I just returned from a busy trip to Italy, that began with a talk to physicians in Rome about kidney exchange, after which I moved on to talk to students in Padua.
Both were fun in different ways. Here are some of the students gathered for a spritz after one of my talks in Padua.
Yesterday I had the pleasure of speaking about market design in the Aula Magna of the University of Padua, where Galileo lectured. Below is a video. I start to speak around minute 14:20.
Here is a video recording of my talk in Rome yesterday at the Istituto Superiore di Sanità. There are some introductions by people with vast accomplishments in Italian transplantation and kidney exchange, Giuseppe Feltrin (director of the National Transplant Center), Antonio Nicolò (professor of Economic Theory at the University of Padua) and Lucrezia Furian (Kidney and Pancreas Transplant Surgery Unit - Department of Surgical, Oncological and Gastroenterological Sciences of the University Hospital of Padua)*.
My talk begins at 27:55.
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*Although her web page didn't yet reflect this, Dr. Furian was very recently promoted to the rank of Full Professor of Surgery. Congratulations Lucrezia!
Following my talk in Rome today, I'll be speaking in Padua tomorrow and Wednesday, first giving a seminar on controversial markets, and then a public lecture on market design.
The Design of Markets. Una Nobel Lecture di Alvin Eliot Roth
"On Wednesday 8 May the University of Padua hosts the Nobel Lecture
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"The meeting opens with greetings from the vice-rector Antonio Parbonetti and the director of the Galilean School of Higher Studies, Gianguido Dall'Agata . The guest is introduced by Antonio Nicolò , coordinator of the Social Sciences Class of the Galilean School.
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"The Nobel Lecture, which is held in English , is open to the public . To participate, reservations are required
You can also follow the meeting via live streaming on YouTube .
The Padua Nobel Lecture by Alvin Eliot Roth is preceded, on Tuesday 7 May at 3pm, by a seminar aimed exclusively at professors, researchers, fellows of the Department of Economic Sciences of the University of Padua - dSEA .
The Economics Seminar is entitled " Controversial markets and repugnant transactions " and is held at the department headquarters in via del Santo 33 in Padua.
I'm traveling this weekend to help inaugurate the celebration of the 90th anniversary of Italy's Istituto Superiore di Sanità (Higher Institute of Health). Below is their press release, which also notes that my talk will mark the 20th anniversary of the publication of my paper with Tayfun Sonmez and Utku Unver:
Roth, Alvin E., Tayfun Sonmez, and M. Utku Unver, "Kidney Exchange," Quarterly Journal of Economics, 119, 2, May, 2004, 457-488
"Thanks to his work, 'crossover' kidney transplants are possible; next May 6th lectio magistralis in person and streaming.
"The cycle of scientific conferences that the Istituto Superiore di Sanità dedicates to the 90th anniversary of its foundation begins with a lectio magistralis by the Nobel Prize winner for economics Alvin Roth. On May 6th at 12.30 pm, Professor Roth, whose work has paved the way for the possibility of carrying out crossed kidney transplants between incompatible couples, will hold a keynote address entitled "Matching markets and organ transplantation".
"Exactly 20 years ago, in May 2004, Roth published "Kidney Exchange" in the Quarterly Journal of Economics (the oldest economic studies journal in the United States), the article in which the scholar exposed his "matching theory" by applying it to problem of compatibility between donor and recipient in living kidney transplantation and the need to find a sufficient number of donors for patients waiting for an organ. Roth demonstrated mathematically that, by cross-referencing the immunological data of all couples in which a healthy person wants to donate a kidney to a sick family member but cannot do so due to lack of compatibility, all patients could receive the organ they need. For his studies on stable allocations, defined by the Royal Swedish Academy as "a masterpiece of economic engineering", Roth was awarded the Nobel Prize in 2012.
"Starting from that first algorithm developed by Roth, today cross-kidney transplant programs between incompatible couples (called "crossover") have become a reality in many countries around the world: in Italy 132 transplants of this type have been carried out so far thanks to crossing of 85 pairs of donors and recipients, as part of a complex clinical and logistical program managed by the National Transplant Center which has so far involved 20 different hospitals. In 2023 alone there were 17 crossover transplants, of which 2 were carried out thanks to international exchange programmes: the first, last June, performed in Padua thanks to the crossing with two other Spanish couples, one in Bilbao and one in Barcelona, and the second in Vicenza, with an exchange organized with the Porto hospital.
"Professor Roth will hold his dissertation at the invitation of the National Transplant Center, the Galilean School of Higher Studies and the Department of Economic and Business Sciences of the University of Padua, the university at which the Stanford University economist will continue his series of conferences in Italy. The event, which will be held in the Pocchiari Hall of the Higher Institute of Health starting from 12.30, will be attended by Rocco Bellantone (president of the ISS), Giuseppe Feltrin (director of the National Transplant Center), Antonio Nicolò (professor of Economic Theory at the University of Padua) and Lucrezia Furian ( responsible for the Kidney and Pancreas Transplant Surgery Unit - Department of Surgical, Oncological and Gastroenterological Sciences of the University Hospital of Padua).
"It will be possible to follow the event in person (the request for accreditation can be made to ufficio.stampa@iss.it) and in streaming on the Institute's home page."
Italy-Portugal cross transplants. that click that saved two
"Thanks to a complex work of intervention planning and logistics, managed by the National Transplant Center, the Veneto Regional Transplant Center and the Portuguese institutions, the kidney of the Italian donor was removed in Vicenza and transplanted in Porto in a 41-year-old man while the Italian patient was transplanted with a kidney donated by a 36-year-old woman. The organs were harvested in the two centers simultaneously on the morning of 20 July. The Portuguese kidney arrived at Treviso airport at 2.10 pm on board a Lusitanian Air Force flight: the military delivered the organ to the regional transplant coordinator of the Veneto, Dr. Giuseppe Feltrin, receiving the Italian kidney in exchange. The 118 of Vicenza immediately transported the organ to San Bortolo where the transplantation began immediately. Both surgeries were successful and all recipients and donors went home in excellent condition."
Opposition to surrogacy in Italy has taken aim at the babies of same sex couples.
The NYT has the story:
Surrogacy Emerges as the Wedge Issue for Italy’s Hard Right. Prime Minister Giorgia Meloni has ordered municipalities to stop certifying foreign birth certificates for same-sex couples who used surrogacy, leaving some babies in a legal limbo. By Jason Horowitz
"the government of Prime Minister Giorgia Meloni ordered municipalities to obey a court ruling made in December and stop certifying foreign birth certificates of children born to Italian same-sex couples through surrogacy, which is illegal in Italy.
"The decision has left Martino Libero and several other children suspended in a legal limbo, depriving them of automatic Italian citizenship and residency rights like access to the country’s free health care system and nursery school.
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"Milan, a city that has long served as a cosmopolitan haven for same-sex couples in Italy, has for now complied with the Meloni government order and suspended issuing Italian birth certificates.
"Without official recognition, Libero Martino, 2 months old this month, will have to leave and re-enter the country every few months to remain legal. A court could eventually recognize one of the men as the biological father — they decline to say which one is the sperm donor — and then they could start a separate adoption process for the other.
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"Ms. Meloni’s government has sought to shift the issue away from the status of the children to the practice of surrogacy, which, while legal in the United States and Canada, is illegal or restricted in much of Europe outside of Greece, Ukraine and a few other countries. In Italy, home of the Vatican, it is not only illegal, but it is also widely opposed, including among Catholic corners of the center-left opposition.
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"Prominent members of Ms. Meloni’s Brothers of Italy party have called surrogacy a crime “even worse than pedophilia,” in which gay couples, one of whom is usually the biological father, seek to “pass off” children as their own and mistake “children for Smurfs,” saying gay couples can uniquely afford surrogacy, even though it is overwhelmingly used more by heterosexual couples.
"The party is floating a proposal, made by Ms. Meloni when she was a member of Parliament, to make Italians’ seeking of surrogate births abroad — what she had called “procreative tourism” — illegal and “punishable with three months to two years of prison and a fine of 600,000 to a million euros.”
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"In an interview shortly before her election, as her young daughter ran around her in a Sardinia courtyard, Ms. Meloni said she opposed gay marriage, not because she was homophobic — “I’ve got many, many homosexual friends” — but because she saw it as a step to same-sex adoption, which she opposed, and which the Roman Catholic Church successfully lobbied to exclude from a civil unions law passed in 2016.
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Earlier:
It's hard to ban something that people want and need and is legally available in other jurisdictions, but it looks like Italy might try it regarding surrogacy. Here's a story from Britain's Sunday Times:
Italian families seeking surrogates abroad could face jail or €1 million fines by Tom Kington
"Italians travelling abroad to seek surrogate mothers to start families could face jail time and a million euro fine thanks to a new bill introduced by senators close to Giorgia Meloni, the Italian prime minister.
"The proposed law, which must be approved by the Italian parliament, describes surrogacy as “an execrable example of the commercialisation of the female body and the treatment of babies as merchandise”.
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"An Italian law passed in 2004 banned surrogate pregnancies in Italy, forcing couples to travel to countries such as the United States and Canada to find surrogate mothers."
Here's the announcement from Italy (in Italian), on the site of the Centro Nazionale Trapianti, the National Transplant Center:
Al via programma di trapianti incrociati di rene tra Italia e Usa, firmato l'accordo,
Google translate: "The pilot phase will cover the first three cases and will be limited to three hospitals : for Italy, the kidney transplant center of the Agostino Gemelli Polyclinic in Rome will participate, directed by Professor Franco Citterio, present at the signing of the agreement, while for the USA the University of Toledo Medical Center and the hospitals of Thomas Jefferson University in Philadelphia will be involved . Once the operational and management experimentation has been completed, the program will be re-evaluated for a possible consolidation of the protocol and for the progressive expansion to other living kidney transplant centers of the Italian network.
"The one with the United States is the second international exchange protocol activated by our country: since 2018 an agreement has been in force involving France, Portugal and Spain and which has resulted in three cross transplants with the latter nation. From 2015 to date, the Italian national crossover kidney transplant program has allowed 77 interventions to be carried out . Overall, 2,043 kidney transplants were performed in Italy in 2021, of which 341 from living donors: of these, 5 were carried out through an exchange between donor and recipient pairs. "
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Here's the announcement from the Alliance for Paired Kidney donation, the U.S. partner (in English):
PILOT KIDNEY EXCHANGE TRANSPLANT PROGRAM LAUNCHED BETWEEN US, ITALY
""The goal of the memorandum of understanding, which was signed at the Ministry of Health in Rome, is to provide for the possible treatment of thousands of patients awaiting kidney transplants in both the U.S. and Italy. The agreement was signed on behalf of CNT by its director, Massimo Cardillo, and by Michael A. Rees, MD, PhD, the CEO of APKD and the surgical director of kidney transplantation at the University of Toledo Medical Center in Ohio.
"The new US-Italy program concerns kidney exchange transplantation, in which incompatible living donor and recipient pairs are matched with other incompatible pairs for kidney transplants. Thanks to the agreement between APKD and CNT, incompatible American and Italian donor-recipient pairs will be able to exchange with each other based on a shared algorithm that will verify the level of compatibility between those on the countries’ transplant waiting lists. In this way, patients with kidney failure, who also have an incompatible volunteer donor, will have a greater chance of receiving the transplant they need.
"In addition to the technical-operational aspects – such as the requirements of the participating hospitals, matching algorithm and overall governance of the transplant process – the agreement provides that the costs related to the transplant procedure are borne by the U.S. insurance coverage for the U.S. recipient and the Italian donor, while the Italian National Health Service will cover the expenses for the Italian recipient and the American donor. Transplant surgeries will take place in the country where the recipient is located.
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A critical role was played by Dr. Ignacio Marino, the transplant surgeon who took time off to be the mayor of Rome and is now at Jefferson Hospital in Philadelphia.
His facebook post yesterday describes some details of the proceedings (first in Italian and then in English:
"The agreement was signed by the Italian National Transplant Centre (NTC), represented by director Massimo Cardillo, and the Alliance for Paired Kidney Donation (APKD), a non-profit organisation that runs one of the largest living kidney exchange programmes in the United States, represented by its CEO, Professor Michael A. Rees, MD PhD, director of the Kidney Transplant Centre at the University of Toledo Medical Center, Ohio. The signing of the protocol was attended by the Italian Deputy Minister for Health Pierpaolo Sileri, who has wholeheartedly supported this innovative project from the outlet."
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| Drs. Mike Rees and Ignazio Marino |
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Related earlier posts
The NYT has the story:
Man Paralyzed 12 Years Ago Becomes Italy’s First Assisted Suicide By Elisabetta Povoledo
"Paralyzed 12 years ago in a traffic accident, “Mario” faced a series of legal, bureaucratic and financial hurdles in his pursuit of death
"On Thursday, “Mario,” identified for the first time by his real name, Federico Carboni, ended his life, becoming Italy’s first legal assisted suicide, in his home in the central Italian port town of Senigallia.
"Mr. Carboni, an unmarried truck driver, was surrounded by his family, friends, and people who had helped him to achieve his goal, including officials with the Luca Coscioni Association, a right-to-die advocacy group that assisted Mr. Carboni during the past 18 months and announced his death.
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"An Italian court ruling has declared assisted suicide permissible in Italy under certain limited circumstances, but there is no legislation enshrining the practice, which for Mr. Carboni, led to delays.
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"In a landmark ruling in 2019, Italy’s Constitutional Court said that assisted suicide could not be considered a crime as long as certain conditions were met.
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"The Constitutional Court ruled that in some cases assisting someone could not be considered a crime as long as the person requesting aid met certain conditions: they had to have full mental capacity and suffer from an incurable disease that caused severe and intolerable physical or psychological distress. They also had to be kept alive by life-sustaining treatments.
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"The Roman Catholic Church is firmly opposed to assisted suicide and euthanasia, which it has called “intrinsically evil” acts “in every situation or circumstance.”
I anticipate that we will be reading more in the future about kidney exchange chains started by a deceased donor kidney. In the meantime, here are two recent papers:
From the American Journal of Transplantation:
Deceased donors as non‐directed donors in kidney paired donation
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/ajt.16268
As proof of concept, we simulate a revised kidney allocation system that includes deceased donor (DD) kidneys as chain‐initiating kidneys (DD‐CIK) in a kidney paired donation pool (KPDP), and estimate potential increases in number of transplants. We consider chains of length 2 in which the DD‐CIK gives to a candidate in the KPDP, and that candidate’s incompatible donor donates to the deceased donor (DD) waitlist. In simulations, we vary initial pool size, arrival rates of candidate/donor pairs and (living) non‐directed donors (NDDs), and delay time from entry to the KPDP until a candidate is eligible to receive a DD‐CIK. Using data on candidate/donor pairs and NDDs from the Alliance for Paired Kidney Donation, and the actual DDs from the Scientific Registry of Transplant Recipients (SRTR) data, simulations extend over two years. With an initial pool of 400, respective candidate and NDD arrival rates of two per day and 3 per month, and delay times for access to DD‐CIK of 6 months or less, including DD‐CIKs increases the number of transplants by at least 447 over two years, and greatly reduces waiting times of KPDP candidates. Potential effects on waitlist candidates are discussed as are policy and ethical issues.
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And from Transplant International:
Lucrezia Furian Antonio Nicolò Caterina Di Bella Massimo Cardillo Emanuele Cozzi Paolo Rigotti
First published: 09 August 2020 https://doi.org/10.1111/tri.13712
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/tri.13712
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Abstract: "Kidney paired donation (KPD) is a valuable way to overcome immunological incompatibility in the context of living donation, and several strategies have been implemented to boost its development. In this article, we reviewed the current state of the art in this field, with a particular focus on advanced KPD strategies, including the most recent idea of initiating living donor (LD) transplantation chains with a deceased‐donor (DD) kidney, first applied successfully in 2018. Since then, Italy has been running a national program in which a chain‐initiating kidney is selected from a DD pool and allocated to a recipient with an incompatible LD, and the LD’s kidney is transplanted into a patient on the waiting list (WL).
"At this stage, since the ethical and logistic issues have been managed appropriately, KPD starting with a DD has proved to be a feasible strategy. It enables transplants in recipients of incompatible pairs without the need for desensitizing and also benefits patients on the WL who are allocated chain‐ending kidneys from LDs (prioritizing sensitized patients and those on the WL for longer)."
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Previous posts:
The Washington Post has the story (as a tourist destination...)
Restaurants in Italy are reopening ancient ‘wine windows’ used during the plague
The coronavirus pandemic has inspired a comeback for the socially distant invention.
By Natalie B. Compton Add to list
"In the 1300s, Europeans lived in fear of the plague claiming lives across the continent. In 2020, Europeans face the threat of the coronavirus, a pandemic that has killed more than 728,000 worldwide.
..."Between the wrath of the Black Death in the 1300s and the Italian Plague in the 1600s, wine merchants in the Italian region of Tuscany built “wine windows” to protect buyers and sellers from coming into close contact."
"The socially distant precaution was ahead of its time."
8. Consider the figure: the LMIC mother wishes to donate to her daughter, and the HIC brother wishes to donate to his sister, but neither pair is able to proceed. Without transplantation, the LMIC daughter will die and the HIC sister will remain on dialysis. However, through GKE each patient receives a compatible kidney from the other patient’s donor. Furthermore, the savings attained in the HIC can also support long-term care of the LMIC donor and recipient in their home country.
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