting bits, here are some...

"There's a lone genius—possibly evil and certainly entrepreneurial—behind Ashley Madison. His name is Noel Biderman, and he's the chief executive officer of Avid Life Media, based in Toronto. "Monogamy, in my opinion, is a failed experiment," he declares."
"Avid Life's six websites—including, for older women seeking younger men,, which connects "ambitious and attractive girls" with "successful and generous benefactors to fulfill their lifestyle needs," and, the 1990s throwback where people rate one another's photos"
"Promoting adultery and creating a market for it has made Biderman rich. It has not made him popular."
"...Ashley Madison is drowning in husbands, so many that they threaten to crush the few venturesome ladies who have boldly—and perhaps recklessly—put themselves out there. Each time you log on as a female, it's as if a new batch of peanut butter packets has been dropped over a refugee camp—everyone leaps at them at once, and you are overwhelmed with messages, "winks," and men attempting to interact. The pricing system is cleverly designed to charge the men at their most vulnerable moment: Each time one of those hungry males tries to grab at the peanut butter, he has to spend a few bucks. Creating a profile and browsing others are free, but if you'd like to initiate an e-mail or chat conversation with someone, you must purchase "credits"—200 of them cost $79.00, and they run like a meter (e-mails after the first one cost nothing; charges appear ambiguously on your credit card bill). "
"Curiously, Australia, where Ashley Madison was launched in April 2010, has the highest proportion of women users, at almost 40 percent. Biderman spent a few weeks there and says he noticed that prostitution is legal and that Aussie women aren't happy about it. "I think women down there have a view of the world that men have all these playgrounds—brothels, strip clubs, massage parlors," he says, "and they have nothing." Biederman has spent so much time studying his users, he sounds like an amateur sociologist: "We know there's a lot of doctors on there with god complexes who clearly either deal with so much stress in their lives, or believe they're so important, that having an affair—they're entitled to it."
"Biderman is quick to explain why his business isn't hurting anyone. "You eradicate Ashley Madison, you're not going to eradicate infidelity."
"When I asked Biderman's wife, Amanda, what it's like being joined in holy matrimony with an anti-marriage entrepreneur, she let out a long sigh. "Really, the business itself doesn't match who he is as a person—it's not our lifestyle or value system or any of that," she said. "I mean, yeah, I'd love it if he were working on a cure for cancer. But it's a business, and that's how we look at it."

HT: Benjamin Kay

For a historical view, see Elizabeth Abott, MISTRESSES: A history of the other woman; reviewed here:Mistresses through the ages: Prostitute, concubine, mistress, wife: the boundaries are blurred in this study

Thursday, March 17, 2011

Debate on kidney allocation in NEJM

The attack is by Benjamin E. Hippen, M.D., J. Richard Thistlethwaite, Jr., M.D., Ph.D., and Lainie Friedman Ross, M.D., Ph.D., (some of whose arguments I've already blogged about: How not to assign kidneys), and the defense is by  Alan B. Leichtman, M.D., Keith P. McCullough, M.S., and Robert A. Wolfe, Ph.D. They say (NEJM, March 16):

"On February 16, 2011, the Organ Procurement and Transplantation Network (OPTN), the federal contractor responsible for overseeing solid-organ allocation in the United States, released for public comment three proposed concepts for the allocation of kidneys from deceased donors: using a Kidney Donor Profile Index (KDPI) to rank each kidney according to the length of time that it would be expected to function in an average transplant recipient, allocating the highest-quality 20% of kidneys to the 20% of candidates with the longest expected post-transplantation survival, and giving candidates within 15 years of the donor's age the highest priority in the allocation of the remaining 80% of kidneys....

To place into context the importance of these concepts, it is necessary to understand the existing system. At its core, the current U.S. system for allocating kidneys from deceased donors focuses primarily on how long patients have been waiting for a transplant. This approach contrasts with the allocation algorithms for liver and heart transplantation, which allocate organs on the basis of medical urgency, and the lung-allocation system, which allocates organs on the basis of a mixture of medical urgency and expected survival for 1 year after transplantation.
Under the current system, approximately 15% of donated kidneys (those from older, or a subgroup of less healthy, donors) are designated as “expanded criteria donor” (ECD) kidneys and are allocated according to waiting time alone to transplant candidates who have consented to receive such an organ in anticipation of reducing their pretransplantation waiting time.4 The remaining kidneys are referred to as “standard criteria donor” (SCD) kidneys, and approximately 4% of them are allocated for simultaneous transplantation with a lifesaving organ (liver, heart, or lung), 9% are allocated to patients with zero HLA-A, -B, and -DR antigen mismatches with the donor organ, and the balance are allocated to candidates according to a point system. The point system awards one point for each year a patient is on the waiting list. For SCD kidneys, candidates are awarded one point for each HLA-DR antigen match with a donor organ and four points if they are sensitized against 80% or more of the deceased-donor pool. In addition, patients with kidney failure who have previously donated an organ are awarded priority on their local lists, and pediatric candidates are awarded preferential access to kidneys from deceased donors younger than 35 years of age. About half of all candidates are removed from the list, typically owing to death or worsening health status, without having undergone transplantation.
The United States is divided into 58 donor service areas (DSAs), each served by a single organ procurement organization (OPO) that is responsible for recovering deceased-donor organs for transplantation. Most DSAs have a population of 3 million to 10 million people. Waiting time varies considerably among DSAs according to the prevalence of end-stage kidney disease (which is generally higher in large urban populations); the efficiency of the OPO in identifying possible donors, obtaining consent for donation, and recovering organs from donors; the opportunities within the DSA for referral and wait-listing for transplantation; and the practices of the individual transplant centers regarding the acceptance and discard of organs. The typical time to transplantation among recipients ranges from less than 6 months to more than 72 months, depending on their DSA and blood type. Therefore, the value of the extra allocation priority (1 to 4 years) given for sensitization and HLA-DR matching varies by geographic location.
The current allocation algorithm does not (with the exception of ECD transplantation) account for differences in potential survival of recipients and donated organs, and the dichotomous ECD–SCD distinction does not accurately assess the relative survival potential of many deceased-donor kidneys.4,5 Moreover, the allocation priority awarded for longer waiting time, HLA-DR match, and sensitization does not reflect the biologic effects of these elements on the survival of candidates, allografts, or recipients. By focusing on waiting time, rather than appropriately weighted medical factors, the current system makes access to transplants very different for otherwise similar patients.
As a consequence of the current allocation system and the aging of the candidate pool, the lifespan of patients after kidney transplantation in the United States has declined by 18 months since 1995. Computer simulations based on the current donor pool suggest that more than 35,000 years of post-transplantation survival, and more than 10,000 years of incremental post-transplantation survival (i.e., extra years of life that would not have been achieved if the patient had continued to undergo dialysis rather than receiving a transplant), are lost each year.2 We believe that survival matching as described in the OPTN concept document has the potential to reclaim many of these lost years of life and therefore warrants serious consideration.
"The loss of tens of thousands of future life-years that might be realized and enjoyed by transplant recipients and the increase in the waiting list resulting from an unnecessarily high rate of repeat transplantation are intolerable consequences of the current kidney-transplant algorithm and urgently need correction through the mechanism of survival matching. Although we suspect that there are opportunities for improvements to the kidney-allocation concepts that have been submitted for public comment by the OPTN, we believe that the core concepts — adoption of the KDPI and survival matching — warrant the strongest endorsement and the earliest possible implementation by the kidney-transplant community."

Organ donation from death row?

A thought provoking op-ed in the NY Times -- Giving Life After Death Row, By CHRISTIAN LONGO

His circumstances give him time to think, and he writes:
"EIGHT years ago I was sentenced to death for the murders of my wife and three children. I am guilty.
"I spend 22 hours a day locked in a 6 foot by 8 foot box on Oregon’s death row. There is no way to atone for my crimes, but I believe that a profound benefit to society can come from my circumstances. I have asked to end my remaining appeals, and then donate my organs after my execution to those who need them. But my request has been rejected by the prison authorities.
"There is no law barring inmates condemned to death in the United States from donating their organs, but I haven’t found any prisons that allow it.
Aside from these logistical and health concerns, prisons have a moral reason for their reluctance to allow inmates to donate. America has a shameful history of using prisoners for medical experiments. In Oregon, for example, from 1963 to 1973, many inmates were paid to “volunteer” for research into the effects of radiation on testicular cells. Some ethicists believe that opening the door to voluntary donations would also open the door to abuse. And others argue that prisoners are simply unable to make a truly voluntary consent.
"I am not the only condemned prisoner who wants the right to donate his organs. I have discussed this issue with almost every one of the 35 men on Oregon’s death row, and nearly half of them expressed a wish to have the option of donating should their appeals run out.
"...I don’t expect to leave this prison alive. I am seeking nothing but the right to determine what happens to my body once the state has carried out its sentence.

"If I donated all of my organs today, I could clear nearly 1 percent of my state’s organ waiting list. I am 37 years old and healthy; throwing my organs away after I am executed is nothing but a waste.

"And yet the prison authority’s response to my latest appeal to donate was this: “The interests of the public and condemned inmates are best served by denying the petition.”

"Many in the public, most inmates, and especially those who are dying for lack of a healthy organ, would certainly disagree."

Christian Longo, a prisoner at Oregon State Penitentiary, is the founder of the organization Gifts of Anatomical Value From Everyone.

And here are some letters to the editor published in response, not all negative.

Wednesday, March 16, 2011

How not to assign kidneys

"That's the title of a NY Times Op-Ed by LAINIE FRIEDMAN ROSS and BENJAMIN E. HIPPEN, criticizing the recent UNOS proposals to change the deceased donor kidney allocation system (about which I recently blogged here and here). (Ross and Hippen don't always agree with each other; here they take opposite sides of the debate on whether it would be ok to compensate donors.)

In their op-ed they write:
"The proposal is supposed to provide deceased-donor kidneys of higher quality to healthier, younger patients instead of to elderly ones who presumably have fewer years to live.

"It sounds simple enough. But the strategy could result in fewer kidneys going from living donors to young candidates, and could lead to more deaths of older or sicker candidates on the waiting list. Moreover, it would do nothing to address the fundamental problem: the persistent shortage of kidneys from donors, both living and deceased.

"The proposal would set up a two-pronged strategy that is intended to increase the number of life-years gained for every donor kidney. Under the proposal, the top 20 percent of kidneys from deceased donors who had been young and healthy would be assigned to the top 20 percent of young healthy candidates. In other words, the best deceased-donor kidneys would be given to patients likeliest to have long lives ahead of them.

"The other 80 percent of deceased-donor kidneys would be allocated first to local candidates within a 15-year age range of the donor, and if no potential candidate were identified, then to the broader pool of candidates. (For example, candidates aged 25 to 55 would get priority for a kidney from a 40-year-old donor who had just died.)

"But while the goal is understandable, the proposal is flawed...

" healthy young patients first dibs on kidneys from young deceased donors might reduce donation rates from living donors to the young candidates, which is at cross-purposes with the goal of extending years of life after transplant. In 2005, the network started giving pediatric transplant candidates priority for kidneys from deceased donors younger than 35. While the pediatric patients received more organs from deceased donors, they got fewer organs from living donors. The likely explanation is that the donors, including many parents, held off, figuring that they could donate later, when the deceased-donor kidney eventually failed. (Those kidneys can last up to 20 years.)

"The new proposal would effectively expand the 2005 rule to all healthier, younger candidates, potentially reducing living-donor transplantation to the very group that stands to benefit the most from it. This would only increase their need for another transplant later, since kidneys from deceased donors do not last as long as kidneys from living ones.

"Giving more organs to young recipients would also come at the expense of “older” recipients, which in this context can mean 50 to 64. (Only a tiny fraction of all kidneys go to recipients older than 70.) Since older candidates on the waiting list are less likely to live long enough to receive a kidney, making them less eligible for transplants will probably result in more deaths on the list, and more pressure on available living donors to donate to older candidates.
"What should be done instead?

"First, allocate kidneys on a broader basis. Under both the current and proposed systems, kidneys are allocated locally. But while a New Yorker with end-stage renal disease will typically wait at least six years for a transplant, her counterpart in Minnesota might wait just two to three. ...

"Second, the network should continue to support first-person consent legislation under which people who have properly declared their willingness to donate their organs in case of an unexpected death cannot have their wishes overruled by their bereaved families.

"But for now, the only sure way to reduce the shortage of organs is to expand transplantation from living donors...

"The network should also keep encouraging innovative efforts like “kidney swaps” or “donor chains.” Kidney swaps involve two donor-recipient pairs who are incompatible within the pair, but can donate to the other pair’s recipient. (Think of it as a square dance where the couples switch partners halfway through.)

Donor chains begin with a living donor willing to donate to anyone on the waiting list. Instead of simply giving that donor’s kidney to the next patient in line, the kidney can go to the would-be recipient in an incompatible donor-recipient pair; that donor, in turn, can then give to another recipient of an incompatible donor-recipient pair, with the chain continuing indefinitely. (Consider it the medical equivalent of “pay it forward.”)

Tuesday, March 15, 2011

Dating fees added to the British inflation index

Along with apps, natch. The Financial Times reports, Apps and dating fees added to inflation basket

"Smartphones and the applications that run on them have been added to the basket that makes up the consumer price index, along with fees paid to dating agencies.

"The Office for National Statistics on Tuesday unveiled changes to the composition of its CPI and retail price index baskets, intended to represent a “typical” shopping basket for households – an exercise it undertakes every year. Because shopping habits change, items are constantly being added and removed from both indices.
"Fees paid to dating agencies have been added to reflect the growing use of internet services to find a partner..."

Matching is everywhere...

“Summa cum fraude:” Plagiarism as a (culturally dependent) repugnant transaction

The NY Times discusses the recent resignation of the German defense minister after it was revealed that parts of his Ph.D. dissertation were plagiarized. The tone of the article is bemusement that anyone but academics could take such a crime seriously, but that the German public did: In Germany, Uproar Over a Doctoral Thesis

"A German author, Peter Schneider, even gravely linked the whole mess to Bill Clinton’s impeachment drama, since they both entailed what he called “the same question of honesty.” Leave it to a German intellectual to discern a deep connection between an American president dissembling about oral sex with an intern in the Oval Office and a doctoral student at Bayreuth University cribbing passages in a 475-page dissertation about contrasting constitutional developments.
"The trouble started last month when this country’s most popular cabinet minister, Karl-Theodor zu Guttenberg, a handsome, media-savvy, conspicuously pomaded 39-year-old baron widely presumed to be a leading candidate to succeed Angela Merkel someday as chancellor, tried to brush off charges that he had plagiarized parts of his 2006 thesis.

“Absurd,” was his initial response. And many Germans wanted to believe him. “Well-born, well-spoken and well-groomed,” as The Economist observed about the baron, he had “seemed blunt where others prevaricated, principled where they plotted. Alone among German leaders,” the magazine went on, referring to the gray, proficient bureaucrats who tend to run the country, he made “voters’ hearts quicken.”

Ms. Merkel backed him up, even as German graduate students and others, by the tens of thousands, began to organize, signing an open letter of protest that heaped scorn on her. Several hundred protesters hung their shoes on the iron fence outside the Defense Ministry in Berlin in a sly (again, typically German) multivalent allusion both to the now familiar Arab insult of displaying the soles of one’s shoes and also to the missing footnotes in Mr. Guttenberg’s dissertation.
"At the same time, however, Mr. Guttenberg’s troubles thrust into embarrassing national relief the dirty secret that to gain such credentials, many Germans, well-connected ones anyway, apparently cut corners or worse, and universities often look the other way. The minister couldn’t admit to having farmed out his dissertation, because that’s literally a crime here, but he was generally suspected of having hired someone to write the work for him (how else to explain why he seemed so blithely oblivious to the contents of his own thesis?). And to add insult to injury, his advisers had even awarded him a rank of “summa cum laude” (“Summa cum fraude” was another of those protesters’ placards), notwithstanding that the thesis seems to have poached material from one of those very advisers.
"Mr. Poschardt fumed in Welt Online recently that when news broke some years ago about the Rev. Dr. Martin Luther King Jr.’s plagiarizing parts of his dissertation, Americans hardly reacted. For Germans the nonchalance may seem as odd as it is for many Americans to hear that Horst Seehofer, the married chairman of Mr. Guttenberg’s Christian Social Union, the Bavarian partner to Ms. Merkel’s conservative Christian Democratic Union, was elected to his post after it was reported that his mistress had given birth to a child. Germans debated his improprieties, but in the end overlooked them.

"And this gets back to the author Mr. Schneider and the Clinton impeachment scandal.

"Despite the cultural gulf, both incidents, the president’s and the minister’s, which were incited by peripheral, if not actually private, affairs, prompted fits of national anguish: for Americans about sex, for Germans about integrity.
"The widespread expectation now is that Mr. Guttenberg, whose popularity has not dimmed but increased, according to the latest polls, will retreat for a while, and, like Mr. Clinton, after an obligatory period of remorse, come back. First he will have to contend with prosecutors, who the other day announced they had opened an investigation. Plagiarism entails breach of copyright crimes here."

Monday, March 14, 2011

Academic letters of reference

At the Chronicle of Higher Ed, David Roediger writes of The Failed Promise of Electronic Applications

"It would have been easy enough, some years back, when I started to get requests to put recommendation letters on Interfolio, to connect the new practice with general trends to outsource university jobs, cut the positions of support workers, and privatize service work in public universities.

"Indeed, my own department at the University of Illinois at Urbana-Champaign quickly moved from maintaining its own dossier service for graduate students to partially subsidizing their applications for jobs made through Interfolio. Back then, when I thought about the switch in labor terms, I was able to quickly decide that the change was justifiable because it saved work, including, for staff members, the drudgery of photocopying.

"Mostly, though, I hoped the new electronic processes would save me labor. The department's old dossier service file was acceptable to most employers and used by all students. However, when writing recommendations on behalf of colleagues who had jobs but were seeking new ones, each letter had to be an individual production, as faculty candidates were outside the dossier system.

"Moreover, I hoped that the new systems would ease the burden of writing endless letters for undergraduates to get into doctoral programs and could centralize that process. Indeed, law schools were something of a model: Centralized recommendation-letter banks, organized either at the university level or by the Law School Admission Council, had greatly eased letting-writing, envelope-licking, and mailing. One student, one letter.
"Several years into the process, it is clear that, within the humanities, labor is not being saved—even on the supply side of sending out the recommendation letters electronically. Interfolio itself remains cumbersome and, contrary to the centralized law-school model, graduate schools have adopted countless variants for handling the letters. Some schools require hard copies, sometimes gathered by the student into a file, sometimes not. Where letters supporting job applications are concerned, two schools recently asked that I forward my recommendation letters through the student, forgetting confidentiality altogether.

"Odd little boxes asking that professors use a check mark to give a percentile ranking to students on everything from honesty to industry to leadership had been a feature of the older paper-application forms. Retaining those idiosyncratic grids—each school using them seems to survey a different set of virtues—sometimes now justifies departments' holding on to distinctive formats rather than adopting a standardized recommendation letter. Fellowship applications are almost militantly idiosyncratic in the forms that letters are required to take. No standard practices have emerged.

"Most important, school after school contracts for its own systems, meaning the letters are not just sent either through an agency or individually. Instead they fall into an endless number of electronic delivery systems, each slightly different, most new, and typically with giant bugs to be worked out. So frequently do those systems not work—or not work in concert with configurations of the sender's computer—that some searches are now accompanied by the e-mail contact of the person shepherding tutorials or end runs around the system.

Sunday, March 13, 2011

Adoption as a (less) repugnant transaction

You wouldn't think that adoption would sometimes be regarded as a repugnant transaction, i.e. as something that some people didn't want other people to do, but in fact there have in many times and places been laws and customs that prevent certain sorts of people from adopting certain other sorts of people, e.g. inter-racial or inter-ethnic or inter-religious adoptions of various sorts. (And of course there have also been restrictions barring certain kinds of couples, e.g. same sex couples, from any kind of adoption.)

The Telegraph reports that things are changing in England in this regard:

Adoption shake-up: new guidelines will stop 'social-engineering': "New adoption guidelines have been announced by the Government to break down the barriers faced by potential parents and children."

"Michael Gove, the Education Secretary, said some of the limitations put on adopters in the past - based on ethnicity, sexual orientation and faith - was ''social engineering of the worst kind''.
Outlining the adoption guidance being introduced, the minister said: ''At the moment, the system simply doesn't allow many of those people who are desperate to help the chance to give young people and children a loving home.
''It has always been the case unfortunately that far too many children are growing up in circumstances where sadly they won't have the architecture or stability that means they can achieve everything of which they are capable.''
The Government said progress in adoption has stalled in recent years, with the number of children placed for adoption falling by 15 per cent between March 2009 and 2010, and more children waiting longer to be adopted.
Black children took over 50 per cent longer on average to be placed for adoption than children from other ethnic groups, and children over five were four times less likely to be adopted compared to children under five in the last year.

Mr Gove said: ''What I do find difficult to accept is that we've created over time a web of rules that mean that we are not always putting the interests of children first.
''We all know that the length time which children spend in institutional care once they be been taken into care is far too long, when those children could be adopted by loving parents.''
He said the average amount of time children spend in care before being adopted is 21 months.
''One of the reasons that they sound so long is that for far too long, we have made an idea of the perfect the enemy of the good,'' he said.
Speaking about the barriers faced by adopters previously, he said: ''We said that this particular couple can't adopt because, in the past, they might have the wrong sexuality, they might even have the wrong ethnic background.
''It could be that they're too young, it could be that their social background doesn't make for perfect match. That sort of thinking is social engineering of the worst kind.''

Saturday, March 12, 2011

Twelve international criminal markets

I'm not confident of the data, but numbers one and two are drugs and human trafficking, and number five is human organs.
This from Transnational Crime In The Developing World: A February 2011 Report from Global Financial Integrity. The detailed report is here.

Roughly organized in terms of overall cash flow here is their list of goods illicitly traded across borders (the ordering depends not only on highly unreliable estimates, but on how the categories are aggregated...).
  1. Drugs
  2. Human trafficking
  3. Illicit wildlife
  4. Counterfeit goods and currency ("If imitation is the sincerest form of flattery, counterfeiting is the criminal form.")
  5. Human organs (my worries about data sources are compounded by noting that their figures for legal US transplants come from a 2008 article in the Economist, rather than e.g. from UNOS/OPTN data, which is easily available on the web)
  6. Small arms
  7. Diamonds
  8. Oil
  9. Timber
  10. Fish
  11. Art and artifacts
  12. Gold
From the executive summary:
"This report analyzes the scale, flow, profit distribution, and impact of 12 different types of illicit trade: drugs, humans, wildlife, counterfeit goods and currency, human organs, small arms, diamonds and colored gemstones, oil, timber, fish, art and cultural property, and gold. Though the specific characteristics of each market vary, in general it can be said that these profitable and complex criminal operations originate primarily in developing countries, thrive in the space created by poverty, inequality, and state weakness, and contribute to forestalling economic prosperity for billions of people in countries across the world.

"The global illicit flow of goods, guns, people, and natural resources is estimated at approximately $650 billion. Though data is scarce and experts are constantly debating the relative merits and weaknesses of every new study, it is generally accepted that illicit drug trafficking and counterfeiting are the two most valuable markets. This report finds the illicit drug trade to be worth roughly $320 billion and counterfeiting $250 billion. These numbers reflect the potential for huge profits which is
the fundamental driver of criminal trade."

HT: Bettina Klaus

Friday, March 11, 2011

Unraveling in the war for new private equity talent

Kevin Roose at Dealbook writes of A Grab for Wall Street’s Rising Stars Before They’ve Risen

"Some of the world’s largest private equity firms are in a tug of war over top talent. But the competition isn’t over brand-name executives commanding eight-figure salaries. Instead, firms are fighting for the affections of bankers barely old enough to rent cars.

"This month starts the private equity recruiting season, an annual Wall Street ritual in which young analysts from leading investment banks like Goldman Sachs and Morgan Stanley are wined and dined by Kohlberg Kravis Roberts, the Blackstone Group, TPG Capital and a handful of other top-flight firms. The industry is gearing up earlier than ever this year, with some firms already making offers for jobs that won’t start until the fall of 2012, a full 18 months from now.

Five years ago, it happened in September, then July, then May, then April. This year, it’s March,” said a senior partner at a large private equity firm, who spoke on the condition of anonymity because he was not authorized to comment on the hiring process.

Young analysts typically fulfill two-year contracts at their banks before making the switch to the more prestigious, higher-paid world of private equity. It’s a common move often referred to as “two and out.” Many of these analysts, referred to as “pre-M.B.A. hires,” are contacted by private equity firms only months into their first post-collegiate jobs, and some are as young as 22.

“There is a shortage of stars, and that gives a strong incentive for a given firm to be the first,” said Adam Zoia, chief executive of Glocap Search, whose clients include leading private equity firms. “But everyone sensible — the clients, the banks, the candidates — believes it’s in no one’s interest to start this early.”

"Top firms have traditionally made informal agreements to synchronize their recruiting drives. It is a delicate monthlong dance that can include cocktail hours, meet-and-greets with executives and interview marathons sometimes referred to as “Super Saturdays.” This year, many of the largest firms scheduled events in April, approximately the same time as last year.

"But in early March, word spread that Bain Capital, the $65 billion private equity firm, was holding interviews and making offers to top candidates, according to several people familiar with the matter. Bain’s competitors — some of which moved early in previous years — were forced to scramble. They quickly rearranged schedules and, in some cases, canceled planned recruiting events in order to make their offers as soon as this week.

Every year, we talk to the other private equity firms and actually pretend we have a vested interest in being reasonable about this,” said a private equity executive who oversees his firm’s hiring efforts. “And every year, some jerk kicks off the process a month early.” The executive, who also spoke on the condition of anonymity to avoid angering rival firms, called the analyst recruiting process “one of the last vestiges of completely rogue behavior” in the well-heeled world of private equity.

"Bain declined to comment.

"The early recruiting process has serious limitations. Private equity firms are essentially wooing young analysts with less than a year’s experience, giving them little time to learn crucial skills like building complex financial models to value companies. Few have also received the annual performance reviews necessary for identifying top talent.

The kids we’re talking to got out of college last summer, spent six months in training, entered the job in January, and have done exactly nothing since then,” the executive said. “So we’re asking them about their transaction experience, and they’re talking about what fraternity they were in.”
"Competition is fierce. According to industry insiders, more than a thousand analysts are expected to apply for perhaps 50 spots at the largest buyout firms this year. Coming from a so-called target group can help an analyst’s chances — Goldman Sachs’s technology, media and telecom group and Morgan Stanley’s mergers and acquisitions group are thought to be the cream of the crop — but there are no guarantees.
"In perhaps the clearest sign that the recruiting frenzy has hit a boiling point, several smaller private equity firms have hired star students or well-connected ones straight out of college. Industry experts say they don’t expect that trend to spread to mega-firms like K.K.R. and Blackstone. But even longtime private equity players, like the executive managing his firm’s hiring process, admit that the competition has made anything possible.

It’s a land grab,” the executive said. “And it’s a land grab for completely undeveloped property.”

HT: Eric Budish, the market design guy at Chicago, who writes "Back in my former life as a wall street guy this recruiting process was in spring of the second year (of a two year gig... )

Thursday, March 10, 2011

More on random graph models of kidney exchange

A new paper by Panos Toulis and David Parkes explores random graph models of kidney exchange: A Random Graph Model of Kidney Exchanges: Efficiency, Individual-Rationality and Incentives

"In kidney exchanges, hospitals share patient lists and receive transplantations. A kidney-paired donation (KPD) mechanism needs to promote full sharing of information
about donor-patient pairs, and identify a Pareto efficient outcome that also satisfies participation constraints of hospitals. Random graph theory is applied to the kidney exchange problem to provide a two-fold benefit: early experimental results can be explained analytically, and complex models with participation of multiple hospitals can be studied in terms of incentives in a methodological way. In this paper, we introduce a random graph model of the KPD exchange and then fully characterize the structure of the efficient outcome and the expected number of transplantations that can be performed. We derive a square-root law between the welfare gains from sharing patient-donor pairs in a central pool and the individual sizes of hospitals, which also illustrates the urgent need for the nationwide expansion  of such programs. Finally, we establish through theoretical and computational analysis that enforcing simple individual rationality constraints on the outcome can mitigate the negative impact of strategic behavior by hospitals."

While they consider only two-way exchange, their results parallel those obtained in the random graph model that Itai Ashlagi and I wrote about in Ashlagi, Itai and Alvin E. Roth, "Individual rationality and participation in large scale, multi-hospital kidney exchange," working paper, January 2011.

One of the developments it has been exciting to witness is the increasingly interdisciplinary work on kidney exchange, which now involves surgeons, economists, operations researchers and computer scientists. Here at Harvard, a lot of the connection to computer science comes through David Parkes, Yileng Chen, and the EconCS group.

I enjoyed speaking at the interdisciplinary seminar run by the Center for Research on Computation and Society (CRCS, pronounced "circus"). You can see my talk on the CRCS video site, ordered by dates, Monday, September 20, 2010: Alvin Roth on Kidney Exchange. From about 27 minutes to 13 minutes from the end (if you get that far, it's an 85 minute video:), you can hear me start to talk about some of the issues explored in these two papers.

Wednesday, March 9, 2011

Kidney exchange software

Itai Ashlagi has made available some of the  kidney exchange software (for both cycles and chains) that we used in two recent papers.

He writes: "To use
(i) one should have cplex and
(ii) please cite

The software either generates simulated patient/donor pairs as well as a compatibility matrix, or alternatively gets as an input such data. It finds an allocation that maximizes the number of transplants using cycles and chains each of a different bounded length. (Chains begin with non-directed donors.)"

Itai has also created a video abstract of the second paper above, about incentives for participation in large scale kidney exchange:

Tuesday, March 8, 2011

Medical progress in the last 200 years

(the Legislature created Mass. General on Feb. 25, 1811, but it didn’t open to patients until a decade later.)

"When Massachusetts General Hospital opened in 1821, most patients were required to apply in writing for admission. They could be turned away for “bad morals’’ — and discharged for spitting, drinking, smoking, or swearing. Patients who followed the rules stayed for two months on average at an all-inclusive daily rate of 43 cents.

"They endured hemorrhoid and cataract surgery and amputations without anesthesia — assistants held them down, and sometimes they got opium and brandy for pain. Patients seeking treatment of broken legs or arms died as often as they went home."

I'm hopeful that equally big gains will be made in the next 200 years, so that much of today's medicine will look primitive in retrospect.

In particular, of interest to readers of this blog who have been following the great advances made in the past half dozen years in kidney exchange, I hope the time will come soon when that will seem a primitive stopgap, replaced by e.g. xenotransplants or even stem cell therapy to help patients grow new kidneys, not to mention cures for diabetes and other causes of kidney failure...

Monday, March 7, 2011

Non-simultaneous kidney chains are getting longer

Mike Rees' revolution in non-simultaneous extended altruistic donor (NEAD) chains continues to grow in importance in kidney exchange. Since the 2009 NEJM paper reporting the first NEAD chain, which accomplished 10 transplants (and therefore required 20 surgeries, ten of them nephrectomies), chains have been getting both more frequent and often longer.

The venerable transplant center at the University of Pittsburgh reports its recent involvement in a long chain:
A UPMC First: Transplant Team Participates In Large Multi-State Kidney Chain Involving 32 Operations and 16 Transplants
"The paired kidney exchange, coordinated by the National Kidney Registry, involved 32 patients and 16 transplants performed at 12 U.S. hospitals over two months. It marked the first time that UPMC participated in a kidney chain."

The National Kidney Registry is one of the relatively nimble networks that, following the New England Program for Kidney Exchange, and Rees' Alliance for Paired Donation, have grown by recruiting sometimes overlapping networks of transplant centers.
Sean Hamill at the Pittsburgh Post Gazette gives the story a competitive angle by contrasting the NKR with the national exchange that is slowly gearing up (emphasis added, on which I'll comment after):

"This most recent chain started Dec. 17, 2010, and by the time it ended Feb. 11 it involved 16 donors and 16 recipients at 12 transplant centers in nine states from New York to California. Mr. Johnson's transplant and Ms. Dolezal's kidney removal both took place Feb. 10 in Pittsburgh and both of them are doing well.
"A national program that could push the number of paired donations from nearly 400 last year nationally to 3,000 or more a year has been the dream for the last half decade. That's significant when 93,000 people are on the national waiting list for kidneys and only about 17,000 a year get transplants

"Last fall, the United Network for Organ Sharing, an organization that oversees the nation's organ and transplant network, finally began its long-awaited pilot program that will attempt to do just that and link all of the eligible patients from the nation's more than 200 transplant centers.

"But Garet Hil, founder and president of the National Kidney Registry in Babylon, N.Y., which organized the 32-person chain, said UNOS's pilot program "is a failure."

"Mr. Hil, who runs a consulting and software development company, sits on the Kidney Paired Donation Pilot working group that has been trying to make the program work.

"I've witnessed a program with a flawed design, working in a bureaucratic way that's not going to get many people transplanted," he said Friday in a phone interview. "The program has been out since October and it's only done two transplants and we've done 60 since then -- including this chain" of which UPMC was a part.
"He has a host of criticisms with the pilot program, including that it allows only small chains that would give just two or three people new kidneys at a time, while the National Kidney Registry runs chains, like this recent one, where dozens of people get new kidneys.

"Ken Andreoni, an Ohio State University transplant surgeon who chairs UNOS's kidney committee, has heard Mr. Hil's arguments and concerns before and he believes he's just being too impatient.

"I'm in this for the 50-year- and 100-year-long issues," he said, adding that they will take time to solve.

"He concedes the pilot program is slowed by the bureaucracy of having to follow rigid rules that aim to maximize successful transplants and minimize risk.

"But that's the price you pay when you're creating what is to be a real national program that answers to everyone, unlike Mr. Hil's registry.

"The pilot program has had a difficult time because, first, the patients who have signed on are typically the most difficult patients to match, with significant variables that make them hard to match.

"And while UNOS would love to run long chains like the registry, currently it believes that shorter, two- and three-person-paired chains are safer because they're less complicated, Dr. Andreoni said.

"He doesn't see it as the competition Mr. Hil does.

"In the end, if you get people off the waiting list, that's great," Dr. Andreoni said, "no matter who is doing it."

About the controversy about long versus short chains, the concerns about long chains are based in part on a modeling error, see this earlier post: Nonsimultaneous kidney exchange chains produce more transplants than simultaneous chains

And the issue about having only hard-to-match patients enrolled so far in the national exchange, that is likely to be a problem that will need to be addressed at a fairly fundamental level, because the current incentives make that a tempting strategy for transplant centers. See this earlier post: Kidney exchange when hospitals are the players

Finally, regarding time horizons, I sure hope that in 50 and 100 years we'll have better cures for kidney disease than transplantation. But for the next 10 or 20 it's likely to be the best solution by far for patients with end stage renal disease, and so we'd better keep figuring out how to make the best use of it.