Friday, June 23, 2017

Kidney transplant in June 1950

I'm accustomed to calling Murray's 1954 surgery the first successful kidney transplant, and indeed the first successful organ transplant.
(see my post  A transplant makes history--Joseph Murray’s 1954 kidney operation ushered in a new medical era.)

But there were earlier attempts, and there's room to disagree on what constitutes a success. Here's a recent anniversary article about an earlier kidney transplant, from a deceased donor (and also before immunosuppression--Murray's surgery involved a live donation from one identical twin to another...)

This Day In Science June 17, 1950 – First successful kidney transplant operation was performed

"On June 17th 1950 Dr. Richard Lawler performed the first successful kidney transplant. The recipient was Ruth Tucker, a 44-year-old woman who had polycystic kidney disease (PKD).
...
"A transplant was risky but the only real option for survival for Tucker, as dialysis was not yet widely available. The donor kidney was removed from a patient who had died of cirrhosis of the liver.

“Not the most ideal patient, but the best we could find,” said Dr. Lawler after the surgery. The transplant surgery was quick, and 45 minutes after removal of the kidney from the donor the operation was complete. Tucker was released from the hospital a month later.
"The kidney functioned for at least 53 days, but it was removed 10 months after the surgery as it had been rejected. This transplant was conducted well before the development of immunosuppressant drugs and tissue typing which would have helped prevent organ rejection.

"Ruth Tucker had PKD in both of her kidneys, leaving one non-functioning and the other functioning at 10%. The donor kidney gave her body the chance to resume normal kidney function, therefore when the donor kidney was removed, Ruth was able to live another 5 years with her one remaining kidney. She died in 1955 from coronary artery disease which was unrelated to PKD and her organ transplant.

"Dr. Richard Lawler never performed another transplant, saying that he “just wanted to get it started”.
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Here's some more detail on the website of the Little Hospital of Mary in Chicago, where the surgery was performed.

First Successful Organ Transplant, Little Company of Mary, 1950

"The surgery was extremely courageous, given that it was done without anti-infection drugs, tissue typing and other advances that are now standard. A Newsweek article a week after the surgery was headlined, “Borrowed from the Dead”. The article stated, “Successful transplants have been made of bones, skin, nerves, tendons and eye corneas. But up to last week, no vital human organ had ever been moved from one person to another. Then, in a daring surgical feat, Dr. Richard M. Lawler of the Little Company of Mary Hospital, Chicago, removed a diseased kidney from Mrs. Ruth Tucker…The patient was ‘willing to gamble rather than lie back and wait for death,’ Dr. Lawler said.” A month later, Tucker was released from the hospital, a medical miracle. She lived five years before dying from a coronary occlusion following pneumonia."

Thursday, June 22, 2017

Ben Edelman calls out Uber

Ben has been following Uber for some time, and he's calling them out for their law-breaking business model:

Uber Can’t Be Fixed — It’s Time for Regulators to Shut It Down
From many passengers' perspective, Uber is a godsend — lower fares than taxis, clean vehicles, courteous drivers, easy electronic payments. Yet the company’s mounting scandals reveal something seriously amiss, culminating in last week’s stern report from former U.S. Attorney General Eric Holder.
Some people attribute the company’s missteps to the personal failings of founder-CEO Travis Kalanick. These have certainly contributed to the company’s problems, and his resignation is probably appropriate. Kalanick and other top executives signal by example what is and is not acceptable behavior, and they are clearly responsible for the company’s ethically and legally questionable decisions and practices.
But I suggest that the problem at Uber goes beyond a culture created by toxic leadership. The company’s cultural dysfunction, it seems to me, stems from the very nature of the company’s competitive advantage: Uber’s business model is predicated on lawbreaking. And having grown through intentional illegality, Uber can’t easily pivot toward following the rules.

Repugnance to Science: Brecht's "Life of Galileo" at the Young Vic

I had the great pleasure of seeing a timely production of Brecht's Life of Galileo at the Young Vic.
Before his troubles with the Church, Galileo has a Silicon Valley vibe:
"When a young man in Siena, I saw how a couple of builders, after five minutes argument, replaced a thousand-year-old system for moving graniteblocks by a new and more practical arrangement of the tackle. Then andthere I knew-the old age is past and a new age is here."

Later in the play, the Cardinal Inquisitor explains to the Pope why the Church should regard science with repugnance:

" A terrible unrest has come, into the world. It is this unrest in their own minds which these men would impose on the motionless earth. They cry: the figures compel us. But whence come their figures? They come from doubt, as
everyone knows. These men doubt everything. Are we to establish human
society on doubt and no longer on faith? ‘You are my master, but I doubt if
that is a good thing.’ That is your house and your wife, but I doubt whether
they should not be mine.’ "
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Climate change anyone?



Wednesday, June 21, 2017

Travel while on dialysis

One of the burdens of kidney failure is that, while waiting for the chance of a transplant, patients often have to spend several hours several times a week on dialysis.  This means most patients can't travel without arranging dialysis sessions at their destination.

After my Morishima Lecture in London, Silvina Lindner pointed out to me that there is an emerging marketplace for dialysis travel.

Here's the website of Connectus Medical, which offers to help arrange dialysis in more than 150 countries.

(In another approach, see my post on efforts towards portable dialysis.)

Tuesday, June 20, 2017

Needed: International responsibility sharing for refugees

The Scalabrinians, a Catholic organization concerned with refugees, has issued a report:

International Migration Policy Report:
Responsibility Sharing for Large Movements of Refugees and  Migrants in Need of Protection
A report of the Scalabrini migration study centers June 2017
It's table of contents reminds us that the problem is not limited to any one region of the world. Here are the chapter headings...

  1. Introduction
  2. Rohingyas: The People for Whom No One is Responsible
  3. South Sudan: A Young Country Divided by Civil War
  4. Politics and Responsibility Sharing in Facing the Migration Crisis in Europe
  5. The Challenges of Migration Trends and Shared Responsibility in Latin America and the Caribbean 
  6. Knocking on the Door: Vulnerable Populations at the US-Mexico Border
  7. Conclusion
Here is the Conclusion:

"The five papers in the 2017 International Migration Policy Report of the Scalabrini migration study centers demonstrate that the global community is at a crossroads with regard to the protection of large movements of refugees and migrants. Common to each analysis is the absence of adequate responsibility-sharing mechanisms to ensure that all nations contribute to the protection of persons on the move.

"In Europe, nations continue to point the finger and not accept responsibility collectively, with front-line nations, such as Greece and Italy, bearing the brunt of protection responsibilities. In Africa, regional cooperation, while noble, is insufficient to the need, leading to protracted refugee situations with little options for improvement.

"The Rohingya ethnic group of Myanmar is stateless, with few nations in the region willing to accept them permanently, as their villages are being burned and their population being killed by the Myanmar military. Latin America and the Caribbean are largely immigrant-producing countries, with the majority of their migrant populations attempting to reach the United States and Canada, but with many settling in nations within the region. In North America, the United States, the wealthiest nation on earth, is using deterrence tactics to prevent unaccompanied children and women and children in families from arriving at the US border.

"The policy recommendations in these papers point to the need for a uniform global model for responsibility sharing in the context of large movements of persons. Such a model would apply to the entire international community and would help relieve the burden on front-line states, many of which do not have the capacity to deal with large populations.

"As such, it is vital that the processes leading to a Global Compact on Responsibility Sharing for Refugees and the Global Compact on Safe, Orderly, and Regular Migration continue and lead to binding agreements by 2018. The Scalabrini migration study centers will continue to inform and participate in these processes and will raise concerns and solutions, based on its expertise and experience serving refugees and migrants around the world.

"As Pope Francis has stated, the world must move beyond a “globalization of indifference” to migrants to international solidarity: “It is important that nations in the forefront of meeting this present emergency not be left alone, and it is also essential to initiate a frank and respectful dialogue among all the countries involved in the problem — countries of origin, transit, or reception — so that, with greater boldness and creativity, new and sustainable solutions can be sought.”1

1  Pope Francis in an address to the Vatican diplomatic corps on January 11, 2016.799

Monday, June 19, 2017

Listen to my Morishima Lecture: Marketplaces and Market Design (audio only)

Below you can listen to a podcast of my lecture in honor of Michio Morishima at the LSE last Thursday. (Update: I've also added links to video below.)

I showed slides in my lecture, but I think you can actually follow the talk without them.  The introduction is by Professor Nava Ashraf.  My talk ends at minute 60, and then you can hear a half hour of questions and answers, many raised by my discussion of repugnant transactions.
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Update:
Here are two videos of the event; the first mostly follows me and not the slides, the second is audio plus slides.

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Sunday, June 18, 2017

Mail order opiods, paid for by bitcoin, ordered over the dark net

The NY Times has the story:
Opioid Dealers Embrace the Dark Web to Send Deadly Drugs by Mail

"In a growing number of arrests and overdoses, law enforcement officials say, the drugs are being bought online. Internet sales have allowed powerful synthetic opioids such as fentanyl — the fastest-growing cause of overdoses nationwide — to reach living rooms in nearly every region of the country, as they arrive in small packages in the mail.

The authorities have been frustrated in their efforts to crack down on the trade because these sites generally exist on the so-called dark web, where buyers can visit anonymously using special browsers and make purchases with virtual currencies like Bitcoin.

The problem of dark web sales appeared to have been stamped out in 2013, when the authorities took down the most famous online marketplace for drugs, known as Silk Road. But since then, countless successors have popped up, making the drugs readily available to tens of thousands of customers who would not otherwise have had access to them."
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For an earlier post on the Silk Road marketplace and its demise, see

Monday, June 1, 2015

Saturday, June 17, 2017

A long transplant chain in Nebraska

An 18 person chain (9 donors and 9 transplants) is celebrated in Nebraska:
After transplant chain, donors meet those whose lives they saved
By Julie Anderson / World-Herald staff writer  Jun 9, 2017

"On Thursday, 18 people — nine living donors and nine recipients from across Nebraska and one other state — gathered at the Nebraska Medical Center to learn how a chain begun by an Omaha mother of seven had come together and how it is making a difference in the lives of the recipients, one as young as 5.

Until then, none had known how many were involved in what now ranks as the largest single-hospital living-donor kidney transplant chain in Nebraska history and one of the largest chains at a single hospital in the United States. Previously the medical center’s largest transplant exchange was a three-way exchange in July 2016."

Friday, June 16, 2017

Breast milk sales and bans

Cambodia is banning more than surrogacy (see Wednesday's post):
Ban on breast milk sales throws spotlight on growing international trade

"Cambodian authorities have permanently banned the sale and export of human breast milk after suspending exports from a US company that has been collecting it from impoverished mothers for more than two years.

The ban has put the spotlight on a global trade in breast milk to other mothers, bodybuilders, cancer patients and breast-milk fetishists.

 ...
Cambodian women have been earning between $US7 and $US10 ($9 to $13) a day for selling their milk to the company.

Ambrosia Labs issued a statement saying "we believe in empowering the mothers of Cambodia with a way to make money while nurturing their families, as well as others, through the donation of their excess milk".

"We work hard to set and monitor guidelines to ensure that we are not taking milk out of infants' mouths," the company said, adding it does not accept milk from mothers of infants younger than six months.

But Ing Kantha Phavi, Cambodia's Minister of Women's Affairs, said the sale of breast milk could stunt children's growth and development and thwart the government's efforts to promote breastfeeding among new mothers.

The ban has been welcomed by the United Nations' children's agency, UNICEF, in a country where breastfeeding has been in decline.

"Breast milk could be considered as human tissue, the same as blood, and as such, its commercialisation in Cambodia should not be supported," the agency said.

"Cambodian welfare groups also welcomed the ban.

"Even if women agree to do it voluntarily, they often have no other choices and face economic pressure," said Ros Sopheap, the director of the women's rights group Gender and Development for Cambodia."
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In related news, here's a story from the South China Morning Post, about what appears to be a small but growing domestic market:
Chinese mums cash in on latest and lucrative craze: selling surplus breast milk
Although the trade is not large, the commodity can sell online for as much as US$22 per 250ml

Thursday, June 15, 2017

Morishima Lecture at the LSE: Marketplaces and Market Design--live webcast, June 15

I'll speak on Marketplaces and Market Design




Marketplaces and Market Design


Hosted by STICERD

OLD THEATRE, OLD BUILDING




Speaker


Professor Alvin Roth

Professor Alvin Roth




Chair


Professor Nava Ashraf

Professor Nava Ashraf




Nobel laureate Alvin Roth will deliver this year’s Morishima Lecture on the topics of game theory, market design and experimental economics.
Alvin Roth is the Craig and Susan Shaw Professor of Economics at Stanford University. He was awarded the 2012 Nobel Memorial Prize in Economics Sciences jointly with Lloyd Shapley, for their work on the theory of stable allocations and the practice of market design. 
Nava Ashraf is Professor of Economics at the London School of Economics and Political Science. She is also Director of Research of the Marshall Institute for Philanthropy and Social Entrepreneurship.
STICERD (@STICERD_LSE) brings together world-class academics to put economics and related disciplines at the forefront of research and policy. Founded in 1978 by the renowned Japanese economist Michio Morishima, with donations from Suntory and Toyota, we are a thriving research community within the LSE.  

Wednesday, June 14, 2017

Surrogacy in Southeast Asia gets complicated

This Week in Asia has the story:
HOW ASIA’S SURROGATE MOTHERS BECAME A CROSS-BORDER BUSINESS
Clampdowns on surrogacy in Cambodia, Thailand and India have led to the emergence of complex, cross-border operations that put women, children and would-be parents at greater risk than before
BY AUDREY WILSON

"Since surrogacy brokers began recruiting women from a sleepy community in Cambodia’s Takeo province last year, they seem to have knocked on every door except for that of village chief Ouk Savouen. By his estimates, at least a dozen women in the village, an hour’s drive from Phnom Penh, have delivered babies for foreign couples.

"When Savouen reported the matter to police in 2016 there was little they could do as at that time the industry was operating in a legal grey area. A lack of government regulation against the practice had made Cambodia popular with foreign couples (“intended parents”) seeking surrogate mothers – and this popularity had only grown following decisions to ban the practice in India, Nepal and neighbouring Thailand.

"So the recruiters kept coming. In Savouen’s village – where many families owe informal debts and gambling is popular, even among women – offers from brokers seeking surrogates were particularly tempting. A standard payment for a pregnancy would be in the region of US$10,000, more than five times the annual wage for a garment worker and enough to build a new home or pay off a loan.

"In October, there was what Savouen viewed as a breakthrough: the health ministry followed other countries in the region by deciding to ban foreigners from seeking commercial surrogacy within its borders.

"That decision may have been welcomed by people like Savouen, but it’s had a host of unintended, and unpleasant consequences, not least among them the chaos it has caused for surrogates and intended parents whose embryos were implanted before the decision was made. The ensuing chaos forced Phnom Penh in recent weeks to announce an “exit strategy” for such children, though dozens of intended parents are still reporting problems in taking custody of their newborns.

"More worryingly, say campaigners, is that the decision, alongside other countries’ clampdowns on surrogacy, has led to the emergence of a new, unregulated cross-border industry that exists outside any national jurisdiction and puts women, children and parents at greater risk than before.

"It is now not uncommon for a couple in one country to pay a surrogate in a second, via an agency in a third, for a child that will be born in a fourth, all in an effort to comply with the letter of the law in the various jurisdictions. And while such arrangements help agencies skirt the legal issues, critics say they make it easier for one side or another to cheat on payment issues and, in the worst case scenarios, give rise to fears over human-trafficking.
...
"Since the ban in Cambodia, intended parents are increasingly being directed to Laos. “Laos is now in the position Cambodia was in early 2016,” said US organisation Sensible Surrogacy. “There is no law, so surrogacy is permitted only because the government has not stepped in to regulate the practice yet.”

"Several companies mention operations in Laos on their websites, including Thailand-based New Genetics Global, which left Cambodia immediately after the ban, and Laos Fertility, which is based in the US. Talent IVF Asia is operating in Vientiane with Laotian surrogates, according to Families through Surrogacy.

"A representative for Laos Fertility said its clinic had opened in Vientiane after the clampdown in Thailand and provided a price list, with hospital service fees listed in Thai baht. Its website states that surrogate mothers remain with their families during the pregnancy.

"Embryos are implanted in surrogate mothers in Vientiane while the women often receive prenatal, delivery, and postnatal care in another country, such as Thailand.
...
"The shift towards cross-border trade has presented other issues. In April, a Thai man was arrested at the Laos border carrying semen in a nitrogen tank bound for a clinic in Vientiane. New Genetics Global recommends that intended parents travel to Laos to donate sperm, Lam said.
...
"Experts warn women, children and parents remain at risk. “Wherever surrogacy is unregulated, there are reports that surrogates are vulnerable and don’t always get the money promised,” said Patricia Fronek, a professor at Griffith University in Australia who specialises in surrogacy and adoption. She added that intended parents were often asked for more money than originally agreed. Fronek also said there was “a legal question about trafficking when women are transported across borders”.

Tuesday, June 13, 2017

Yesterday was Loving Day: 50 years of legal inter-racial marriage throughout the United States

Yesterday was Loving Day, the anniversary of the Supreme Court decision on June 12, 1967 in the case of Loving v. Virginia, that bans on interracial marriage were unconstitutional.

I don't think anyone can help being reminded of the Supreme Court decision on June 26, 2015, that decided that bans on same sex marriage were unconstitutional (in the less fortuitously named case of OBERGEFELL ET AL. v. HODGES, DIRECTOR, OHIO DEPARTMENT OF HEALTH, ET AL.).

Here's the NY Times, on a couple married in 1950 in California: ‘We Are Not Unusual Anymore’: 50 Years of Mixed-Race Marriage in U.S.

"When they married in Oakland in 1950, mixed-race marriage had just become legal in California, the result of a lawsuit that reached the State Supreme Court. They are among the oldest living interracial couples legally married in the United States. It would be nearly two decades before all couples like them across the country were allowed to marry.

On Monday, they will mark the 50th anniversary of Loving v. Virginia, the United States Supreme Court case that overturned antimiscegenation laws nationwide. Mildred and Richard Loving, a black woman and a white man, had been sentenced to a year in a Virginia prison for marrying each other. The case would serve as a basis for the Supreme Court decision allowing same-sex marriage."

Monday, June 12, 2017

Organ preservation could bring big changes to transplantation

Transplantation would be a lot less hectic if organs could be preserved. Here's a 42-author paper (the biggest coauthorship I've been involved in) that discusses some of the possibilities.

The promise of organ and tissue preservation to transform medicine 
 Sebastian Giwa, Jedediah K Lewis, Luis Alvarez, Robert Langer, Alvin E Roth, George M Church, James F Markmann, David H Sachs, Anil Chandraker, Jason A Wertheim, Martine Rothblatt, Edward S Boyden, Elling Eidbo, W P Andrew Lee, Bohdan Pomahac, Gerald Brandacher, David M Weinstock, Gloria Elliott, David Nelson, Jason P Acker, Korkut Uygun, Boris Schmalz, Brad P Weegman, Alessandro Tocchio, Greg M Fahy, Kenneth B Storey, Boris Rubinsky, John Bischof, Janet A W Elliott, Teresa K Woodruff, G John Morris, Utkan Demirci, Kelvin G M Brockbank, Erik J Woods, Robert N Ben, John G Baust, Dayong Gao, Barry Fuller, Yoed Rabin, David C Kravitz, Michael J Taylor & Mehmet Toner

Nature Biotechnology 35, 530–542 (2017) doi:10.1038/nbt.3889
Published online 07 June 2017
Abstract: The ability to replace organs and tissues on demand could save or improve millions of lives each year globally and create public health benefits on par with curing cancer. Unmet needs for organ and tissue preservation place enormous logistical limitations on transplantation, regenerative medicine, drug discovery, and a variety of rapidly advancing areas spanning biomedicine. A growing coalition of researchers, clinicians, advocacy organizations, academic institutions, and other stakeholders has assembled to address the unmet need for preservation advances, outlining remaining challenges and identifying areas of underinvestment and untapped opportunities. Meanwhile, recent discoveries provide proofs of principle for breakthroughs in a family of research areas surrounding biopreservation. These developments indicate that a new paradigm, integrating multiple existing preservation approaches and new technologies that have flourished in the past 10 years, could transform preservation research. Capitalizing on these opportunities will require engagement across many research areas and stakeholder groups. A coordinated effort is needed to expedite preservation advances that can transform several areas of medicine and medical science.
View full text

Sunday, June 11, 2017

Portable hemodialysis?

When I was in Trento I was approached by a team from an Italian-Californian startup that is trying to develop a portable hemodialysis system that could fit in the overhead compartment on a plane, or could allow a van to become a mobile dialysis provider.  Here's their webpage: EasyDial, and good luck to them.

Saturday, June 10, 2017

FutureEd

FutureEd is a new(ish) educational think tank at Georgetown, founded by veteran Ed writer Thomas Toch.


"FutureEd is an independent, solution-oriented think tank at Georgetown University's McCourt School of Public Policy. We are committed to bringing fresh energy to the causes of excellence, equity, and efficiency in K-12 and higher education on behalf of the nation's disadvantaged students. As a nonpartisan, public-facing organization, we work to produce clear, compelling analysis on key education issues for policymakers, practitioners, the media, and other key education change agents and influencers at the federal, state, and local levels—promoting smart policymaking in a complex and fast-changing educational landscape."

School choice is one of the topics they cover.

Friday, June 9, 2017

Snippets of Advice to Young Economists

During the AEA meetings in January, the Lindau festival recorded some short video snippets. Here's an edited collection of words of advice for young economists from eight old ones...

Thursday, June 8, 2017

California's right to die law: early days

The Mercury News brings us up to date on California's right to die law
California’s right-to-die law: Patients struggling to find doctors who will help
"It’s been nearly a year since California began allowing terminally ill residents to end their lives with the help of a physician. And for Ray Perman, the right-to-die law worked exactly as lawmakers intended.

"On Feb. 4, as his family gathered around his bed, the 64-year-old Piedmont resident ingested a lethal dose of sedatives and passed away peacefully — in his own home, on his own terms — after years of battling cancer.
...
"But for many other Californians, the End of Life Option Act — which took effect June 9, 2016 — has led to a desperate race against time. Frustrated and unable to care for themselves, these terminal patients have frantically searched to find the required two physicians they must work with to terminate their lives.

"Add in the law’s mandated 15-day waiting period between the two oral requests they must make to the two doctors for the medication and it’s often too late to follow through with their plans.
...
“At this stage in the law, it’s a little bit of a hard road,’’ said Judith Geisser, a retired attorney who lives in Oakland.
"Geisser watched as her dying brother’s oncologists — one in Santa Rosa who had treated him for colorectal cancer, another in San Francisco who had diagnosed his subsequent brain cancer — politely declined to help him die, or even refer him to colleagues who would.
...
"Geisser offers this advice to anyone who wants to take advantage of the law: Start your search for the two physicians sooner rather than later.

“When you’re not healthy, and not at your best, that’s not the time to manage the path through this law,’’ said Geisser, who was forced to scramble to find a physician to help her 67-year-old brother Pat fulfill his last wish.
...
"Opponents of the law, including Californians Against Assisted Suicide, have watched its implementation with dread and cite a litany of concerns.

“It’s bad policy,’’ said the group’s spokesman, Tim Rosales.

"He said there are too many loopholes in the law, including the fact that the law doesn’t require those patients receiving lethal prescriptions to get any type of counseling beforehand from a mental health professional. In addition, he said, “there’s no requirement that somebody who stood to gain financially from that individual’s passing could not be involved in the process.’’
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see my earlier post:

Friday, June 10, 2016

Wednesday, June 7, 2017

Alex Peysakhovich is thriving at Facebook

Here's Alex Peysakhovich, on a list of  top 30 thinkers under 30

ALEXANDER PEYSAKHOVICH'S THEORY ON ARTIFICIAL INTELLIGENCE

"Alexander Peysakhovich is technically a behavioral economist, but he bristles a bit at being defined that narrowly. He's a scientist in Facebook's artificial intelligence research lab, as well as a prolific scholar, having posted five papers in 2016 alone. He has a Ph.D. from Harvard University, where he won a teaching award, and has published articles in the New York Times, Wired, and several prestigious academic journals.

Despite these accomplishments, Peysakhovich says, "I'm most proud of the fact that I've managed to learn enough of lots of different fields so that I can work on problems that I'm interested in using those methods. I've co-authored with economists, game theorists, computer scientists, neuroscientists, psychologists, evolutionary biologists, and statisticians."

Peysakhovich's interdisciplinary work is driven by his deep interest in understanding decision-making—both human and machine—and by his desire to figure out how artificial intelligence can improve our decision-making processes. He builds tools that help people make better choices, and machines that can turn data into, as he puts it, "not just correlations but actual causal relationships."
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The photo in the article comes from Alex's dissertation defense at Harvard (in 2012, when I was already at Stanford, hence that particular picture...)

Tuesday, June 6, 2017

Frank Delmonico and the recent organ transplant meeting at the Vatican

When I was in Trento, I participated in a panel on markets for human organs, and had the chance to ask Dr. Ignazio Marino about the recent
Vatican statement on organ transplantation, which I pointed out seemed to conflate killing prisoners for their organs with much more ordinary attempts to increase voluntary organ donation.  Dr Marino replied that this had been part of the diplomacy involved with the Chinese delegation.

Here's an article about the backstory to some of that diplomacy, and the role played by my old friend Frank Delmonico

One doctor’s war against global organ trafficking
By Ryan Connelly Holmes And Dan Sagalyn May 29, 2017

"A controversy was brewing. Delmonico, a leading voice on ethical organ transplantation, had planned a February 2017 summit in Rome for representatives of more than 40 countries to discuss the ethics of transplanting organs and to sign a pledge to uphold high standards.

"But there was a hitch: A key invitee to the forum was Dr. Jiefu Huang, who has led reform of China’s organ donation practices. Critics, including some in the Vatican, wanted at the summit no representatives of China, which for years sold and transplanted organs from executed prisoners.

"Delmonico, however, saw the Chinese presence as a good thing. It was “an opportunity for them to proclaim a new day and be accountable” that the practice has stopped, he said. In fact, some of the Chinese old guard have attacked Huang because of his efforts to stamp out unethical and corrupt methods of obtaining organs.
...
"Pope Francis did not attend, but Marcelo Sánchez Sorondo, the chancellor of the Pontifical Academy of Sciences did. In a significant development, China signed the summit’s statement condemning the use of organs from prisoners and advocating the creation of national laws to prosecute transplant-related crimes. Beijing’s two delegates were joined by 75 other signatories representing more than 50 institutions and more than 40 nations at the conference. Delmonico called it a “seminal event” in the fight for global reform."
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I hope that this effort at diplomacy, aimed at ending the practice of using executions as the primary source of organs in China, will not be a source of confusion regarding attempts to increase the availability of organ transplants by ethical means.

Monday, June 5, 2017

More from the Festival of Economics Trento

I'm back home, after two exciting days in Trento (and two long days of travel). There are a bunch of videos, and some press coverage, for those of you who speak Italian or like to use Google Translate.

You can hear the videos in English if you click on the URL, then start the video by clicking on the arrow in the middle of the screen, and then clicking on the gear icon in the lower right hand corner to select English. (It isn't enough to just click on the English symbol in the upper right...)

Here's a 1 minute video in English, a sort of trailer for my talk on global kidney exchange:

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Here's a link to the full video of my first talk, on global kidney exchange.
Mercato e disuguaglianze nella salute

The questions and answer period begins at minute 44, with a question by the eminent transplant nephrologist Giuseppe Remuzzi about his concern (which he mentions is also Frank Delmonico's) that the Philippines and Mexico, where Global Kidney Exchange has begun, are places where there is not only transplant infrastructure, but also illegal, black market organ trafficking.  He ends by saying that he remains to be (but hopes to be) convinced that GKE is a good idea.
My answer begins at minute 46:40.
I replied in part "One reason people get kidneys in illegal black markets is that they don't have better opportunities.  We would like to provide them with a better opportunity..."


Here's a video of the panel on my book: Matchmaking. La scienza economica del dare a ciascuno il suo  Play Video  It begins with a talk about the book, by Professor Dino Gerardi.  Afterwards I spoke in reply to questions from the moderator and the audience, and you can hear me in Italian translation.


And here's the panel on markets for organs "exploitation or opportunity?" also in Italian:
Mercati per il corpo umano: sfruttamento o opportunità?
I very much enjoyed meeting Ignazio Marino, the transplant surgeon who was for a time Mayor of Rome.

Below are some news reports on these sessions
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Here's a news story right after my talk on global kidney exchange, which was introduced by Tito Boeri:
"Il sistema delle catene" per donare gli organi
Al Teatro Sociale il Nobel Roth descrive il suo progetto per incrociare pazienti e donatori di Paesi ricchi e poveri
G-translate: "The Chain" system for organ donation
Al Teatro Sociale Nobel Roth describes his project to meet patients and donors of rich and poor countries

and here:
Dai modelli matematici si possono salvare molte vite umane. Il Premio Nobel Alvin Roth a Trento
"From the mathematical models you can save lives. The Nobel Prize Alvin Roth in Trento
We die because we can not afford a transplant. Roth: "Our program intends to solve the problem by crossing supply and demand"
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Here's a story covering my "book talk," in which Prof Dino Gerardi talked about the Italian translation of Who Gets What and Why, and I answered questions:
Matchmaking. La scienza economica del dare a ciascuno il suo


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Here's a story about the panel discussion on markets for body parts, moderated by Mario Macis, with Nico Lacetera, me, and Ignazio Marino, the transplant surgeon who was  mayor of Rome:
Mercati per il corpo umano: sfruttamenti o opportunità
Il premio Nobel Roth ha dialogato con l'ex sindaco di Roma (e chirurgo) Marino su trapianti e denaro

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Here's a pre-festival story:
Oggi alle 16 l'inaugurazione al Palazzo della Provincia. Alle 18 al teatro Sociale l'apertura è affidata al Nobel Alvin Roth. Da domani anche la nostra emittente sarà in piazza S.Maria Maggiore 
Festival dell'economia, su il sipario


And here are two article from the Italian Jewish press:
Festival Economia – Pagine Ebraiche
Salute diseguale, in cerca di una cura
Pubblicato in Attualità il ‍‍30/05/2017 - 5

Il Nobel Alvin Roth a Pagine Ebraiche
“L’economia può riparare il mondo”

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Updates:

Business Insider Italia has an interview with Ignazio Marino:
Ignazio Marino: “Il mercato nero dei trapianti si può mettere all’angolo salvando molte vite”
(Google translate doesn't seem to do a good job turning it into English, but the very last sentence is
"Quello che ci ha mostrato Roth è un sistema trasparente e può togliere ossigeno ai trafficanti”.
GT renders that as 'What showed us Roth is a transparent system and can remove oxygen to "traffickers.'


Here's a story with an inflammatory headline but a reasonable account, as near as I can tell from Google Translate:
L'economista che vuole legalizzare il traffico d'organi per salvare ricchi (e poveri) del mondo
"The economist who wants to legalize organ trafficking to save the rich (and poor) in the world
"In the US there are 100 thousand people on the waiting list for a kidney transplant but only 12 thousand a year. In the Philippines you do not pay you dialysis. In China they were using executed prisoners as donors. The organs of the problem is global and the Nobel Alvin Roth has the answer (maybe): scambiamoceli among us"
by Francesco Floris, June 7, 2017 

Sunday, June 4, 2017

Old enough to drive, old enough to register to donate in Illinois

Here's the press release
Illinois Senate Unanimously Passes Legislation to Strengthen Organ Donor Registry
The "Drive for Life" Bill Would Allow 16- and 17-Year-Olds to Join State Registry

"SPRINGFIELD, Ill., May 16, 2017 /PRNewswire-USNewswire/ -- In an overwhelming bipartisan show of support, the Illinois State Senate unanimously passed (53-0) HB 1805, the "Drive for Life Bill".  Supported by the Secretary of State, a coalition of state legislators and Gift of Hope Organ and Tissue Donor Network and Mid-America Transplant, this critical legislation amends Section 6-117 of the Illinois Vehicle Code to allow Illinois residents 16 and older to join the organ donor registry. The bill will now be presented to Illinois Governor Bruce Rauner to sign into law.
...
"Illinois is one of only three states in the union that does not allow 16- and 17-year-olds to register their wishes to become organ donors. The "Drive for Life Act" would ensure all residents 16 and older may choose to officially join the First-Person Authorization Registry. While the law gives 16- and 17-year-olds the right to express their wishes, parents and legal guardians will maintain the right to give or revoke consent until the registered donors turn 18-years-old."

Saturday, June 3, 2017

Online markets for prostitutes, including children are difficult to abolish

Illegal markets are hard to close down, and that goes double for advertisements for illegal markets, in which free speech issues and third-party issues ('we just post ads, we don't vouch for the advertisers') may also be in play.

In this regard, see some of my earlier posts about the website Backpage, which is in various sorts of legal battles.

Some followups:

In the Washington Post: A movie about online sex-trafficking might actually get laws changed

"It’s tough getting a consensus on anything these days, but child sex abuse and human trafficking are generally considered indefensible crimes. So who’s defending them?

According to “I Am Jane Doe,” that would be Google. And Microsoft. And Facebook. And Yahoo.

Directed by Mary Mazzio (“Lemonade Stories,” “Underwater Dreams”) and coming to Netflix May 26 after a theatrical run earlier this year, the documentary advocates for victims of online trafficking while taking principal aim at the classified-ad website Backpage.com, a notorious venue for sex ads and transactions, many involving children. In its indictment of Backpage.com and the tech companies that are indirectly supporting the website, the film may also give a public relations boost to members of Congress working to tighten laws surrounding Internet liability.
...

According to Section 230 of the 1996 Communications Decency Act, online service providers cannot be held liable for third-party content. But that means if someone sells a 13-year-old on its pages, Backpage says, it isn’t responsible. And so far, court after court has agreed — to the relief of First Amendment absolutists, and the Silicon Valley companies mentioned above, which support, financially, organizations defending Backpage’s position.

...
Backpage was once part of Village Voice Media and is now owned by a Dutch firm, although founders Michael Lacey and Jim Larkin and chief executive Carl Ferrer have been named in the suits. “I Am Jane Doe” picks up the Backpage saga in 2010 with lawsuits filed by girls who were trafficked on its pages, and continues through a Senate subcommittee investigation led by Sen. Rob Portman (R-Ohio) in January, as well as criminal charges of pimping and money laundering brought by then-California Attorney General Kamala D. Harris, now a Democratic senator. It also focuses on the effort that has thus far made the most headway — a civil suit that continues in Washington state, piloted by lawyer Erik Bauer. Backpage will try to get that case dismissed during a summary judgment hearing Wednesday. A jury trial is scheduled for Oct. 9.
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In the meantime, the closing of Backpage's "adult" ads section hasn't shut down other ads:

Fox News: Prostitution still thrives on Backpage despite site shutdown of 'adult' section

The NY Times : Backpage’s Sex Ads Are Gone. Child Trafficking? Hardly.

"In the midst of a Senate investigation, a federal grand jury inquiry in Arizona, two federal lawsuits and criminal charges in California accusing Backpage’s operators of pimping children, the website abruptly bowed to pressure in January and replaced its sex ads with the word “Censored” in red.

Even so, Tiffany — a street name — did not stop using the site, she said. Instead, her ads moved to Backpage’s dating section. “New in town,” read a recent one, using words that have become code for selling sex. “Looking for someone to hang out with.” Other recent dating ads listed one female as “100% young” and suggested that “oh daddy can i be your candy.”

In the fight against child sex trafficking, shutting down an epicenter like Backpage was a major victory, but one against a relentless foe that quickly unfurled new tentacles. The demise of Backpage’s adult ads undermined the trade, but it also illustrated how difficult it is to stamp out the practice of selling children for sex. The crime is rarely punished with the full force of the law — charges like rape or statutory rape — officials say; in many places it leads to just a citation, instead of an arrest.

For Tiffany, 18, the demise of Backpage’s adult listings has made things far more unpredictable — and dangerous, she said. The old ads allowed her to try to vet customers by contacting them before meetings, via phone or text message. With far fewer inquiries from the dating ads, she said, her first encounters with men now take place more often on the street as she gets into cars in red light districts around the Bay Area."

Friday, June 2, 2017

Who can be parents in Italy? (Adoption by same sex couples...)

In Italy, Confusion and Division Over Same-Sex Parenting
Court ruling highlights conflicting views over the rights of homosexual couples as parents

"An Italian court’s decision to recognize two homosexual men as the fathers of twin children has exposed confusion and a deep divide in the country over parenting rights of same-sex couples.

It was disclosed earlier this week that a court in the northern Italian city of Trento granted the men full rights as parents to their six-year-old twins, who were born in Canada through surrogacy.

The gay community hailed the decision—the first to accord full parental rights to a non-biological father—as historic in a country that last year became one of the last in Europe to approve civil unions for gay couples. But the ruling kicked up controversy right away, with the head of the main group opposing the civil-unions bill saying it marked a “sad day for Italy.”
...
"The 2016 legislation approving civil unions stopped short of addressing broader questions of parental rights and other family law issues for same-sex couples. Political opposition was so fierce that lawmakers scotched any reference to adoption or parental rights to get the bill passed. As a result, Italian law today recognizes only the biological parent, and joint adoption by gay couples isn’t allowed.

Italian courts have been left to fill that gap in a haphazard way, with some judges approving adoption requests by gay partners of a biological parent and others turning them down. The result: up to 1,000 children of gay couples are caught in a legal limbo.
...
"Riccardo and Lorenzo, the Trento couple who released only their first names, sought to break new ground. The pair, an entrepreneur and a civil servant in their 50s who have been together for more than 20 years, were married in Canada. Their twins were born in Canada via surrogacy, a practice that is illegal in Italy. Canadian law allowed both men to be listed as the twins’ fathers on the birth certificate.

Once back in Italy, the couple sought to have the Italian state recognize the Canadian birth certificate, seeking a parental status that affords more rights than adoption in Italy. An adoptive parent’s relatives have no legal relation with the adopted children, who therefore have no legal status when it comes, for instance, to inheritance from grandparents. The court granted the couple’s request, effectively recognizing both men as fathers.

“[We] sought no more than to see our children’s legal family rights protected, just as with other families,” they said in a statement.

Nichi Vendola, a gay Italian politician and leader in the fight for same-sex rights, hailed the decision. “When you raise, care for and love a child, you’re a father, mother, parent,” he said.

In Italy, however, court decisions don’t set legal precedent, so the legislative gap remains for parliament to fill. With Italy headed to elections this year or next, there is little political appetite to take up the bruising battle over parenting rights again."

Thursday, June 1, 2017

Remembering when deceased donor transplantation was regarded as repugnant

From New Zealand, a story with several notable features:
the patient received a heart-lung transplant, and her heart was successfully donated to another patient, at a time when deceased donation (and brain death) gave rise to some repugnance:
 Kay Burnett celebrates 30 years of a ground-breaking heart-lung transplant

"Sir Magdi Yacoub calls Burnett an outlier. One of the few who broke the statistics.  The 81-year-old transplant surgery veteran speaks from Egypt, where he still teaches. These days, Sir Magdi is a globally revered transplant pioneer. He has a professorship, a knighthood and a membership of the Queen's exclusive Order of Merit. But back then, as Burnett sat in a London flat awaiting her only hope at life, some were calling him a murderer.

"It's easy to forget that transplanting organs from braindead patients was once deeply polarising. "The hate was abundant," Sir Magdi says. He won't repeat the hate mail's contents, but there was a lot of it – "a lot, a lot, a lot". ...
They said he was killing a living person to take their heart. "But the patient is not living. If my brain is dead – I'm not there."

...

"The domino-donor idea was born of Sir Magdi's frustration at wasting useable hearts. At the time, lung transplants were technically risky – even today they have lower survival rates. But transplanting a heart and lung together ensured the pressure generated by the heart was matched exactly by the lung. It also ensured an instant blood supply, helping the windpipe heal immediately.

"But for those, like Burnett, who needed only a new lung, that meant binning a potentially functioning heart.

"We were very short of donor organs. We still are. So I did not want to be sending it to the pathology department when I could be transplanting it."

"And so domino-donor transplants were born. While the domino-donor hearts were compromised, having been subjected to high blood pressure from the lung, or pulmonary hypertension, Sir Magdi realised that could be an advantage. Heart patients with severe pulmonary hypertension could receive a heart pre-conditioned to that high pressure, which then normalises over time.

"Burnett's was not the first domino-donor transplant – that was undertaken by Sir Magdi 11 days earlier, on April 28. The heart-lung recipient survived; the heart recipient did not.

History now mostly says the first successful domino transplant was conducted in the United States, but contemporary news reports say Burnett's transplant happened just hours earlier. Burnett was all over the British press, with The Sun once reporting her dead.

Who was first is not important, Sir Magdi insists. What matters is learning from people such as Burnett and Andrew Whitby – another Harefield patient, named the longest-surviving heart-lung transplant recipient when his 30-year anniversary ticked over in 2015.

HT: Frank McCormick

Wednesday, May 31, 2017

Kidney donation today on behalf of a future recipient

Here's a forthcoming article in Transplantation, interesting for both what it says and who says it.

The authors include prominent transplant professionals at UCLA (which is an important, innovative and productive kidney transplant center), and also the rising-star economist and matching theorist Marek Pycia.  I recall a time when collaborations between economists and transplant professionals was unusual, and so I'm glad to see new collaborations of that sort arise.

The paper itself is about taking future care of young kidney patients who may need a (second or third) kidney donation later in life. The NKR and UCLA are implementing a voucher system that would allow a donor (e.g. the young patient's grandparent, or parent) to donate as a non-directed donor today, on behalf of a specific, current kidney patient, in return for a commitment that best efforts would be made to end some future kidney exchange chain with a chain-ending kidney for the designated patient, when the need arises.


Vouchers for Future Kidney Transplants to Overcome ‘Chronological
Incompatibility’ Between Living Donors and Recipients
Jeffrey L. Veale, M.D., , Alexander M. Capron, Nima Nassiri, Gabriel Danovitch, H. Albin Gritsch, Joseph Del Pizzo, Jim C. Hu, Marek Pycia, Suzanne McGuire, Marian Charlton, and Sandip Kapur,

Transplantation Published Ahead of Print DOI: 10.1097/TP.0000000000001744

Abstract
Background: The waiting list for kidney transplantation is long and growing. The creation of :vouchers" for future kidney transplants enables living donation to occur when optimal for the donor and transplantation to occur later, when and if needed by the recipient.

Methods: The donation of a kidney at a time that is optimal for the donor generates a :voucher‘" that only a specified recipient may redeem later when needed. The voucher provides the recipient with priority in being matched with a living donor from the end of a future transplantation chain. Besides its use in persons of advancing age with a limited window for donation, vouchers remove a disincentive to kidney donation, namely, a reluctance to donate now lest one‘s family member should need a transplant in the future.

Results: We describe the first 3 voucher cases, in which advancing age might otherwise have deprived the donors the opportunity to provide a kidney to a family member. These 3 voucher donations functioned in a nondirected fashion and triggered 25 transplants through kidney paired donation across the United States

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See my earlier post: 

Thursday, August 4, 2016




Tuesday, May 30, 2017

Health inequality at the Trento festival of economics, June 1-4

The city of Trento hosts a festival of economics each year. I'll be participating. Here's an English announcement of this year's theme:
Trento Economics Festival 2017: “the Unequal Health”

And here: Festival dell'Economia: 1-4 giugno

Here's the web page and program in Italian and in English (click on the Union Jack)

Here's a page describing the three events that I'll take part in on June 1 and 2. In the first I'll speak about market design and kidney exchange, in the second about my book, which recently came out in Italian, and the third event will be a panel discussion of repugnant transactions:

Mercato e disuguaglianze nella salute

introduce Tito Boeri In che misura facilitare l'incontro tra domanda e offerta di organi può salvare vite umane e...

0118:00
Visions

Market design, kidney exchange, and health inequality

introduced by Tito Boeri
To what extent can facilitating the bringing together of supply and demand for organs save human lives and reduce health inequality? In particular, is it possible to organise the exchange of kidneys efficiently, taking into account ethical and regulatory restrictions? To what extent is this exchange between rich and poor countries manageable on a global scale?
Teatro Sociale
0215:00

Matchmaking. La scienza economica del dare a ciascuno il suo

a cura di Einaudi ne discutono Dino Gerardi, Matteo Motterlini coordina Tonia Mastrobuoni



0218:30

Mercati per il corpo umano: sfruttamento o opportunità?

coordina Mario Macis In Italia così come in molti altri paesi, il fabbisogno di organi per trapianti è superiore...




0218:30
Intersections

Markets for the human body: exploitation or opportunity?

speaker and coordinator Mario Macis
In Italy, as in many other countries, the demand for transplant organs exceeds supply, and the gap is increasing over time. Is it possible to consider the idea that providing monetary payment for donors or other forms of exchange, as takes place in other countries, may contribute towards filling the gap between supply and demand? Is there not a risk of introducing unacceptable forms of exploitation and unfairness?
Palazzo della Provincia - Sala Depero

Monday, May 29, 2017

Matchmaking and market design: Italian interview

Here's an interview in Italian, largely on kidney exchange, published in advance of the Trento festival (which I plan to blog about tomorrow)
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Scambio di reni e matching markets, le ricette di Roth
Roth rivela l’intuizione e presenta l’ultimo libro: «Nei matching markets scegliamo e veniamo scelti»

Corriere di Verona28 May 2017Marika Damaggio

Sunday, May 28, 2017

Obstacles to Organ Donations: The Dire State of Kidney Transplantation--Cato Institute

Here's a panel discussion at the Cato Institute (pointed out to me in a comment on a previous post by Haksing Zimik):
Obstacles to Organ Donations: The Dire State of Kidney Transplantation

Featuring Ike Brannon, Visiting Fellow, Cato Institute; Jeremy Marcus, Legislative Director and Deputy Chief of Staff, Rep. Matt Cartwright; Sally Satel, M.D., Senior Fellow, American Enterprise Institute; Keith Melancon, M.D., Director, George Washington Transplant Institute; Kurt Schuler, Kidney Donor; moderated by Peter Russo, Director of Congressional Affairs, Cato Institute.

The video is 38 minutes of interesting, moderate discussion, and ends rather abruptly--I gather the discussion continued beyond the video.