Anticipating kidney exchange in Germany in the Frankfurter Allgemeine Zeitung

  Here's an op-ed in the Frankfurter Allgemeine Zeitung, celebrating the anticipated beginning of kidney exchange in Germany.

Der Volkswirt Hoffnung durch Tausch  by Ágnes Cseh, Christine Kurschat, Axel Ockenfels und Alvin E. Roth

Here's the English translation (from a slightly earlier draft):

Hope through exchange

Germany's new draft law on kidney donation

Imagine this: Your child needs a kidney transplant, but due to tissue incompatibility you cannot be a donor yourself. And it's the same for me. What if you donated a kidney to my child and I donated a kidney to yours in return? Through this ‘cross-donation’ we could give our children the chance of a longer life with a better quality of life.

In Germany, such cross-donations are not usually permitted. Only people who are ‘obviously close in a special personal relationship’, such as relatives and spouses, are allowed to donate kidneys. This is now set to change. The Federal Cabinet has presented a draft bill to amend the Transplantation Act, which would allow cross-donations and other forms of living kidney donation. These include ring exchanges with more than two participating couples as well as longer donor chains initiated by a non-directed, anonymous donation.

People who hear about cross-donation for the first time are sometimes skeptical. However, these concerns can be dispelled on closer inspection. In our neighboring countries and in many other countries, such donations have long been successfully established in compliance with the highest ethical standards.

In cross-donation, no prices are paid for kidneys and there is no trading in kidneys. A system in which potential cross-donors are registered and referred centrally can be implemented in an abuse-proof manner, as experience abroad has shown. The Ministry of Health's draft calls for a close relationship to continue to exist between donor and recipient who register together in the kidney donation program, but no longer necessarily between the donor of an organ and the recipient of the same organ. The couples involved can be guaranteed anonymity, so that mutual influence can be ruled out and at the same time the altruistic motive for donating to the next of kin remains unchanged.

But what happens if the donor has already donated their kidney, but the cross-donor suddenly cancels? To avoid such situations, the two kidneys are removed from the two donors at the same time, and the two patients also receive the two organs at the same time. The four surgical teams communicate in order to coordinate the procedure safely.

The argument that authorizing cross-donation could increase the pressure on potential donors does not stand up to closer scrutiny either. The option of cross-donation does not create any additional pressure that is not already exerted on compatible donors. Instead, cross-donation merely expands the pool of potential donors. 

Incidentally, cross-donation also shortens the waiting list for post-mortem donations, so that patients without donors can also be helped. At the same time, cross-donation can protect the legitimate interests of those people who do not wish to donate if it is implemented in a suitable institutionalized manner and the best possible information is provided.

Germany now has the opportunity to learn from the existing systems in Europe in order to avoid mistakes in the regulations and their implementation for the benefit of organ recipients and donors. This applies, for example, to the establishment of a nationwide kidney donation program, from funding and equipment to biomedical expertise. The Federal Ministry of Health is making important proposals here. The large gaps in data on potential donors and recipients could soon be closed, the option of enabling international coordination of cross-donations is being considered from the outset, and the transplant centres are being encouraged to register all donor-patient pairs centrally for referral. Without such regulations, individual clinics could be incentivized to only selectively register pairs, with the result that fewer transplants can be carried out overall.

Other aspects of the draft should be reconsidered. For example, it is not advisable that couples can only participate in the kidney exchange program if donor and recipient are incompatible. Compatible couples can receive a more suitable kidney through participation and at the same time other patients can be helped, as more cross-donations are made possible through participation. This in turn can shorten the waiting list for all patients who do not have their own donor and therefore cannot participate in the kidney exchange program.

It is good news that new forms of living organ donation are now also to be made possible in Germany. The precise organization of these new forms of organ donation is crucial to their success. It can be modelled on the experiences of other countries and at the same time adapted to the specific legal, historical and ethical framework conditions in Germany. The initial investment would be amortized very quickly through the savings in treatment costs for expensive dialysis. 

In view of the draft law, we are optimistic that the wish of many potential donors to help can be fulfilled in the future, thus improving the care situation for kidney patients in Germany.

Ágnes Cseh (University of Bayreuth), Christine Kurschat (University of Cologne), Axel Ockenfels (University of Cologne and Max Planck Institute for Research on Collective Goods in Bonn) and Alvin E. Roth (Stanford University)

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Here's the (rather opaque) graphic the newspaper created (maybe it's a celebration by kidneys):

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Here's a link to what I think was my first op-ed in German on allowing kidney exchange there...

Thursday, March 17, 2016

German organ transplant law should be amended or reinterpreted to allow kidney exchange: my op-ed in Der Tagesspiegel

Simulating kidney exchange policies in Germany

 Here are a set of simulations designed to help Germany establish a national (rather than a fragmented) kidney exchange system.

Itai Ashlagi, Ágnes Cseh, David Manlove, Axel Ockenfels & William Pettersson,  Designing a kidney exchange program in Germany: simulations and recommendations. Central European Journal of Operations Research  (2024). https://doi.org/10.1007/s10100-024-00933-0

"Abstract: We examine some of the opportunities and challenges concerned with establishing a centralized national kidney exchange program in Germany. Despite the many advantages of a national program, without deliberate design and policy intervention, a fragmented kidney exchange program may emerge. We study a number of collaboration strategies, and resulting simulations suggest that transplant centers may find it advantageous not to fully participate, resulting in a net reduction in the number of transplants. These results also suggest that allowing more forms of kidney exchange, such as three-way exchanges and non-directed donations, can significantly increase the number of transplants while making participation in a national program more attractive and thus national coordination and cooperation more robust. We propose a multi-level policy approach that is easy to implement and would promote an efficient German kidney exchange program that benefits recipients, donors and hospitals."

...

The concluding sentence of the paper is:

"Germany should establish a robust, well-functioning national KEP that can be easily and straightforwardly integrated into an international KEP."

###########

Background:

Thursday, July 18, 2024

Kidney exchange in Germany: draft of a proposed law

Kidney exchange in Germany: draft of a proposed law

 Yesterday the German Federal Cabinet published the draft of a law that would allow kidney exchange in Germany. Below is the text of the press release from the Ministry of Health,  via Google Translate. (Prof. Dr. Karl Lauterbach is the Federal Minister of Health.)

Lauterbach: Überkreuzspende gibt Nierenkranken Hoffnung  Cross-donation gives hope to kidney patients

July 17, 2024

"In the future, kidney donations should also be possible between two different couples. This is the aim of the draft of a third law amending the Transplantation Act - amendment of the regulations on living organ donation, which was approved by the Federal Cabinet today.

This makes it possible for a donor's kidney to go not only to their partner, but also to a recipient from a second couple who in turn donates a kidney (living cross-donation). At the same time, the law ensures increased protection for donors, who should receive better information and medical and psychosocial support.

Dying on the waiting list must come to an end. In the long term, we therefore need the opt-out solution. In the short term, we can make more organ donations possible through cross-donation: those who donate themselves can be helped more quickly in their personal environment. Up to now, living donations have only been possible between partners. In the future, it should also be possible between couples who are not so close. This initially gives hope to many kidney patients.

Federal Minister of Health Prof. Karl Lauterbach

The main changes

Cross-living kidney donations are made possible

Donation and receipt of a kidney “crosswise” by another organ donation partner in medically incompatible organ donation couples.

In the case of a cross-donation, the two couples no longer have to know each other - but the close relationship between the incompatible partners remains mandatory.

Regulation of non-directed anonymous kidney donations.

The tasks of the transplant centers in the context of a cross-living kidney donation and a non-directed anonymous kidney donation are regulated. The transplant centers decide on the acceptance of incompatible organ donation pairs and non-directed anonymous kidney donations from donors and transmit the data required for the placement to a central office for the placement of kidneys in the context of the cross-living kidney donation. After the placement decision has been made, the transplant centers concerned organize the removal and transfer jointly.

Establishment of a national program for the arrangement and implementation of cross-living kidney donations. A body for the arrangement of kidneys within the framework of cross-living kidney donations will be established or commissioned. The arrangement procedure will be laid down by law.

Distribution of kidneys in the context of cross-living kidney donations exclusively according to medical criteria and while maintaining anonymity. The authorization of the German Medical Association to determine the state of medical science in guidelines is expanded to include the rules for accepting and distributing kidneys from incompatible organ donation pairs and from non-directed anonymous kidney donations in the context of cross-living kidney donations.

The previously applicable principle of subsidiarity in Section 8 Paragraph 1 Sentence 1 Number 3 TPG is repealed in order to also enable preemptive kidney transplants.

Previously: removal of organs from a living person only if no post-mortem organ was available.

Donor protection is further strengthened

Expansion of the regulations to clarify and specify donor suitability.

Introduction of compulsory psychosocial counseling and evaluation. The necessary knowledge and skills for the

Psychodiagnostic evaluation and psychotherapeutic treatment can only be carried out by medical or psychological specialists with specific training or further education in psychological, psychosomatic or psychiatric issues (so-called mental health professionals). The independence of the expert ensures that the consultation and evaluation is not influenced by the transplant medical managers in the transplant center, that there are no professional dependencies with these managers and that the expert is solely committed to the interests of the donor. The requirements for the qualifications of the independent expert will in future be set out in the guidelines of the German Medical Association.

Individual support for donors through the introduction of a living donation companion who accompanies and advises the donor throughout the entire donation process in the transplant center. The living donation companion must be a doctor, nurse or person experienced in psychological or psychotherapeutic issues and must be professionally experienced and independent of the specific transplant process. He or she may not be involved in the removal or transfer of the organs, nor be subject to instructions from a doctor who is involved in these measures.

Introduction of federal legal requirements for the activities of living donation commissions.

Granting of additional points

Living kidney donors who themselves require a kidney transplant later in life due to an illness should receive additional points when kidneys are arranged, the amount of which should be determined in the guidelines of the German Medical Association."

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Axel Ockenfels writes:

" I took a quick look at the draft bill that was passed by the federal cabinet in Germany today and that would allow kidney exchange. There are many good aspects in the bill, such as the mandatory participation of hospitals in a national exchange program and the possibility of non-directed donations (which was more controversial), as we suggested to the Ministry in a paper by Ashlagi, Cseh, Manlove, Ockenfels and Pettersson.   

"I am happy to see that the draft seems to agree that the details of matching should be delegated to experts and not overly specified in the law, as suggested by Tayfun Sönmez, Utku Ünver and me in a comment on the previous draft, as well as by others.  

"One consequence of the previous draft would have been that non-directed donations would almost always have gone to patients on the waiting list and would not have been included in the kidney exchange. We advised against this and are happy to see that the draft bill document now states that "a non-directed anonymous kidney donation is in principle initially made in favour of a recipient of an incompatible organ donor pair" (p. 67, DeepL translation), and that it also allows chains of kidney donations initiated by non-directed donors (although I find the wording of the draft somewhat unclear in this respect).  

"We also strongly recommended that compatible pairs be allowed to participate in kidney exchanges, yet the bill would still make this impossible: "Participation as a pair of compatible organ donors and organ recipients in a crossover living kidney donation, on the other hand, is not envisaged, as a living organ donation would be immunologically possible in these pairs. There is therefore no need to enable cross-living kidney donation for these couples as well" (p. 66, DeepL translation). 

"This is unfortunate because the inclusion of compatible pairs has many benefits and can sometimes make everyone better off, including the patient in the compatible pair, additional donor-patient pairs, and patients on the waiting list. However, this may not be the last word, as there is still room for change in the upcoming legislative process. 

"The document also comments on the possibility of cross-border exchanges: "Commissioning the institution that already handles the procurement of post-mortem donated organs [namely Eurotransplant] also opens up the option of establishing an international programme - comparable to the exchange of post-mortem donated organs - within the Eurotransplant Network" (p. 31, DeepL translation)."

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Here are all my posts on Germany and kidney exchange.

Growth pains for legal marijuana, in Germany and New York

Transitioning from a thriving black market for marijuana to a regulated legal market isn't so easy.

The Guardian has the story from Germany, where so far clubs, but not shops, have been legalized:

Cannabis legalisation hampered by most German of substances: red tape. Activists say the rollout of laws permitting recreational use of the drug has been hampered by a ‘bureaucratic monster’  by Deborah Cole

"Joints now mingle openly with pints among fans watching the European football championship in host nation Germany, which in the spring became the first big EU country to legally allow personal recreational use of cannabis.

"That is, provided the fan is over 18, only carrying a small amount of the narcotic, not smoking in the stands of a stadium and not in possession of more than three plants at their officially registered home.

...

"The hotly disputed law passed by Olaf Scholz’s three-party coalition, which took effect in April, legalised cultivating up to three plants for private consumption, the possession of 50g (1.75oz) of cannabis at one time at home and 25g in public.

...

"A key phase began on 1 July with the establishment of registered cannabis clubs, which proponents say are vital to assuring the smooth path towards legal weed and supplanting the underworld street trade.

...

"In order to thwart drug tourism, members must have lived in Germany for six months, sign up to a club for a minimum of three months and have a clean criminal record for narcotics.

"Clubs are dependent on fee-paying members to start operating but are not allowed to advertise, said Marten Knopke of the Cannabis Social Club Leipzig, thus robbing them of a key source of capital needed to rent offices and land for growing purposes. Consumption on club premises is also verboten.

“We are subject to more restrictions than any alcohol company,” Knopke said, echoing a frequent complaint from the cannabis scene about drinking, which kills more than 60,000 people in Germany each year. “The government has also made it really difficult for us to stand up to the hidden [narcotics] market.”

...

“There are no shops where you can buy, meaning they [foreign tourists]" will end up buying something on the underground market, which is very dangerous in Berlin,” because of contaminated drugs and the role of the mafia in the trade, he said."

********

And here's the New York Times on New York:

The Real Problem With Legal Weed, By Charles Fain Lehman

"When New York legalized recreational marijuana in 2021, the future seemed bright. ...

"Three years later, things are not going to plan. Gov. Kathy Hochul has called New York’s legalization rollout “a disaster.” Mayor Eric Adams has spent months demanding that Albany fix the current system. “What happened?” The New Yorker recently asked in a feature on the collapse of the state’s marijuana “revolution.”

...

"There are around 140 recreational dispensaries operating statewide — about one for every 148,000 New Yorkers. Instead of shopping legally, New Yorkers tend to get their weed from the illegal shops that now blanket the state. Estimates suggest that there are anywhere from 2,000 to 8,000 in New York City alone, with uncounted more from Ithaca to Oneonta. Recent crackdowns have temporarily sealed more than 400 stores — only a small fraction of the total in the city.

"These shops undercut the legal stores, offering the same high at a fraction of the price. And they attract crime: There were 736 robbery complaints at unlicensed shops last year, according to the New York Police Department. Shootings are not uncommon, including the killing of a 36-year-old man captured on video last April.

"They also sell to teenagers, as The Times has reported. Teachers, prevention experts and pediatricians have raised the alarm about high schoolers smoking or vaping marijuana at school."

Child labor in soccer

Many laws seek to protect children from being exploited in the labor market, and there is widespread repugnance when it appears that such exploitation is taking place. (Think of the issues associated with children sewing soccer balls in Pakistan...)

But minors can also be professional athletes, and that turns out to be an issue in the Euro 2024 competitions, because star Spanish player Lamine Yamal is only 16 years old. (He was scouted at 6...)

Here's the story

Why Spain are Risking 30,000 Euro Fine by Playing Lamine Yamal at Euro 2024, by Robin Mumford 

"Yamal has started in each of Spain's group games so far, against Croatia and Italy, but a German law put Spain at risk of a €30,000 fine for his involvement in the game against Italy. That's because the German Youth Protection Act prohibits under-18s from working beyond a certain time - usually 8pm.

"Spain's first group game kicked off at 6pm local time, but their game against Italy started at 9pm. While there is an exceptional rule within the German law that authorises athletes to work until 11pm, the match finished very close to that time anyway, and post-match showers and interviews are also considered within the realms of labour, which means Spain may very well have met the conditions to be hit with a fine."

HT: Peter Biro

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The Centre for Sport and Human Rights has a White Paper called

CHILD LABOUR IN SPORT. Protecting the Rights of Child Athletes

Morals and the limits of markets, WZB Berlin, 11 - 12 July 2024

 Here's a conference that looks interesting:

Morals and the limits of markets, WZB Berlin, 11 - 12 July 2024

Organizers:  Hande Erkut and Dorothea Kübler

"The workshop will focus on the limits of markets, the morality of decisions in markets, and paternalism. It will bring together scholars from different disciplines (mainly economics, political science, and philosophy) who are working on these topics. The workshop aims to foster discussions across disciplines on the ethical considerations surrounding market activities, repugnant markets, and the government’s role in regulating such markets."

Preliminary Program:Preliminary Program:

Thursday, July 11, 2024

9:00 – 9.30 Registration/ Workshop Opening

9:30 – 10.50 Sandro Ambühl (University of Zurich)  Interventionist Preferences and the Welfare State: The Case of In-Kind Nutrition Assistance

Tammy Harel Ben Shahar (University of Haifa), Lean Out: On the Morality of Participating in Positional Competitions

10:50 – 11:10 Coffee Break

11:10 – 12:30 Benjamin Sachs-Cobbe (University of St Andrews) Taking Jobs and Doing Harm

Colin Sullivan (Purdue University) Paternalistic Discrimination

12.30 – 13:20 Lunch

13:20 – 15:20 Hande Erkut (WZB), Repugnant Transactions: The Role of Agency and Severe Consequences

Erik Malmqvist (Univeristy of Gothenburg)  How Exploitation Harms

Constanze Binder (Erasmus University Rotterdam) Universities and Markets: New Challenges to Academic Freedom

15:20 – 15:50 Coffee Break

15.50 – 17:10 Robert Stüber (NYU Abu Dhabi) Why High Incentives Cause Repugnance: A Framed Field Experiment + Do Prices Erode Values

Aksel Sterri (Oslo Metropolitan University)  Bodily Justice

17:30 Visit to Neue Nationalgalerie

19:00 Conference Dinner

Friday, July 12, 2024

9.30 – 10:50 Axel Ockenfels (University of Cologne)  The Demand and Supply of Paternalism

Søren Flinch Midtgaard (Aarhus University) Reaction Qualifications and Paternalism

10:50 – 11.10 Coffee Break

11:10 – 12:30 Roberto Weber (University of Zurich) What Money Shouldn’t Buy: Aversion to Monetary Incentives for Health Behaviors

Amy Thompson (Oxford University) Defending a Moral Limit to Markets: Beyond a Singular Asymmetry Thesis

12.30 – 13:30 Lunch

13:30 – 15:30 Sili Zhang (LMU Munich)  What Money Can Buy: How Market Exchange Promotes Values

Peter Dietsch (University of Victoria)  The Centrifugal Nature of the Labour Market, Justice, and Public  Policy

Rahel Jaeggi (Humboldt University Berlin)  TBA

15:30 – 16:40 Coffee Break / Poster Session

Miguel Abellán (University Lüneburg) Timo Heinrich (TU Hamburg)

Victor Chung (University of Toronto) Iliana Melero (University of Zaragoza)

Denise Feigl (University of Regensburg) Brandon Long (University at Buffalo)

Ben Grodeck (University of Exeter) Reha Tuncer (LISER)

16:40 – 18:00 Nicola Lacetera (University of Toronto) Save and Let Die? Economic Factors and the Support of Medically Assisted Death

Stefan Gosepath (Frei University Berlin) Containment of the Market

19:00 Farewell Dinner

Kidney exchange in Germany?

 A draft law to make kidney exchange legal in Germany, and to allow nondirected donation, is making some progress: here (with the help of Google Translate) is a news story on the proposed new law.

Living kidney donation should be made easier

"In order to reduce the organ shortage in Germany, Federal Health Minister Karl Lauterbach (SPD) wants to make living kidney donations easier. This emerges from a draft amendment to the Transplantation Act. The Star first reported.

"According to the draft, the previously prescribed “proximity ratio” for so-called cross donations will no longer apply in the future. To date, couples in which one person wants to donate a kidney to the other but this is not possible due to incompatibility are only allowed to “cross-donate” with another couple in a comparable situation if there is a close relationship between the couples. This is intended to prevent organ trafficking and commercialization.

"In the future, this cross donation could be made without proximity, thereby significantly expanding the circle of recipients. According to the draft bill, the donation should be anonymous and organized by transplant centers. The aim of anonymity is to prevent money from being paid for an organ.

"Anonymous kidney donations should also be possible in principle. In the future, people in Germany could donate a kidney for selfless reasons without knowing who it is going to. In countries like the USA, this option has existed for a long time."

HT: Dorothea Kubler

Organ donation day in Germany

 Yesterday was organ donation day in Germany. Here's a post from the German Health Economics Association (DGGÖ): Day of Organ Donation on June 3, 2023

"In Germany, there are about 8,500 people waiting for an organ donation (www.Bundesärztekammer.de). On the Day of Organ Donation, the German Society for Health Economics (dggö) wants to emphasize the urgency of increasing organ donation rates to improve the lives of these individuals. This applies equally to deceased organ donation and living donation. An international comparison also shows that there is room for improvement in Germany: Both in terms of living and deceased donations per million population, Germany lags behind in the EU (see Figure 1).

...

"On Wednesday, May 31, 2023, Nobel laureate in economics and professor at Stanford University, Alvin Roth, spoke to a broad audience in the 6th virtual dggö Talk (see https://www.dggoe.de/aktuelles for details) about the possibilities of kidney exchange between compatible but previously unknown pairs and the implementation of cross-over donations and exchange chains in the US.

"Unlike in the US, in Germany, living donation outside of close family is only possible if a close relationship between the donor and recipient has been officially confirmed. Alvin Roth noted in the case of cross-over kidney donations, that it was very complicated for German hospitals to build up and prove a close relationship between two pairs of donors in front of a commission. This should be simplified, especially considering the overall strong support for kidney exchange among the German population. As Figure 2 from a survey conducted by Roth and Wang (2020) illustrates, 79% even agree to kidney exchange across borders and outside of family and friends, although such an exchange is currently not legally possible in Germany.

*********

Earlier: 

Tuesday, May 30, 2023

Kidney exchange, around the world and in Germany? German Health Economics Association (DGGÖ) webinar 

Kidney exchange, around the world and in Germany? German Health Economics Association (DGGÖ) webinar tomorrow

Tomorrow  I'll be giving a talk in Germany (8am California time, 17:00 in Germany), hosted by the German Health Economics Association (DGGÖ).  (Bob Slonim will be giving a talk in this series in the summer.)

My title will be Kidney Exchange to increase transplantation: around the world, and in Germany?

(One big issue is that kidney exchange isn't yet supported in Germany.) 

There is a webinar address at the above link for those who might like to listen.

Market Design at the Max Planck Institute: Axel Ockenfels will become a Director, of ‘Economic Design & Behavior’

 Here's the announcement from the Max Planck Institutes:

Axel Ockenfels Appointed New Director at the Max Planck Institute for Research on Collective Goods in Bonn

"University of Cologne economist and expert in market design will establish the research department ‘Economic Design & Behavior’ at the MPI in addition to his work at the University of Cologne

"Axel Ockenfels, professor at the University of Cologne, will become a new director at the Max Planck Institute for Research on Collective Goods in Bonn in August 2023. He will establish a new department there, to be called ‘Economic Design & Behavior’. Its aim will be to design market, incentive, and decision architectures, based on modern behavioral research. Professor Dr. Ockenfels will thus complement the departments of Professor Dr. Matthias Sutter and Professor Dr. Christoph Engel at the institute, which focus on behavioral research from an economic and legal perspective. He will continue to teach and conduct research at the University of Cologne.

"As a faculty member of the University of Cologne, Professor Ockenfels heads the Cologne Laboratory for Economic Research and coordinates both the ‘Center for Social and Economic Behavior’ and the research division ‘Market Design & Behavior’ of the Cologne-Bonn Cluster of Excellence, ECONtribute. His appointment to the MPI in Bonn will further intensify the cooperation between the Faculty of Management, Economics and Social Sciences at the University of Cologne and the MPI in Bonn, a cooperation that has already contributed to the creation of a prestigious research center for economic behavior and design research in recent years.

...

"The new department at the Bonn MPI will also investigate ethical aspects of institutions and behavior as well as the opportunities and risks of modern computer technology for new markets. Most recently, Ockenfels has contributed to crisis management, for example with proposals for a market design to secure the supply of vaccines, to avoid supply disruptions in the energy sector, and to reduce energy consumption.

...

"Brief CV Axel Ockenfels

"Axel Ockenfels studied economics at the University of Bonn until 1994. He received his doctorate and habilitation from the University of Magdeburg, with periods abroad at Penn State University and Harvard University. Subsequently, he was Emmy-Noether Junior Research Group Leader at the Max Planck Institute for Economics in Jena. In 2003, he became Professor of Economics at the University of Cologne. Research periods have taken him to Stanford University and, currently, to the University of California in San Diego, among other places.

"In 2005, Ockenfels became the first economist in 17 years to be awarded the Gottfried Wilhelm Leibniz Prize of the German Research Foundation (DFG). He is a member of the National Academy of Sciences Leopoldina, the Berlin-Brandenburg Academy of Sciences and Humanities, the North Rhine-Westphalian Academy of Sciences and Arts, and the National Academy of Science and Engineering (acatech). He also sits at the Economists’ Round Table in the Federal Chancellery and on the Scientific Advisory Board at the Federal Ministry of Economics and Climate Protection (BMWK)."

Surrogacy guidelines: necessity, not convenience

 As surrogacy becomes increasingly well established in the U.S., it is regulated not only by state laws, but  also via voluntary standards put forward by trade organizations as conditions of membership.

One is  the SOCIETY FOR ETHICS IN EGG DONATION AND SURROGACY (SEEDS), which calls itself "a nonprofit organization founded by a group of egg donation and surrogacy agencies, whose purpose is to define and promote ethical behavior by all parties involved in third party reproduction." 

They have a set of guidelines published this year which member organizations are supposed to subscribe to.  One of those guidelines seems to say that surrogacy agencies should only work with intended parents who can't have children on their own. That is, they want to facilitate surrogacies that they regard as necessary rather than those that might be merely convenient.

SOCIETY FOR ETHICS IN EGG DONATION AND SURROGACY, STANDARDS of ETHICAL CONDUCT for SEEDS MEMBER AGENCIES

"24.Agency Screening of Intended Parents

"a. An Agency shall not provide service to Intended Parents unless they demonstrate a need for surrogacy associated with a disease, condition or status characterized by:

"i. the failure to establish a pregnancy or to carry a pregnancy to live birth after regular, unprotected sexual intercourse;

"ii. a person’s inability to reproduce either as a single individual or with their partner without medical intervention; or

"iii. a licensed physician’s or mental health professional’s findings based on a patient’s medical, psychological, sexual, and reproductive history, age, physical findings and/or diagnostic testing. 

*******

The legal blog Above the Law has a post about this:

Should 'Social Surrogacy' Be Permitted? by Ellen Trachman

It says in part:

"What does the law say? States like Louisiana and Illinois specifically require documented medical need of intended parents in a surrogacy arrangement to comply with the state surrogacy law. Louisiana requires that a doctor “who has medically treated the intended mother … submits a signed affidavit certifying that in utero embryo transfer with a gestational carrier is medically necessary to assist in reproduction.”

"Utah previously required “medical evidence … show[ing] that the intended mother is unable to bear a child or is unable to do so without unreasonable risk.” But that provision was struck down by the State Supreme Court after determining it was unconstitutional as applied to a same-sex male couple and could not be read a in gender-neutral way. (The SEEDS standard is, by contrast, gender neutral.)

"Other states with surrogacy-specific statutes — like California, Washington, Colorado, New Jersey, and New York — are silent on medical need and, therefore, implicitly permit social surrogacy arrangements. And then those states with no surrogacy law, much of the country, permit social surrogacy by default.

"The SEEDS standard, of course, only applies to member agencies and does not prevent nonmember agencies from supporting social surrogacy arrangements or for those arrangements to occur independent of agencies."

***********

Stephanie Wang and I anticipated to some extent that this could be an issue in our paper

Roth, Alvin E. and Stephanie W. Wang, “Popular Repugnance Contrasts with Legal Bans on Controversial Markets,” Proceedings of the National Academy of Sciences (PNAS),  August 18, 2020 117 (33) 19792-19798.

We surveyed populations in the U.S. and several other countries on transactions that were legal in some of them and illegal in others. We presented vignettes, and asked if they should be legal.  Because we wanted to give surrogacy a good chance of being perceived as repugnant, we made clear in the surrogacy vignette that there was no medical necessity, it was sought for convenience:

"James and Erica are a married couple in [home country]. They want to have a child, but Erica does not want to become pregnant due to the demands of her career as a model. Maria is a married mother in the Philippines. Maria’s husband is out of work, and Maria has decided to become a surrogate mother to earn additional income. James and Erica hire Maria to carry and give birth to a child from James and Erica’s sperm and egg. James and Erica pay Maria a year’s average income in the Philippines, and everyone signs a contract making it clear that James and Erica are the child’s biological parents and will have custody after the child is born."

You can see in the paper (or in this 2020 blog post) that (even) under these circumstances, clear majorities favored making this kind of voluntary surrogacy legal, not only in the U.S. and Philippines where surrogacy is legal, but also in Spain and Germany where surrogacy is illegal.

Multiple offer mechanisms in school choice, when information gathering is costly

 When it's costly to gather information needed to inform yourself about your own preferences, having a guaranteed offer in hand may justify the effort to gather necessary information.  Here's a paper that considers that as a first order issue:

The Case for Dynamic Multi-offer Mechanisms, by Julien Grenet YingHua He Dorothea Kübler

January 2022, (Forthcoming: The Journal of Political Economy)

Abstract: We document quasi-experimental evidence against the common assumption in the matching literature that agents have full information on their own preferences. In Germany’s university admissions, the first stages of the Gale-Shapley algorithm are implemented in real time, allowing for multiple offers per student. We demonstrate that non-exploding early offers are accepted more often than later offers, despite not being more desirable. These results, together with survey evidence and a theoretical model, are consistent with students’ costly discovery of preferences. A novel dynamic multi-offer mechanism that batches early offers improves matching efficiency by informing students of offer availability before preference discovery.

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Update: the paper appears as

Grenet, Julien, YingHua He, and Dorothea Kübler. "Preference Discovery in University Admissions: The Case for Dynamic Multi-offer Mechanisms." Journal of Political Economy, volume 130, number 6, June 2022, 1427-1476,  https://www.journals.uchicago.edu/doi/epdf/10.1086/718983

A step towards kidney exchange in Germany

 Here's an announcement of the German Medical Association's endorsement of kidney exchange, in the Deutsches Ärzteblatt.

Ärztetag spricht sich für Cross-over-Lebend­spende aus Mittwoch, 3. November 2021

Google translate: Doctors' day advocates cross-over living donation

"Berlin - The 125th German Medical Association (DÄT) has spoken out in favor of expanding the number of living organ donors. From the point of view of the medical parliament, a cross-over living donation - as it is already allowed in other countries - should also be made possible in Germany in the future.

"New legal regulations are required for this. Specifically, paragraph 8, approach 1 of the Transplantation Act (TPG) would have to be expanded, a donor-recipient pair can agree with a suitable second pair that two living organ donations are carried out crosswise (i.e. donor A / recipient B and vice versa).

"Living organ donation must be reorganized and rethought based on the current state of science," said Günther Matheis, President of the Rhineland-Palatinate Medical Association ( LÄKRLP ), at yesterday's debate.

T"he TPG currently limits the donor-recipient group for living organ donation to first- or second-degree relatives, spouses, fiancés or other persons who are obviously particularly close to the donor. The DÄT believes that a similar fate can bind people who have not been known to one another just as closely as people who are close to one another.

"In view of over 9,000 patients on the waiting lists who are urgently waiting for a life-sustaining transplant and the still far too low number of available donor organs, possible changes to the regulations on living organ donation have long been discussed in Germany."

HT: Axel Ockenfels

Earlier posts: https://marketdesigner.blogspot.com/search?q=Germany+AND+kidney&max-results=20&by-date=true

Course allocation at the Technical University of Munich, by Martin Bichler and Soeren Merting

 Here's a paper describing a recently designed and implemented course assignment system at the Technical University of Munich:

Randomized Scheduling Mechanisms: Assigning Course Seats in a Fair and Efficient Way  by Martin Bichler and Soeren Merting

Abstract: Course assignment is a very widespread problem in education and beyond. Typically, students have preferences for bundles of course seats or course schedules over the week, but courses have limited capacity. This is an interesting and frequent application of distributed scheduling, where payments cannot be used to implement the efficient allocation. First-Come First-Served (FCFS) is simple and the most widely used assignment rule in practice, but it leads to inefficient outcomes and envy in the allocation. It was recently shown that randomized economic mechanisms that do not require monetary transfers can have attractive economic and computational properties, which were considered incompatible for deterministic alternatives. We use a mixed-methods design including field and laboratory experiments, a survey, and simulations to analyze such randomized mechanisms empirically. Implementing randomized scheduling in the field also required us to develop a solution to a new preference elicitation problem that is central to these mechanisms. The results of our empirical work shed light on the advantages that randomized scheduling mechanisms have over FCFS in the field, but also on the challenges. The resulting course assignment system was adopted permanently and is now used to solve course assignment problems with more than 1700 students every year.

Course allocation at Eötvös Loránd University, by Attila Rusznák, Péter Biró, and Rita Fleiner)

At Eötvös Loránd University in Hungary, there's a course allocation system that gives rise to intense course exchange after its official conclusion (some of which may be planned in advance). Here's a description and analysis:

Seat transfers in the course allocation mechanism of Eötvös Loránd University  by A. Rusznák, P. Biró and R. Fleiner, 2021 IEEE 15th International Symposium on Applied Computational Intelligence and Informatics (SACI), 2021, pp. 503-508, doi: 10.1109/SACI51354.2021.9465548.

"Abstract: We initiate the study of the course allocation mechanism of the largest Hungarian university, ELTE, based on a real data provided for three semesters in 2018-2019. Besides introducing their priority based mechanism and the structure of their course registration data provided, we analyse a special issue coming from a students’ survey related to seat transfer. We identify the seat transfer actions in the last stage of the mechanism from the data that we describe in a transfer graph, and we analyse this network observing interesting patterns."

"In Hungary the course allocations are conducted at every major university by the same administrative system, called Neptun, and most universities use a simple first-come-first-served method. However, the largest university in Hungary, ELTE, uses a three-phase priority-based method [12]. In the first phase the students can submit their most preferred bundles, and the university admission may adjust the quotas of the courses based on these initial inputs. The second phase is the most important, where the students are ranked at each course based on a scoring system and lottery for breaking ties. They have a week to select their best bundles, but the mechanism is dynamic, the students can be unsure whether they will really get admission to a course. After finalising the assignment based on priorities and quotas, in the third phase of the mechanism a simple first-come-first-served method is used to allocate the remaining open slots. This final round also facilitates the informal seat transfers and swaps, a topic that we focus on in this paper. We conducted an online survey at ELTE sent to all registered students, and we received more than 3000 replies in total, so we could identify the main practices and issues for this priority based mechanism. We also received the complete course allocation record from their Neptun system for three recent semesters in 2018-2019. We will use this rich data to check the issues and strategies reported in the students’ survey, starting with the analysis of the seat transfers and swaps in the last stage of the mechanism.

...

"One of most critical comments was concerned with the rejection of the students even from their main courses that fits in their ideal curriculum. Some students mentioned that they could only get admission to some of their important courses by getting a favour from another student, who had higher priority at that course, so could take it in the second stage, and then transfer the course to them in the third stage. The transfer can be observed in the data as the withdrawal of a student and an almost immediate registration by another student. In this paper we initiate the study of this issue by studying the course allocation record of ELTE for the years of 2018-2019, that we describe in the next section."

A glimmer of hope for German kidney transplants: a discussion of kidney exchange

 Axel Ockenfels (who, along with Dorothea Kubler has been at the forefront of advocating for kidney exchange in Germany) forwards me this announcement (translated from German):

"the German Federal Ministry of Health is organizing a digital symposium on Tuesday, June 29, 2021, from 09:30 to approx. 15:30 on the topic of "Expanding the donor pool for living organ donation - a perspective for Germany?", to which we cordially invite you. Please feel free to forward the invitation to interested parties from your industry.

"An organ transplant is often the only way to save the lives of seriously ill people or to restore their quality of life. In view of long waiting times for a post-mortem organ donation, the question of living donation sometimes arises. Living organ donation has been permitted in Germany since 1997 within narrow limits and under special conditions. The donor and recipient must be "manifestly close in a special personal bond." However, living donation may be excluded in such cases for medical reasons. In order to increase the chances of organ transplantation for patients who are affected by this, some countries have established so-called kidney exchange programs.

"The symposium will take a look at various possibilities for extending organ donation: What are the opportunities and risks associated with cross over donation, pooled donation and so-called non-directed living donation? What procedures are necessary to protect donors? These and other questions will be discussed from a medical, legal and ethical perspective with an interdisciplinary audience. 

"We would be delighted if you could contribute your expertise to the discussion and if we could welcome you at the event on

"Tuesday, June 29, 2021, 09:30 - approx. 15:30 hrs.

...

"welcome to the event. The invitation is explicitly transferable. 

"If you would like to attend the event, please register by June 28, 2021 at the following link: Event Management Tool link.

Yours sincerely

"Joachim Becker

"Head of the Department of Medical and Professional Law, Prevention

Translated with www.DeepL.com/Translator (free version)"

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This seems like a potentially very positive first step, despite (or maybe because) of the fact that it seems to be signed by the Ministry of Health's department of prevention... (Leiter der Abteilung Medizin- und Berufsrecht, Prävention)

A previous post observed that kidney exchange receives popular support in Germany:

Thursday, July 30, 2020

Surrogacy and global kidney exchange receive popular support even where banned, in PNAS by Roth and Wang

(It turns out that I have a lot of previous posts related to kidney exchange in Germany...)

Vaccine supply and delivery in Germany: I'm interviewed in Zeit

 Here's an interview in the German newspaper Zeit, in which I was asked in early February about the vaccine rollout here and there. (Google translate is pretty readable, although some of the Q&A is a bit garbled by the translation from English to German and re-translation back into English...)

"Die Welt kann es sich leisten, einiges zu bezahlen" Alvin Roth weiß, wie man begehrte Güter effizient verteilt. Er hat den Nobelpreis dafür bekommen. Ein Gespräch über knappen Impfstoff und wie er vermehrt werden kann.  Interview: Lisa Nienhaus

Google Translate: "The world can afford to pay a lot" Alvin Roth knows how to efficiently distribute desirable goods. He got the Nobel Prize for it. A conversation about scarce vaccine and how it can be propagated. Interview: Lisa Nienhaus February 15, 2021,

The interview starts off talking about congestion, and line jumping, and the tradeoffs between speed and fairness (and how it's really costly to allow some vaccine to expire unused in the name of fairness).  It then turns to shortages of vaccine in the near term:

ZEIT ONLINE: Attempts are being made to build new production facilities. But in Germany we are - to be honest - pretty late.

Roth: But now is not the time to give up. Everything we build now may help us in August. Even if Germany is running late, there is still time to expand production facilities. Especially since these systems would certainly not have to be destroyed after Covid. Being able to produce mRNA vaccines oneself is also a good thing in the future. Vaccine production is not that complicated. You can build production facilities anywhere. And you should too.

ZEIT ONLINE: It's not happening on a large scale yet. What to do?

Roth: Laws are really useful for that. Pfizer / BioNTech and Moderna could be forced to license the production technology to other German pharmaceutical companies.

ZEIT ONLINE: That sounds radical.

Roth: I only think it's logical. If you had a pharmaceutical company, you'd think, "I'm paid by the dose. I've got enough capacity to ship to the whole world in the next year and a half. Why should I hurry?" There is no need to set up production facilities just to supply the world in six months instead of 18. It doesn't make any difference from a business perspective. But for the German or American government, these two options are by no means equivalent. It is important that we vaccinate quickly. We need a lot more production capacity than the pharmaceutical companies think it makes sense.

ZEIT ONLINE: Economists rarely suggest such a strong market intervention. And that also applies to companies that we must first be grateful to because they show us a way out of lockdown.

Roth: It's a global pandemic. It is economically necessary to think about how to avert the damage to the economy. But of course you have to pay the manufacturers. Many forget that.

ZEIT ONLINE: How fair the companies think that probably depends on how much you pay them.

Roth: Yes. But the world can afford to pay a lot. Because the world economy is currently largely at a standstill. We have a multi-trillion dollar economy. Paying a billion to save a trillion is good business.

ZEIT ONLINE: Why is that not happening so far?

Roth: The pharmaceutical companies themselves don't think that way at the moment. But we need the vaccine now. And it's very expensive for the world to shut down its economy like that. If you lose a few percentage points of GDP growth in Germany, that's a huge number. And there is almost no amount to pay to license the vaccine that is not worth it.

Surrogacy and global kidney exchange receive popular support even where banned, in PNAS by Roth and Wang

Popular repugnance contrasts with legal bans on controversial markets
Alvin E. Roth and  Stephanie W. Wang
PNAS first published July 29, 2020 https://doi.org/10.1073/pnas.2005828117

reviewed by Nicola Lacetera and Mario Macis

Abstract: We study popular attitudes in Germany, Spain, the Philippines, and the United States toward three controversial markets—prostitution, surrogacy, and global kidney exchange (GKE). Of those markets, only prostitution is banned in the United States and the Philippines, and only prostitution is allowed in Germany and Spain. Unlike prostitution, majorities support legalization of surrogacy and GKE in all four countries. So, there is not a simple relation between public support for markets, or bans, and their legal and regulatory status. Because both markets and bans on markets require social support to work well, this sheds light on the prospects for effective regulation of controversial markets.

"Our main result is that (unlike prostitution) the laws banning surrogacy and GKE do not seem to reflect popular demand. Neither do these bans reflect that opponents of legalization feel more strongly than supporters.

...

"All three transactions are the subject of current debate in at least one of the countries we surveyed.¶¶ Based on the results of our surveys, we do not see entrenched popular resistance to either surrogacy or GKE (or simple kidney exchange) where it is presently illegal, and thus, we anticipate that efforts to lift or circumvent current restrictions are likely to be increasingly successful, while efforts to legalize or decriminalize prostitution where it is presently illegal may face greater opposition from the general public.

"Understanding these issues is important, not just for the hundreds of Spanish couples stranded outside of Spain while they look for a way to bring their surrogate children home and not just for the people in need of kidney exchange but for whom it is out of reach in Germany or in the Philippines. These issues are also of importance to social scientists in general and economists in particular. When markets enjoy social support, when they are banned, and when, in turn, bans are socially supported are questions that touch upon many transactions, particularly as social and economic interactions are increasingly globalized.

"Our findings suggest that the answer to these questions may not be found in general public sentiment in countries that ban markets or legalize them. Rather, we may have to look to the functioning of particular interested groups, perhaps with professional or even religious interests, that are able to influence legislation in the absence of strong views (or even interest) among the general public about the markets in question."

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Here's the published citation:

Roth, Alvin E. and Stephanie W. Wang, “Popular Repugnance Contrasts with Legal Bans on Controversial Markets,” Proceedings of the National Academy of Sciences (PNAS),  August 18, 2020 117 (33) 19792-19798; https://doi.org/10.1073/pnas.2005828117 

Death with dignity, in Germany

Medically assisted suicide, controversial everywhere, has come to Germany.

The Lancet reports:
Germany overturns ban on assisted suicide
Rob Hyde
Published:March 07, 2020DOI:https://doi.org/10.1016/S0140-6736(20)30533-X

"Germany's supreme court has lifted a ban on professionally assisted suicide in a landmark ruling. ...

"Following a campaign by doctors and terminally ill patients, Germany's supreme court has lifted a law which outlawed the provision of assisted-suicide services. These services could range from signing a prescription for a lethal overdose of sedatives, to providing consultation to terminally ill patients on how they could travel outside of Germany to end their lives legally.

"Speaking from Germany's Federal Constitutional Court in Karlsruhe, Judge Andreas Voßkuhle said the 2015 law—paragraph 217 of the German Criminal Code—did not allow a person either “the right to a self-determined death” or “the freedom to take one's life and seek help doing so”. This law, he said, therefore violated the German constitution, and was now void.

"The association Sterbehilfe Deutschland e.V. (Assisted Suicide Germany) was among those campaigning against paragraph 217. Roger Kusch, head of the organisation and Hamburg's former senator for justice, said that the ruling by the supreme court marked “…a wonderful day for our association, for the association members and also for all interested citizens.” He said the ruling meant that no-one now has to suffer the pressure “…from churches and from other people, who believe they have to influence the entire population and the whole of society.”

"Others, however, are less jubilant. Frank Ulrich Montgomery is president of the Standing Committee of European Doctors, which represents national medical associations across Europe. He fears that the supreme court's ruling will mean the principle of doctors preserving life could be rendered obsolete.
...
"“Euthanasia” comes from the Greek word euthanatos (which means easy death), and means taking steps to end an individual's life to relieve suffering. In a medical context, euthanasia refers to a doctor using painless means to end a person's life, providing the patient and the patient's family agree. Assisted suicide, by contrast, refers to when a person is helped to kill themselves. Switzerland has eight right-to-die clinics and is the European country most often associated with euthanasia. However, euthanasia and assisted suicide are legal not only in Switzerland, but also in Belgium, Luxembourg, and the Netherlands, although each country varies on how it defines both terms. In Germany, the issue of the state legalising euthanasia is highly sensitive, especially given that the Nazis used the same term to describe the murder of hundreds of thousands of disabled people."

Essential and inessential services under corona virus lockdown (guess before reading--coffee, cannabis, etc?)

We're under "shelter in place" orders in Santa Clara County, with everyone hunkering down, except for essential services:

Bay Area orders ‘shelter in place,’ only essential businesses open in 6 counties

"Six Bay Area counties announced “shelter in place” orders for all residents on Monday — the strictest measure of its kind yet in the continental United States — directing everyone to stay inside their homes and away from others as much as possible for the next three weeks in a desperate move to curb the rapid spread of coronavirus across the region.

"The directive was set to begin at 12:01 a.m. Tuesday and involves San Francisco, Santa Clara, San Mateo, Marin, Contra Costa and Alameda counties — a combined population of more than 6.7 million. It is to stay in place until at least April 7.
...
"Businesses that do not provide “essential” services must send workers home. Among those remaining open are grocery stores, pharmacies, restaurants for delivery only and hardware stores. "
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So I was glad to get this email from our local Stanford campus coffeehouse (which I agree is an essential service):

These Coupa Locations are still Open For Take-Out, Curbside-Pickup & Delivery
Today 9:00am - 3:00pm
 Green Library
571 Escondido Mall in Stanford
(nevertheless, our Wednesday morning market design coffee will meet by Zoom, while we shelter in place...)
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Schools are closed (I guess they might be both essential and sources of contagion).  This being California, there are other essential services:
San Francisco: Cannabis deemed as an essential medicine, dispensaries to remain open
"The San Francisco Department of Public Health released a statement on Tuesday letting San Francisco residents know dispensaries will remain open despite having a shelter in place order.

"The Department states cannabis is an essential medicine."

*************
Nevada is different:  Nevada Brothels Requiring Customers To Wear Masks

Germany (where prostitution is also legal) is different in a different way, Stephanie Wang forwarded this shelter in place announcement from Germany:
https://www.land.nrw/de/pressemitteilung/landesregierung-beschliesst-weitere-massnahmen-zur-eindaemmung-der-corona-virus
via Google translate, a list of what is inessential:
"Already on Sunday, the Ministry of Labor, Health and Social Affairs decrees that almost all leisure, sport, entertainment and educational offers in the country will be discontinued. As of Monday, all so-called "entertainment companies" such as bars, clubs, discotheques, arcades, theaters, cinemas and museums have to close. The same regulation applies to prostitution companies."