Altruistic kidney donors in Israel

 The Forward has the story

Why Israel has more altruistic kidney donors than any other country in the world By Michele Chabin

"Israel is in the bottom half of countries when it comes to organs harvested after death, the type used in most transplants globally. ...

"But ...for more than a decade the number of Israelis who have donated kidneys while they are still alive and well has increased to the point that Israel is the worldwide leader in live donations per capita.

"That’s in large part thanks to the Jerusalem-based nonprofit ... Matnat Chaim, Hebrew for “gift of life,” which recruits and encourages individuals in good health to donate a kidney for purely altruistic reasons. 

"Of the more than 1,450 live kidney donations Matnat Chaim has facilitated, more than 80% percent were altruistic – donated by individuals who had no connection to the recipient. According to the group’s records, it made at least half of the matches between recipients and live donors in Israel from 2015 to 2022.

"Rabbi Yeshayahu Heber, whose life was saved by kidney from a live donor, founded Matnat Chaim in 2009 with his wife Rachel. Rabbi Heber, who died from COVID-19 in April 2020, had said he was moved to recruit volunteer donors after watching other kidney patients die for lack of transplants. 

"On Israel Independence Day this spring, Rachel Heber was awarded the prestigious Israel Prize in honor of the couple’s lifesaving work. 

...

Broadly speaking, the medical definition says that death occurs when the brain is no longer functioning, even if the heart is still beating. There are exceptions, but most ultra-Orthodox rabbis say death occurs when the heart stops beating and the person stops breathing.

“The problem is, if you wait until the heart stops, you can’t harvest the organs,” said Judy Singer, Matnat Chaim’s assistant director.

"For these reasons, Heber made it his mission to recruit live kidney donors.

"With other groups, including the Halachic Organ Donor Society and the Israel Transplant Authority, Matnat Chaim has convinced many religious Jewish communities to encourage members to donate altruistically. “Today, religious Jews, and haredim especially, are at the forefront of live kidney donations,” Singer said. “They say, I can’t donate an organ after death, but take my kidney and help someone now.”About 90% percent of Matnat Chaim’s kidney donors belong to the Modern Orthodox or ultra-Orthodox streams of Judaism.

“That number used to be 97%, but we’re always looking to increase the number of secular donors and Arab donors,” Singer said.

"The group has arranged for “many” Arab Israelis to receive transplants, she said, but did not share numbers for those recipients. Matnat Chaim is looking to work with an Arab group or individual to increase the number of Arab donors and recipients in the future, she added.

...

"According to the Ministry of Health, 656 transplants were carried out in Israel in 2022. Of those about half — 326 — came from living donors. By comparison in the U.S. that same year, about 15% of all organ donations came from living donors.

"Though transplant rates have been rising in both countries, many are still dying for lack of a donor. In Israel, 77 people died waiting for one in 2022."

 

Congress acts on deceased organ system

 Last week the House and Senate passed, and forwarded to the president an Act meant to facilitate the reform of the U.S. system for recovering and allocating deceased donor organs for transplant, by contracting with different firms for different tasks, i.e. by breaking up the monopoly presently operated by UNOS.:

H.R.2544 - Securing the U.S. Organ Procurement and Transplantation Network Act118th Congress (2023-2024) | Get alerts

BILL

Sponsor:	Rep. Bucshon, Larry [R-IN-8] (Introduced 04/10/2023)
Committees:	House - Energy and Commerce
Committee Meetings:	05/24/23 10:00AM 05/17/23 10:00AM 04/19/23 10:00AM (All Meetings)
Committee Reports:	H. Rept. 118-140
Latest Action:	Senate - 07/28/2023 Message on Senate action sent to the House.  (All Actions)
Tracker: Tip	This bill has the status Passed Senate Here are the steps for Status of Legislation: Introduced Passed House Passed Senate To President Became Law

“(1) IN GENERAL.—The Organ Procurement and Transplantation Network shall—

“(A) be operated through awards to public or private entities made by the Secretary ..."

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Here's a story in the Washington Post:

Congress authorizes overhaul of troubled organ transplant system  By Lenny Bernstein

"Congress approved a thorough revamp of the troubled U.S. organ transplant system Thursday, providing health officials with the authority to break monopoly control of the way kidneys, livers, lungs and other organs are delivered to sick patients.

"For 37 years, one nonprofit organization, the United Network for Organ Sharing, has held the federal contract to run the system, relying on a 1984 law that blocked almost all competition. With a unanimous vote Thursday night, the Senate rewrote the law to let the federal Health Resources and Services Administration break that stranglehold and solicit bids from other for-profit and nonprofit groups.

"The House approved the same measure Tuesday. President Biden is expected to sign it.

...

"Exactly how HRSA plans to redesign organ transplantation is still being worked out. The agency announced its intention to overhaul the system in March and went to Congress for the authority it needed."

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HRSA earlier this month held an OPTN Industry Day to start surfacing their (still evolving) plans to put out bids for both a transitional period and then for a next generation deceased-donor organ transplant system.

Here's the relevant HRSA page:

Organ Procurement and Transplantation Network Modernization Initiative

Drug markets: the replacement of agriculture by chemistry

Labs are replacing fields as the source of addictive drugs. Here are two stories, from National Affairs, and the Financial Times.

The current issue of National Affairs has this essay on drugs, drug use, and overdose deaths:

How to Think about the Drug Crisis by Charles Fain Lehman

"A reported 111,219 Americans died from a drug overdose in 2021. That figure has risen more or less unabated, and at an increasing pace, since the early 1990s. Back in 2011, 43,544 Americans died from a drug overdose — less than half the 2021 figure. Ten years earlier, in 2001, it was 21,705 — less than half as many again. And the problem keeps getting worse: The 2021 figure is nearly 50% higher than it was in 2019.

...

"The National Center for Health Statistics estimates that there were roughly 110,000 overdose deaths in the year ending December 2022 — essentially unchanged from a year earlier.

...

"Historically, illicit drugs — heroin, cocaine, marijuana, etc. — were derived from plants grown in fields or greenhouses. But licit pharmacology has long been able to use simple, widely available precursor chemicals to synthesize the active ingredients in these substances. This sidesteps the complex processes of farming altogether. At some point in the past several decades, drug-trafficking organizations learned to use the same techniques at scale. Using precursors sourced primarily from China, they now synthesize a variety of opioids — the class of drugs that includes heroin.

"The most widely known of these is fentanyl, a synthetic opioid conventionally used in anesthesia that is 50 times stronger than heroin. Some are stronger still — carfentanil, the most potent opioid known thus far, is roughly 100 times stronger than fentanyl. In 2021, synthetic opioids were involved in roughly two out of every three overdose deaths.

...

"Complicating the story further is the increasing purity and declining cost of methamphetamine, another synthetic drug with an exploding death rate. After synthetic opioids, methamphetamine is now the second most common cause of drug overdose death. It's also the only tracked drug where deaths not involving synthetic opioids are increasing. That these two lab-produced substances are replacing "organic" drugs at the same time is not a coincidence.

"Why have these drugs taken over the market? Because they're a much better value proposition for sellers. Synthetic drugs significantly reduce production costs, both because chemistry is less labor- and input-intensive per unit produced than farming and because lab production is much easier to obscure from interdiction efforts that drive up costs. Furthermore, because the potency per dose is higher, drug-smuggling operations can move a smaller amount of fentanyl than heroin for the same profit.

"Of course, the stronger the drug, the higher the risk of overdose. Drug-overdose death rates used to be low in part because for the first century or so of modern American drug use, the potency of illicit drugs was constrained by what traffickers could grow in a field. Synthetic drugs remove this limit."

********

And this from the FT:

How fentanyl changed the game for Mexico’s drug cartels.  by Christine Murray

"In the last decade, fentanyl has become the leading cause of death for young adults in the US. Mexico’s illegal drug trade has also adapted to the shift from plant-based drugs towards synthetics, creating a new, streamlined and highly profitable arm of the illicit business with fewer workers and lower costs — but just as much violence.

"The change has caused friction in two of Washington’s most important relationships, with China and Mexico.

...

"Instead of employing tens of thousands of agricultural labourers, the entire fentanyl industry in Mexico could function with “cooks” estimated to number in the hundreds, who were mostly not qualified chemists, Reuter said. Fentanyl’s growth appears to have hit heroin production in particular, with poppy growing in Mexico still well below its peaks, according to the UN Office for Drugs and Crime."

David M. Kreps Symposium: Homo economicus, Evolving. November 17, 2023

Homo economicus, Evolving

The Stanford Graduate School of Business is hosting the inaugural David M. Kreps Symposium, entitled Homo economicus, Evolving.

Inaugural Symposium

David M. Kreps Symposia comprise a series of symposia on topics of broad interest to the faculty of the Stanford Graduate School of Business. The series was created through the generous support of friends and alumni of Stanford GSB, to honor the career of Prof. Kreps.

Date

November 17, 2023

Location

Stanford Graduate School of Business

In orthodox economic models, the individual agent, Homo economicus, is self-interested and rational, with fixed preferences and perfect foresight. However, economists are increasingly modeling individuals who are generous to others, who have preferences that depend on the context and that change, and who have cognitive limitations. This evolving vision of Homo economicus has profound implications for what we learn from economic analyses. The symposium will discuss this continuing evolution of economists’ representations of people’s motives and cognitive capabilities, and the implications of this evolution for specific contexts and public policy and, more broadly, for the discipline.

Registeropen in new window

Featured Speakers

Samuel Bowlesopen in new window

Research Professor and Director of the Behavioral Sciences Program, Santa Fe Institute

Rachel Krantonopen in new window

James B. Duke Professor of Economics, Duke University

Uskali Mäkiopen in new window

Professor of Practical Philosophy, University of Helsinki; Director of TINT - Centre for Philosophy of Social Science

Eldar Shafiropen in new window

Class of 1987 Professor in Behavioral Science and Public Policy; Professor of Psychology and Public Affairs; Inaugural Director, Kahneman-Treisman Center for Behavioral Science & Public Policy, Princeton University

Kidney brouhaha in Israel: is a good deed still good when performed by a shmuck?

 Recently a three way kidney exchange was performed in Israel. This would have been unremarkable under most circumstances: Israel has an active kidney exchange system.  But it caused a strong reaction in the Israeli press, because one of the donors, a  well-known rightwing activist who wanted to donate a kidney so that his brother could receive one, announced that he wanted his kidney to go only to a Jew.

Here's the Ynet story (you can click to render it in English):

 kidney in a transplant marathon: "The condition was - only for a Jew

Here's the Times of Israel (already in English):

Right-wing journalist causes stir by announcing his kidney would go only to a Jew

There were many more, but you get the idea.  Some of the stories point out that the Israeli National Transplantation Center uses an algorithm* that doesn't see the religion of the recipient, so it's not clear that this was a declaration with consequences.  It was meant to provoke, and it did.

But it's a complicated issue.  In the U.S. (and in Israel), donations can be made to a specific individual, but not to a class of individuals.  With living donation, it means that the donor can choose a specific person to donate to, and it isn't an issue how they choose: no one has to donate an organ to anyone, and every donation saves a life (and maybe more than one, particularly since  living donation reduces competition for scarce deceased-donor kidneys). So if this donor had been able to donate to his brother, no one would have thought twice that he was glad to be donating to a fellow Jew.  What made his announcement provocative was that his kidney wasn't going to his brother: his brother was getting a kidney from an anonymous other donor. [Update clarification/correction: this donation was apparently an undirected (except for the 'only' condition) altruistic donation, not part of an exchange involving the donor's brother.]

Among the people I corresponded with about this is Martha Gershun, a kidney donor who thinks and writes clearly, and has given me permission to quote some of what she said.

"I’m wondering if we find the presentation of the story troubling:  “Right-wing journalist and Temple Mount activist causes stir by announcing his kidney would go only to a Jew.”  We would react badly to a story that said:  “Right-wing Trump supporter says he will only give his kidney to a white man.”

"What if instead the stories were:  “Observant Jewish father of 8 wants to donate to a fellow Jew” and “Rural man from West Virginia seeks to help another in his community”?  Would we find those stories more acceptable?"

Part of the feeling that this is a bit complicated has to do with the fact that we don't (and maybe shouldn't) look gift horses in the mouth, i.e. we don't and maybe shouldn't delve deeply into the motivation of altruistic acts that do a lot of good. We should applaud good deeds even if they aren't performed by saints. (I blogged yesterday, about paying it forward, an umbrella term for doing good deeds in a spirit of gratitude for having ourselves benefited  from past good deeds performed by others. We generally don't find it necessary to condition our approval on precisely who receives the forward-paid gifts.)

So, while I'm not sorry to see that this statement by a kidney donor is a much discussed provocation, I'm inclined to think that a good deed remains a mitzvah even if not performed by a tzadik, as we might have said in our New York English when I was growing up.

I'll give the last word to a Haaretz op-ed, also in English:

 Is It Kosher to Donate Kidneys Only to Other Jews?  A well-known religious journalist in Israel declared the " -only" donation of his kidney. His act is imperfect, but not immoral by Robby Berman

+++++++++++++++

*On the algorithm used in Israel and elsewhere, see e.g.

Wednesday, January 15, 2020 Kidney Exchange in Israel (supported by Itai Ashlagi)

and

Friday, October 1, 2021 Stanford celebrates Itai Ashlagi and the UAE-Israel kidney exchange

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

Update: related subsequent post 

Monday, July 31, 2023

Altruistic kidney donors in Israel

Paying it forward

 Scott Cunningham, an economist who devotes a lot of his efforts to providing public goods, recently had a post on the phrase "paying it forward." He writes that he connected it with a movie with a similar name, but has recently come to view it differently (for reasons I find too embarrassing to quote, but related to the fact that I use the phrase now and then.)

Wikipedia says "Pay it forward is an expression for describing the beneficiary of a good deed repaying the kindness to others instead of to the original benefactor."  It goes on to say "Robert Heinlein's 1951 novel Between Planets helped popularize the phrase."  I could have first seen it there, as I read much of Heinlein's science fiction when I was a boy.

My associations with the phrase now mostly come from the motivations and actions of some living kidney donors, particularly in kidney exchange chains.

The phrase is certainly is evocative of what we do so much of in academia (when we're doing academia well): it describes the relationship between studying and teaching, and between teachers and students.

********

Scott's post announced that, as part of paying things forward, he's funding a prize for young economists.

Incentives in matching markets: Counting and comparing manipulating agents by Bonkoungou and Nesterov

 Here's a paper that caught my eye in the current issue of Theoretical Economics, Volume 18, Issue 3 (July 2023)

Incentives in matching markets: Counting and comparing manipulating agents by Somouaoga Bonkoungou and Alexander Nesterov

Abstract: Manipulability is a threat to the successful design of centralized matching markets. However, in many applications some manipulation is inevitable and the designer wants to compare manipulable mechanisms to select the best among them.  We count the number of agents with an incentive to manipulate and rank mechanisms by their level of manipulability. This ranking sheds a new light on practical design decisions such as the design of the entry-level medical labor market in the United States, and school admissions systems in New York, Chicago, Denver, and many cities in Ghana and the United Kingdom.

"First, we consider the college admissions problem where both students and schools are strategic agents (Gale and Shapley (1962)) and schools can misreport their preferences as well as their capacities. We show that when all manipulations (by students as well as by schools) are considered, the student-proposing Gale–Shapley (GS) mechanism has the smallest number of manipulating agents among all stable matching mechanisms (Theorem 1). Dubins and Freedman (1981) and Roth (1982) show that this mechanism is not manipulable by students. This result was one of the main arguments in favor of its choice for the NRMP. However, it also has the largest number of manipulating schools among all stable mechanisms (Pathak and Sönmez (2013)). Our result still supports its choice when all strategic agents are considered. What is more, it is still the best choice even when schools can only misreport their capacities, but not their preferences. All these conclusions carry over to the general model where, in addition, students face ranking constraints: although the student-proposing GS mechanism is now manipulable by students, it is still the least manipulable mechanism.

"Second, we consider the school choice problem (Abdulkadiroglu and Sönmez ˘ (2003)) where students are the only strategic agents and also face ranking constraints. Historically, many school choice systems have used the constrained immediate acceptance (Boston) mechanism, but over time shifted toward the constrained student proposing GS mechanisms and relaxing the constraint. We demonstrate that the number of manipulating students (Theorem 2) weakly decreased as a result of these changes."

Algorithms, Approximation, and Learning in Market and Mechanism Design" November 6-9, 2023 in Berkeley (register for funding)

 Here's the announcement

Register for SLMath (MSRI) Workshop: "Algorithms, Approximation, and Learning in Market and Mechanism Design"  November 6-9, 2023 in Berkeley, California, Simons Laufer Mathematical Sciences Institute (SLMath)

Priority Funding Application Deadline: August 31, 2023

Speakers:

Monday, November 6, 2023: Matching Markets without Money

• Jiehua Chen (Technische Universität Wien)
• Federico Echenique (University of California, Berkeley)
• David Manlove (University of Glasgow)
• Alvin E. Roth (Stanford University)
• Jaychandran Sethuraman (Columbia University)

Tuesday, November 7, 2023: Non-Convex Auction Markets

• Elizabeth Baldwin (Merton College, University of Oxford)
• Paul Milgrom (Stanford University)
• Shmuel Oren (University of California, Berkeley)
• Rakesh Vohra (University of Pennsylvania)
• Yinyu Ye (Stanford University)

(Attendee reception follows Tuesday's events)

Wednesday, November 8, 2023: Algorithmic Mechanism Design

• Dirk Bergemann (Yale University)
• Michal Feldman (Tel-Aviv University)
• Jason Hartline (Northwestern University)
• Roger Myerson (University of Illinois, Chicago)
• Sigal Oren (Ben Gurion University of the Negev)

Thursday, November 9, 2023: Learning in Games and Markets

• Michael Jordan (University of California)
• David Parkes (Harvard University)
• Lillian Ratliff (University of California, Berkeley)
• Tuomas Sandholm (Carnegie Mellon University)
• Eva Tardos (Cornell University)

Organ trafficking, and how to reduce it -- Frederike Ambagtsheer in Conversation

Frederike Ambagtsheer, who studies illegal markets for organs and transplants,  has some sensible thoughts on how to combat organ trafficking, not least by increasing the availability of legal, ethical transplantation conducted in high quality hospitals.

Here she is in The Conversation:

Illegal organ trade is more sophisticated than one might think - who’s behind it and how it could be controlled  by Frederike Ambagtsheer

"The organ trade involves a variety of practices which range from excessive exploitation (trafficking) to voluntary, mutually agreed benefits (trade).

"These varieties warrant different, data-driven responses.

"For example, organ sellers are reluctant to report abuses because organ sales are criminalised and sellers will be held liable. Although many can be considered human trafficking victims and be offered protection, this rarely occurs. Law- and policymakers should therefore consider decriminalising organ sales (removing penalties in the law) and offer organ sellers protection, regardless of whether they agree to provide evidence that helps to dismantle criminal networks.

"Countries should also allow medical professionals to safely and anonymously report dubious transplant activity. This information can support the police and judiciary to investigate, disrupt and prosecute those who facilitate illegal organ transplants. Portugal and the UK already have successful organ trafficking reporting mechanisms in place.

"Finally, a contested example of a possible solution to reduce organ scarcity and avoid black market abuses is to allow payments or other types of rewards for deceased and living organ donation to increase organ donation rates. To test the efficacy and morality of these schemes, strictly controlled experiments would be needed.

...

" In short, rather than exclusively focusing on stricter laws, a broader range of responses is needed that both address the root causes of the problem and that help to disrupt organ trading networks."

***********

Here are all my posts that mention Dr. Ambagtsheer's work, which I've followed for more than a decade.

Modify NOTA: a new effort

 Ned Brooks, who has been a force in promoting living kidney donation, is turning his efforts towards a new organization, dedicated to modifying the National Organ Transplant Act (NOTA) of 1984, to allow some compensation of kidney donors.

Here's the organization's website:  Join the Coalition to Modify NOTA

The website starts off with a quote with which I'm in full agreement:

“It’s long past time to modify the 1984 National Organ Transplant Act.”   - Al Roth

*********

Recent related post:

Monday, July 10, 2023

Compensating kidney donors: a call to action by Brooks and Cavanaugh in the LA Times

The Cost of Inaction and the Urgent Need to Reform the U.S. Transplant System: participant statements

 Yesterday's Senate Finance committee hearings on The Cost of Inaction and the Urgent Need to Reform the U.S. Transplant System are on video, and the following witness statements (delivered beforehand) are now also available.

If you only have time to read one, I'd recommend clicking on the testimony of Matthew Wadsworth, the President And CEO of the OPO, Life Connection of Ohio.

Witnesses 

---

1. LaQuayia Goldring
   Patient
   Louisville , KY
   • Download Testimony
2. Molly J. McCarthy
   Vice Chair & Region 6 Patient Affairs Committee Representative
   Organ Procurement and Transplantation Network (OPTN)
   Redmond , WA
   • Download Testimony
3. Matthew Wadsworth
   President And CEO
   Life Connection of Ohio
   Kettering , OH
   • Download Testimony
4. Raymond J. Lynch, MD, MS, FACS
   Professor Of Surgery And Director Of Transplantation Quality And Outcomes
   Penn State Health Milton S. Hershey Medical Center
   Hershey , PA
   • Download Testimony
5. Donna R. Cryer, JD
   Founder And CEO
   Global Liver Institute
   Washington , DC

**********

Thursday, July 20, 2023

Senate Finance Subcommittee on Health Care --testimony on organ transplants, going on now

Senate Finance Subcommittee on Health Care --testimony on organ transplants, going on now

Watch right now or listen later.  UNOS is not popular in the Senate.

 https://www.c-span.org/video/?529461-1/health-advocates-testify-improving-organ-transplant-system

JULY 20, 2023

Health Advocates Testify on Improving Organ Transplant System

Patients and health professionals testify on the effectiveness of the organ transplant system before the Senate Finance Subcommittee on Health Care.

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Another set of links:Subcommittee Hearing

The Cost of Inaction and the Urgent Need to Reform the U.S. Transplant System

Subcommittee on Health CareDate: Thursday, July 20, 2023Time: 10:00 AMLocation: 215 Dirksen Senate Office Building