Kidney and liver donation: the movie trailer for Abundant

 You can see the 1.5-minute trailer for the movie here, or here.

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Earlier: 

Tuesday, September 24, 2024

Abundant: a moving documentary about living organ donors

HRSA has accepted bids to reform deceased donor organ allocation

 Here's yesterday's HRSA press release. (Item 2, Supporting OPTN IT Modernization, might be of most interest to most readers of this blog.)

In Historic Step, HRSA Makes First Ever Multi-Vendor Awards to Modernize the Nation’s Organ Transplant System and End the Current Contract Monopoly

U.S. Department of Health and Human Services
Health Resources and Services Administration

FOR IMMEDIATE RELEASE

September 19, 2024

HRSA NEWS ROOM

newsroom.hrsa.gov

Contact: HRSA PRESS OFFICE

Phone: 301-443-3376

Email: Press@hrsa.gov

As part of the Administration’s efforts, for the first time in the program’s nearly 40-year history, HRSA has awarded separate contracts to reform the organ procurement and transplant network. Multiple vendors will support improving quality and patient safety, modernizing IT, bolstering communications with patients, and more

Today, the Health Resources and Services Administration (HRSA) at the Department of Health and Hunan Services (HHS) announced the first ever multi-vendor contract awards to modernize the nation’s organ transplant system to improve transparency, performance, governance, and efficiency of the organ donation and transplantation system for the more than 100,000 people on the organ transplant waitlist.

The Organ Procurement and Transplantation Network (OPTN) has long faced critiques about lack of transparency, potential for conflicts of interest, IT reliability issues and other structural challenges. As part of the Administration’s transformation of the OPTN, for the first time in 40 years, multiple contractors will provide their expertise and proven experience to improve the national organ transplant system. This transition from a single vendor to multiple vendors to support OPTN operations is a critical step in advancing innovation in the transplant system to better serve patients and their families and implements the bipartisan Securing the U.S. Organ Procurement and Transplantation Network Act signed by the President in September 2023.

“With the life of more than 100,000 Americans at stake, no organ donated for transplantation should go to waste,” said HHS Secretary Xavier Becerra. “For too long, our organ transplant system has fallen short, mired in monopoly. The Biden-Harris Administration has reformed OPTN to require accountability in the operation of organ procurement that our transplant patients and their families demand.”

“One person is added to the waitlist every 10 minutes. Each one relies on and deserves the best care possible,” said HRSA Administrator Carole Johnson. “Today’s action marks a significant advancement in the Biden-Harris Administration’s commitment to doing what it takes to make sure the nation’s organ matching system works for patients, donors, and the families who depend on the OPTN for that life-saving call.”

HRSA is announcing multiple OPTN modernization awards to support critical actions, including:

1. Improving Patient Safety - Arbor Research Collaborative for Health will provide support on patient safety and the policy compliance systems and processes overseen by the OPTN Board of Directors and the Membership and Professional Standards Committee to improve oversight of the multiple entities in the OPTN.
2. Supporting OPTN IT Modernization - General Dynamic Information Technology (GDIT) will focus on the opportunities to improve the OPTN organ matching IT system and inform HRSA’s Next Generation IT procurement and development work.
3. Increasing Transparency and Public Engagement in OPTN Policy Development - Maximus Federal will advance opportunities to improve public visibility and engagement in the OPTN policy making process, including improving transparency around OPTN policy making committees’ deliberations and actions.
4. Strengthening Patient-Centered Communications - Deloitte will focus on improvements in communications from the OPTN, within the OPTN and, importantly, with patients and families.
5. Improving OPTN Financial Management - Guidehouse Digital will address improvements for OPTN’s budget development and management systems and processes.

In August 2024, HRSA announced that the OPTN Board of Directors—the governing board that develops national organ allocation policy—is now separately incorporated and independent from the Board of longtime OPTN contractor, the United Network for Organ Sharing (UNOS). HRSA awarded an OPTN Board Support contract to a new vendor, American Institutes for Research, to support the newly incorporated OPTN Board of Directors.

HRSA launched the OPTN Modernization Initiative in March 2023, including making proposals to reform the decades old OPTN statute and increase funding for the program to better serve patients and families. Within a year, HRSA worked closely with bipartisan leaders in Congress to secure passage of the Securing the U.S. OPTN Act and substantially boost funding to support modernization efforts. Today’s awards represent a key step forward in this work.

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Here's the full list (from OrangeSlices AI):

14 Prime awardees named for $440M in HHS HRSA OPTN Operations Transition IDIQs

The total ceiling for Domain 1 is $30M, Domain 2 is $145M, Domain 3 is $235M, and Domain 4 is $40M. The following awardee information is provided for the HRSA procurement:

1. ABT GLOBAL

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 1 – $30M

2. ARBOR RESEARCH COLLABORATIVE FOR HEALTH

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 1 – $30M

3. GUIDEHOUSE DIGITAL LLC

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 1, 2, 4 – $215M

4. MAXIMUS FEDERAL SERVICES

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 1, 2 – $175M

5. RAND CORPORATION

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 1 – $30M

6. CUSTOMER VALUE PARTNERS

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 2, 4 – $185M

7. GENERAL DYNAMICS INFORMATION TECHNOLOGY INC

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 2, 3 – $380M

8. KPMG LLP

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 2 – $145M

9. UNITED NETWORK FOR ORGAN SHARING

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 2 – $145M

10. ACCENTURE FEDERAL SERVICES LLC

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 3 – $235M

11. LEIDOS INC

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 3 – $235M

12. SAPIENT GOVERNMENT SERVICES INC

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 3 – $235M

13. DELOITTE CONSULTING LLP

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 4 – $40M

14. HIGHLIGHT TECHNOLOGIES INC

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 4 – $40M

The IDIQs include a base ordering period of one year staring on 9/25/2024 and 4 option periods.

Solicitation: 75R60224R0008, OPTN Operations Transition Indefinite-Delivery-Indefinite-Quantity (IDIQ)

Agency: HEALTH AND HUMAN SERVICES HEALTH RESOURCES AND SERVICES ADMINISTRATION

How Do Financial Obstacles Affect Decision-Making Among Potential Living Organ Donors?

 Here's a report on the effects of helping living organ donors with their expenses.

Mandell, Rebecca J., Abigail R. Smith, Kimberly A. Gifford, Barry A. Hong, Nathan P. Goodrich, Amit K. Mathur, Melissa A. Fava, Akinlolu O. Ojo, and Robert M. Merion. "How Do Financial Obstacles Affect Decision-Making Among Potential Living Organ Donors?" Progress in Transplantation (2024): 15269248241268679.

Abstract: Introduction: Living donation increases the organ supply, but associated non-medical expenses can disincentivize donation. Programs aimed at increasing living donation need to better understand how financial obstacles, including lost wages, impact the decision to pursue donation. Methods/Approach: Forty-eight interviews were conducted and analyzed using a grounded theory approach. Findings: Three key themes were identified that influenced decision-making: emotional attachment, temporal flexibility, and job security. These themes emerged when dividing interview participants into 3 groups: close relationship donors, broader network donors, and non-directed donors, representing donation to a family member or friend, a specific person they do not know well or at all, or a non-specified individual, respectively. Most close relationship donors wanted to donate regardless of personal financial cost, based on emotional attachment to the recipient. Wage reimbursement did not typically affect their decision-making but could reduce stress. Since non-directed donors did not donate to a specific individual, they could wait to achieve financial stability before donating, if needed. While wage reimbursement might create more proximate stability, non-directed donors had the flexibility to postpone donations until they could independently achieve financial stability. Lacking emotional attachment and temporal flexibility, broader network donors were particularly active decision-makers and most influenced by wage reimbursement. Across all groups, donors with job security were more resolute about donating. Conclusion: The findings underscore the importance of lost wage reimbursement to facilitate donation and reduce stress, and policies to protect donor job security."

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Related posts:

Thursday, March 31, 2022

National Living Donor Assistance Center (NLDAC) support for lost wages and dependent care

Saturday, September 17, 2022

Non-directed organ donors and NLDAC financial support

An Experimental Study of the Chinese Organ Allocation System

 China presently has a low rate of organ donations per million population, so there's a lot of room for growth.  Here's a study suggesting that giving priority on the waiting list to family members of donors could help (as it has done in Israel):

Li, Danyang, Luo, Jun, Ye, Hang and Zheng, Heng. "Is Family-Priority Rule the Right Path? An Experimental Study of the Chinese Organ Allocation System" The B.E. Journal of Economic Analysis & Policy, vol. 24, no. 3, 2024, pp. 929-964. https://doi-org.stanford.idm.oclc.org/10.1515/bejeap-2023-0213

Abstract: China is experiencing an organ shortage crisis. We experimentally test the effectiveness of the family-priority allocation rule on organ donation and argue that such incentive would be highly motivating in Chinese family-oriented culture. Results of our experiment show that introducing the family-priority rule can not only increase donor registration but also promote family consent. Such priority rule would be particularly effective to increase deceased organ donation in China, as it will significantly promote donor registration and meanwhile generate a consistent higher family consent rate in a more family-orientated culture.

Performance Feedback and Organ Donor Registrations, by House, Lacetera, Macis, and Mazar.

 When you register for a driver's license in the U.S., you fill out a form that has an opportunity to register as an organ donor. Did the clerk who accepts your form ask you if you had checked the box?  Would it help if he/she got feedback on how many organ donor registrations she had facilitated?

Here's an experiment about the equivalent interaction in Canada, where "most of the organ donor registrations in Ontario (pre-Covid-19 pandemic: 85 %) occurred during in-person visits to ServiceOntario centers (Trillium Gift of Life, 2017), which through their customer service representatives (CSRs) provide a wide range of services to residents ranging from issuing driver and vehicle licensing to public health insurance registration and business licensing."

House, Julian, Nicola Lacetera, Mario Macis, and Nina Mazar. "Nudging the Nudger: Performance Feedback and Organ Donor Registrations." Journal of Health Economics (2024): 102914.

"Abstract: In a randomized controlled trial conducted in three waves over 2.5 years and involving nearly 700 customer-service representatives (CSRs) from a Canadian government service agency, we studied how providing CSRs with repeated performance feedback, with or without peer comparison, affected their subsequent organ donor registration rates. The feedback resulted in a 25 % increase in daily signups compared to otherwise equivalent encouragements and reminders. Adding benchmark information about peer performance did not amplify or diminish this effect. We observed increased registration rates for both high and low performers. A post-intervention survey indicates that CSRs in all conditions found the information included in the treatments helpful and motivating, and that signing up organ donors makes their job more meaningful. We also found suggestive evidence that performance feedback with benchmark information was the most motivating and created the least pressure to perform."

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Related post:

Monday, July 22, 2024

Don't take "No" for an answer in deceased organ donor registration (a paper forthcoming after ten+ years)

Don't take "No" for an answer in deceased organ donor registration (a paper forthcoming after ten+ years)

 Here's a paper reporting a "field in the lab" experiment with actual organ donor registrations, that took over ten years to get published (after considerable revision and additional data collection).  But it has an important message for how to ask people to agree to donate their organs after they die, should they happen to be among those rare cases in which deceased organs can be donated.  The paper has two messages: one is that it doesn't increase donor registration to ask people to answer 'yes' or 'no', compared to just asking if they want to register at this time.  The second message is that people who have declined to register as a donor in the past may agree if asked again (so, don't take "no" for a final answer).

Here's the pre-publication version that will appear in AEJ:Policy.

Increasing Organ Donor Registration as a Means to Increase Transplantation: An Experiment With Actual Organ Donor Registrations  by Judd B. Kessler and Alvin E. Roth, AMERICAN ECONOMIC JOURNAL: ECONOMIC POLICY (FORTHCOMING)

Abstract: The U.S. has a severe shortage of organs for transplant. Recently — inspired by research based on hypothetical choices — jurisdictions have tried to increase organ donor registrations by changing how the registration question is asked. We evaluate these changes with a novel “field-in-the-lab” experiment, in which subjects change their real organ donor status, and with new donor registration data collected from U.S. states. A “yes/no” frame is not more effective than an “opt-in” frame, contradicting conclusions based on hypothetical choices, but other question wording can matter and asking individuals to reconsider their donor status increases registrations.

And here's the blog post about and link to the 2014 NBER working paper (which was itself a revision of an earlier version), and some of the press coverage it received at the time:

Tuesday, September 2, 2014

Don't take "No" for an answer: a reconsideration of how to do deceased donor registration

Kidneys for Communities and first responders

The Police Benevolent Association of the City of New York receives national award for helping its members and first responders nationwide battling kidney disease

CLEVELAND, June 14, 2024 /PRNewswire/ -- The Police Benevolent Association of the City of New York (PBA) has been honored with the Kidneys for Communities National Community Impact Award in recognition of its dedication and commitment to promoting living kidney donation and supporting the organization's members who are living with kidney disease.

Kidneys for Communities, a national community-directed donation program, launched its Kidneys for First Responders program with the PBA in June 2023 after New York City police officer Melissa Quinones' successful living kidney transplant. Since then, Kidneys for Communities has worked with first responder organizations to help members and their families who are in need of a lifesaving kidney transplant.

Kidneys for First Responders provides access to and facilitates living kidney donations by connecting people from around the country who want to help first responders with those who need lifesaving kidneys. The program is based on the Community-Directed Donation model that leverages individuals' affinity with membership-based communities.

Ira Brody, Co-Founder of Kidneys for Communities, presented PBA President Patrick Hendry with the National Community Impact Award at the NYCPBA delegate meeting on June 14, 2024. The NYCPBA is the first organization to receive the award.

"This award is a testament to the unwavering dedication that New York City police officers show every day, whether we're protecting our communities or stepping up to help each other," said Patrick Hendry, PBA president. "The success of Officer Quinones' transplant inspired our entire blue family, showing the profound impact we have when we come together. We are committed to continuing this program and serving our active and retired NYPD police officers, our fellow first responders and their families living with kidney disease."

Killing more people than breast cancer or prostate cancer, kidney disease has in recent years been named by the Centers for Disease Control and Prevention as a leading cause of death in the U.S. Meanwhile, the Organ Procurement and Transplantation Network reports that approximately 13 people die each day waiting for a kidney transplant.

"The perseverance of the NYCPBA and the passion of the NYPD in rallying around officer Melissa Quinones were a catalyst for the Kidneys for First Responders program," said Atul Agnihotri, Kidneys for Communities chief executive officer and board president. "The PBA's commitment to the program has resulted in the support of many successful kidney transplants for first responders across the country."

The Police Benevolent Association of the City of New York (PBA) is the largest municipal police union in the nation and represents nearly 50,000 active and retired New York City police officers.

About Kidneys for Communities
Kidneys for Communities is a nonprofit that partners with organizations to impact the lives of their members by offering resources about living kidney donations to members of their communities, increasing the chances of a donor directing a gift-of-life kidney to a fellow member in need of a kidney. Addressing the shortage of living kidney donors through proactive community outreach programs, Kidneys for Communities developed the first-ever national Community-Directed Donation^™ program.

The program unlocks connections created through membership-based communities, with the goal of increasing the number of living kidney donors in the U.S. through paired kidney exchange.   

The Kidneys for Communities leadership team includes innovative leaders, kidney donors, social workers and medical experts in the fields of nephrology and renal transplantation — all of whom have seen this disease up close and are committed to making an impact.

To find out more about how to help first responders who need a kidney transplant, visit kidneysforcommunities.org/first-responders/

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Earlier:

Friday, March 12, 2021   Kidneys for Communities

Tuesday, July 11, 2023   NYC police officer receives a kidney through Kidneys for Communities (KFC:)

Kidneys: compensation and altruism

 Apropos of my debate with Debra Satz this afternoon, here are two articles about kidney donation, from pure altruism or with compensation, in the New York Times and in The Journal of Medicine and Philosophy.

In the NYT:

Let People Sell Their Kidneys. It Will Save Lives., By Dylan Walsh, April 2, 2024

"There are 100,000 people in the United States waiting for a kidney. More than half a million are on dialysis, which from my experience I know to be more of a means of survival than a form of living. ... The National Kidney Foundation estimates that without more investment in preventing diabetes and other ailments, more than one million people will be suffering from kidney failure by 2030, up from over 800,000 now.

...

"Creating a market for kidneys is not a new concept, but it’s historically been met with disgust: Sell what? To be fair, some of the ways to structure such a market would be irresponsible, coercive and deserving of that disgust.

"But others are more thoughtful and prudent. One approach is to make the federal government the sole purchaser of kidneys. Donor and recipient would never meet. Compensation would be fixed, haggling impossible. After the kidney is acquired, the transplant process would unfold in the typical manner."

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In The Journal of Medicine and Philosophy:

Semrau, Luke. "The Altruism Requirement as Moral Fiction." In The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, p. jhae011. US: Oxford University Press, 2024.

"Abstract: It is widely agreed that living kidney donation is permitted but living kidney sales are not. Call this the Received View. One way to support the Received View is to appeal to a particular understanding of the conditions under which living kidney transplantation is permissible. It is often claimed that donors must act altruistically, without the expectation of payment and for the sake of another. Call this the Altruism Requirement. On the conventional interpretation, the Altruism Requirement is a moral fact. It states a legitimate constraint on permissible transplantation and is accepted on the basis of cogent argument. The present paper offers an alternative interpretation. I suggest the Altruism Requirement is a moral fiction—a kind of motivated falsehood. It is false that transplantation requires altruism. But the Requirement serves a purpose. Accepting it allows kidney donation but not kidney sale. It, in short, rationalizes the Received View."

Here's the concluding paragraph:

"I have argued that the Altruism Requirement is a moral fiction. No sound arguments demonstrate its truth. It continues to enjoy widespread endorsement on account of its perceived link to the Received View. It is taken as a means of allowing kidney donation but not kidney sale. Thus, it is unsurprising that, on examination, in ethical argument and in the practice of transplantation, it is, de facto, a No Payment Requirement."

Experiments for organ allocation (an idea whose time may be coming)

 Experiments to improve how deceased donor organs are allocated to waiting patients seem like a good idea...

OPTN Task Force sets goal of achieving 60K transplants by 2026, Jan 26, 2024 

“we need to move quicker, be more responsive, and deliver results for the patients we serve,” said Dianne LaPointe Rudow, DNP, president of the OPTN Board of Directors. “The reality is that while the number of transplants continues to grow, so does the non-use of available organs and allocations of organs out of the intended sequence of offers.

...

"The need is clear. In the case of kidneys, the most transplanted organ, the number of kidneys recovered from deceased donors increased by 56 percent between 2018 to 2023. Yet the number of kidney transplants only increased by 44 percent, meaning that approximately one quarter of kidneys recovered were not transplanted.

...

"Under a proposed variance for expedited placement, currently out for public comment, the task force intends to develop a series of rapid, small-scale tests of innovative organ placement approaches and assess their outcomes to evaluate whether they could be incorporated into future OPTN policies. The task force also has committed to prioritizing studies that evaluate potential frameworks for allocating hard-to-place organs to increase the number of transplants and lower non-use rates."

Legislative proposals to help living kidney donors

 Martha Gershun brings us up to date on various proposed pieces of legislation to help organ donors and increase access to transplants.

Legislative Efforts to Support Living Kidney Donors,  by Martha Gershun, Guest Blogger

"As a member of the Expert Advisory Panel to the Kidney Transplant Collaborative, I have been honored to provide input during the development of the organization’s priority legislation, the Living Organ Volunteer Engagement (LOVE) Act.  This legislation would help build a comprehensive national living organ donor infrastructure that would support a national donor education program, create a donor navigator system, ensure appropriate donor cost reimbursement, collect essential data, and improve all aspects of living organ donation across the country, substantially reducing barriers that limit participation today.

Key provisions of the LOVE Act would:

• Provide reimbursement for all direct and indirect costs for living donation, including lost wages up to $2,500 per week.
• Provide life and disability insurance for any necessary care directly caused by donation.
• Modify NLDAC rules so neither the recipient’s income nor the donor’s income would be considered for eligibility.
• Provide for new public education program on the importance and safety of living organ donation.
• Provide for new mechanisms to collect and analyze data about living organ donation to enable evidence-based continuous process improvement.

Numerous other federal proposals are also currently vying for support to address barriers to living donation on a national level.  They include:

Living Donor Protection Act (H.R. 2923, S. 1384)

• Prohibits insurance carriers from denying, canceling, or imposing conditions on policies for life insurance, disability insurance, or long-term care insurance based on an individual’s status as a living organ donor.
• Specifies that recovery from organ donation surgery constitutes a serious health condition that entitles eligible employees to job-protected medical leave under the Family and Medical Leave Act.

Organ Donor Clarification Act (H.R. 4343)

• Clarifies that reimbursement to living organ donation is not “valuable consideration” (I.e., payment), which is prohibited under the National Organ Transplant Act (NOTA)
• Allows pilot programs to test non-cash compensation to living organ donors.
• Modifies NLDAC rules so the recipient’s income would no longer be considered for eligibility.

Living Organ Donor Tax Credit Act (H.R. 6171)

• Provides a $5,000 federal refundable tax credit to offset living donor expenses.

Honor Our Living Donor (HOLD) Act (H.R. 6020)

• Modifies NLDAC rules so the recipient’s income would no longer be considered for eligibility.
• Requires public release of annual NLDAC report.

Helping End the Renal Organ Shortage (HEROS) Act

• Provides a $50,000 refundable federal tax credit over a period of five years for non-directed living kidney donors.

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And here's one more, from the Coalition to Modify NOTA

National Living Donor Assistance Center (NLDAC): I rotate off the advisory board

 After seven years, I'm rotating off the advisory board of the National Living Donor Assistance Center (NLDAC). During that time, NLDAC's ability to assist living donors increased substantially, and now includes some reimbursement for lost wages, for example.

 At our meetings I learned to appreciate some of the subtleties involved in the interaction between government regulation and organ transplantation.

NYC police officer receives a kidney through Kidneys for Communities (KFC:)

 Police magazine has the story of an anonymous living kidney donor who wanted his/her kidney to go to a first responder, facilitated by  Kidneys for Communities.

NYPD Officer Received Kidney Transplant with Aid of Nonprofit Group and PBA. Kidneys for Communities' Kidneys for First Responders initiative is designed to improve access to and facilitate living kidney donations by connecting those who want to help first responders with those who are in need of a lifesaving kidney donation.  July 7, 2023

"Kidneys for Communities, a national community-directed living kidney donation program, launched its Kidneys for First Responders initiative with its first kidney transplant recipient, New York City Police Officer Melissa Quinones, with assistance from the Police Benevolent Association of the City of New York.

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And here's the KFC press release (doesn't that acronym already sound familiar?):

Kidneys for Communities Announces their ‘Kidneys for First Responders’ Initiative

"Kidneys for Communities’ Kidneys for First Responders initiative is designed to improve access to and facilitate living kidney donations by connecting those who want to help first responders with those who are in need of a lifesaving kidney donation"

"As Dr. Lloyd E. Ratner, who performed Quinones’ transplant, affirms, “The community-directed model, now available to interested communities and pioneered by Kidneys for Communities, is a common-sense approach to growing the pool of living kidney transplant donors. As more communities come on board, we expect it will shorten the critical waiting time for transplant recipients and save lives.”."

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.

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Earlier: 

Tuesday, May 30, 2023

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

Freakonomics replay and update on kidney exchange and organ donation

 Freakonomics Radio yesterday revisited some of their old podcasts about kidney exchange. In one, they interview me, and in another, they interview Ned Brooks, who listened to that interview and went on to become a non-directed kidney donor and to found an organization to support other kidney donors, the NKDO, National Kidney Donation Organization.  You can listen and/or read the transcript at this link:

EPISODE 209

Make Me a Match (Update)

"Sure, markets work well in general. But for some transactions — like school admissions and organ transplants — money alone can’t solve the problem. That’s when you need a market-design wizard like Al Roth. Plus: We hear from a listener who, inspired by this episode, made a remarkable decision.

"Last month, the federal government announced plans to modernize the U.S. organ-donation system. They want to speed up the process by which organ-transplant patients are matched with donated organs, and they also want to reduce racial inequities in the system. When we saw this news, we decided to go into our archive and put together the episode you’re about to hear. It’s a mashup of a 2015 episode, No. 209, called “Make Me a Match,” and a portion of a 2016 episode, No. 237, which includes a personal story from a listener who was inspired by that earlier episode to make a remarkable decision. All the relevant facts and figures have been updated. As always, thanks for listening."

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Here are my previous posts on Freakonomics episodes.

Song of the year Grammy award for organ donation: Bonnie Raitt - Just Like That

Stephanie Wang alerts me to the surprising fact that this year's Grammy Award for Song of the Year is Bonnie Raitt's song, Just Like That, about organ donation.  You can listen below (have some tissues handy):

CNN has the story: 

No one was expecting Bonnie Raitt to win Song of the Year, least of all the singer herself By Hafsa Khalil, CNN  February 6, 2023

"Raitt’s winning song, “Just Like That,” is about a woman visited by a man who is only alive because of the heart he received – a heart that had belonged to the woman’s son.

“I was so inspired for this song by the incredible story of the love and the grace and the generosity of someone that donates their beloved’s organs to help another person live and this story was so simple and so beautiful for these times,” Raitt explained in her acceptance speech.

Donate blood or organs to pay a traffic fine or shorten a prison term?

I spend a lot of my time thinking and writing about repugnant transactions and controversial markets, and some of that intersects with my work on blood and organ donation and transplantation (particularly on the controversial issue of compensation for donors, and how that might intersect with varieties of coercion). But today's post is about two proposals that mix all these things together. (My guess is that many people will find them differently repugnant: think of them as a quick test of your own views.)

In Argentina, a municipal judge proposes blood donation to pay traffic fines, and in Massachusetts several legislators co-sponsor a bill to allow bone marrow (blood stem cell) donation or organ donation to reduce prison sentences.

First, blood donation and traffic fines:

 Mario Macis points me to this story in La Nacion, about a city in the Argentine province of Salta:

En una ciudad de Salta las multas de tránsito se pueden pagar con una donación de sangre  [In a city of Salta, traffic fines can be paid with a blood donation]  (English from Google Translate)

"In the city of Tartagal, Salta, it is possible to pay a traffic ticket with a blood donation . The measure, taken two months ago, generates both support and questioning.

...

"The judge of the Court of Misdemeanors of the Municipality of Tartagal, Farid Obeid , proposed in a ruling last August that those who had traffic fines could pay them with their own blood donation or from third parties on behalf of the offenders.

"It was then determined that donations be made in hospitals, voluntarily and only once; that is to say that repeat offenders cannot opt ​​for blood donation.

...

"The ruling received support and criticism, the latter basically from the health sector. Oscar Torres, president of the Argentine Association of Hemotherapy, Immunohematology and Cellular Therapy , sent a letter to the Deliberative Council of Tartagal indicating that the measure removes the "spirit of solidarity and altruism from blood donation" 

Here's a related story about the ongoing debate (also using Google translate):

Controversy over an unusual municipal project: they claim that fines can be paid with blood. "This controversial project was presented to the Deliberative Council of Tartagal, and criticism has already begun"

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And here's the new bill proposed in Massachusetts (don't hold your breath waiting for it to be passed into law). It's in English, so the phrase about the necessary "amount of bone marrow and organ(s) donated to earn one’s sentence to be commuted" isn't a translation error; I think it's just awkward (i.e. not meant to be chilling). (But the discussion of donated "organ(s)" makes me think of Kazuo Ishiguro's novel "Never Let Me Go"). 

Bill HD.3822, 193rd (Current), An Act to establish the Massachusetts incarcerated individual bone marrow and organ donation program

"Section 170. (a) The Commissioner of the Department of Corrections shall establish a Bone Marrow and Organ Donation Program within the Department of Correction and a Bone Marrow and Organ Donation Committee. The Bone Marrow and Organ Donation Program shall allow eligible incarcerated individuals to gain not less than 60 and not more than 365 day reduction in the length of their committed sentence in Department of Corrections facilities, or House of Correction facilities if they are serving a Department of Correction sentence in a House of Corrections facility, on the condition that the incarcerated individual has donated bone marrow or organ(s). 

...

"The Bone Marrow and Organ Donation Committee shall also be responsible for promulgating standards of eligibility for incarcerated individuals to participate and the amount of bone marrow and organ(s) donated to earn one’s sentence to be commuted. Annual reports including actual amounts of bone marrow and organ(s) donated, and the estimated life-savings associated with said donations, are to be filed with the Executive and Legislative branches of the Commonwealth. All costs associated with the Bone Marrow and Organ Donation Program will be done by the benefiting institutions of the program and their affiliates-not by the Department of Correction. There shall be no commissions or monetary payments to be made to the Department of Correction for bone marrow donated by incarcerated individuals."

Simultaneous HT to Ron Shorrer, Kim Krawiec, Akhil Vohra

Organ donor joke from the Edinburgh fringe

 “My dad suggested I register for a donor card. He’s a man after my own heart.” 

That's a joke by Masai Graham, who won the most popular joke vote this year at the Edinburgh fringe, with 52% of 2,000 votes for another one-liner: “I tried to steal spaghetti from the shop, but the female guard saw me and I couldn’t get pasta.”

Here's the Guardian with more:

Pasta one-liner wins best joke award at Edinburgh festival fringe. West Midlands comedian Masai Graham, who works as a part-time care worker, wins title for second time. by Harriet Sherwood 

Do (some) kidney donors have a right to donate?

 Here's an article that considers whether some potential kidney donors, who have more appetite for risk than some transplant teams, might nevertheless have a right to donate.

Donor Autonomy and Self-Sacrifice in Living Organ Donation: An Ethical Legal and Psychological Aspects of Transplantation (ELPAT) View  , by Nizam Mamode, Kristof Van Assche2, Lisa Burnapp, Aisling Courtney, David van Dellen, Mireille Houthoff, Hannah Maple, Greg Moorlock, Frank J. M. F. Dor, and Annette Lennerling, Transplant International, 35, 2022, https://www.frontierspartnerships.org/articles/10.3389/ti.2022.10131, DOI=10.3389/ti.2022.10131    

ABSTRACT: "Clinical teams understandably wish to minimise risks to living kidney donors undergoing surgery, but are often faced with uncertainty about the extent of risk, or donors who wish to proceed despite those risks. Here we explore how these difficult decisions may be approached and consider the conflicts between autonomy and paternalism, the place of self-sacrifice and consideration of risks and benefits. Donor autonomy should be considered as in the context of the depth and strength of feeling, understanding risk and competing influences. Discussion of risks could be improved by using absolute risk, supra-regional MDMs and including the risks to the clinical team as well as the donor. The psychological effects on the donor of poor outcomes for the untransplanted recipient should also be taken into account. There is a lack of detailed data on the risks to the donor who has significant co-morbidities."

"The donation of a solid organ for transplantation by a person who is alive at the time represents a unique event in healthcare, since the donor will gain no physical benefit from undergoing major surgery, which has a low but nevertheless significant rate of major complications and death (1, 2). Living donors are usually highly motivated individuals, whose appetite for risk differs substantially from that of the healthcare team (3). This may lead to conflicts between the clinical team and potential donors-some examples are given in Figure 1. Were the decisions of the clinical teams correct? This article explores the issues raised by these cases and others, and considers the principles which might help to guide decision-making. It is an overview aimed at healthcare professionals, and is not intended to be an in-depth ethical review."

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And here's a news story from People.com about just such a donor, who exercised his right to donate:

When His Patient Couldn't Find a Kidney Donor, This Doctor Gave His: 'It's a Feeling That's Hard to Describe'  "I was always in awe of people who donated organs. It fascinated me. And I soon decided that I didn't just want to talk the talk," said Dr. Aji Djamali    

By Johnny Dodd 

"Djamali, a nephrologist who chairs the department of medicine at Maine Medical Center Department, was wheeled into an operating room and surgeons removed his kidney. Within minutes another team went to work transplanting the organ into Jartz, who had been diagnosed with polycystic kidney disease (PKD) — an inherited disorder that causes the kidneys to enlarge and stop working — seven years earlier. (The two men met when Jartz was Djamali's patient at the UW Health Transplant Center in Madison, Wisconsin.)

"For Djamali, who was back at work two days later (Jartz was discharged after five days), being able to donate an organ was the culmination of a dream that began decades earlier while in medical school.

...

"Looking back on the experience, Djamali struggles to find the words to properly convey what it feels like to give a part of his body to another person.

"It's a feeling that's hard to describe," he says. "It's like watching your child being born. It's just this sensation of freedom, elation and happiness."

"But, of course, there was another reason why he did it. The veteran physician knew that the story of his actions might spur someone else to perform a similar act.

"Half of the reason was to help John," says Djamali, who is in touch with Jartz on a daily basis. "But the other reason was to encourage people to help others, to inspire them to consider stepping up and helping the 90,000-plus patients across the nation who are on waiting lists to get a transplant."

Three living kidney donors talk about their experience

 Tonight at 6pm Eastern, three donor stories from the National Kidney Donation Organization (NKDO)

Click Here to Register

Gary Becker's last paper: appropriately, on a monetary market for kidneys (with Julio Elias and Karen Ye, JEBO, 2022)

 Gary Becker, who passed away in 2014, has a new paper, finished by his coauthors Julio Elias and Karen Ye. It recounts how the shortage of transplantable kidneys has only increased as the demand has grown, and the argument for paying donors is as strong as ever.  (In the meantime, the obstacles to that approach haven't vanished.)

The shortage of kidneys for transplant: Altruism, exchanges, opt in vs. opt out, and the market for kidneys*  by Gary S.Becker, Julio Jorge Elias, and Karen J.Ye, Journal of Economic Behavior & Organization, Volume 202, October 2022, Pages 211-226 (Another link to the paper is here, temporarily.)

Abstract: "In 2007 we published a paper on organ transplants that used data from 1990–2005. We proposed a radical solution of paying individuals to donate kidneys, and claimed that this would clean out the waiting list for kidney transplants in a short period of time. In this paper, we revisit the topic, and examine 14 years of additional data to see if anything fundamental has changed. We show that the main altruistic based policies implemented, such as kidney exchanges or opt out systems for organ procurement, have been unable to solve the problem of shortages. Our analysis suggests that, because of the reaction of direct living donors to increases in other sources of donations, the supply curve of kidney transplants is highly inelastic to altruistic policies. In contrast, a market in organs would eliminate organ shortages and thereby eliminate thousands of needless deaths."

Here's the most relevant part of the first footnote:

*"We started working on this paper together with Gary Becker in 2011. In 2012, we presented the paper at the Law and Economics Workshop and the MacLean Center's Seminar Series of the University of Chicago. The paper was unfinished when Becker passed away in May 2014. In this version of the paper, we updated the data and made some additions. The paper preserves all the economic analysis that was developed in the last version that we collaborated with Becker.

"Becker wrote his first article about the organ shortage in 1997, as part of his monthly BusinessWeek Column. The article was entitled How Uncle Sam Could Ease the Organ Shortage. In the article, he “suggest(s) considering the purchase of organs only because other modifications to the present system so far have been grossly inadequate to end the shortage.”

"In the 2000s, Julio Elias collaborated with Becker in a paper that uses the economic approach to analyze the consequences of legalizing the purchase and sale of kidneys for transplants from both deceased and living donors. In 2014, Becker published with Julio Elias a column in the Saturday Essay section of the Wall Street Journal entitled Cash for Kidneys: The Case for a Market for Organs. For Becker, the problem of the organ shortage and finding ways to solve it was a lifelong project. This paper reflects some of his last thoughts on this problem."

Here are their conclusions:

"The current state of the market of kidney transplants is a disaster. Over the last years, the waiting list has grown in over 4000 individuals each year, while transplants have grown by only about 250 per year. The result has been longer and longer queues to receive organs. 4000 patients died each year while waiting 3 and a half years on average for a transplant. According to our estimations, the annual social cost of those who die while waiting for kidney transplants is over $7 billion.

"Neither kidney exchange programs nor opt out systems nor educational campaigns to increase donations from altruistic donors have solved the problem of shortages. The main reason for their mild effects, as we show in this paper, is that the altruistic supply curve of kidney transplants is highly inelastic to these type of policies because of the reaction of direct living donors to increases in other sources of donations.

"The only feasible way to eliminate the large queues in the market for kidney transplants is by significantly increasing the supply of kidneys. The introduction of monetary incentives could increase the supply of organs sufficiently to eliminate the large queues and thereby eliminate thousands of needless deaths, and it would do so without increasing the total cost of kidney transplant surgery by a large percent.

"A market for the purchase and selling of organs would appear strange at first. However, much as the voluntary military today has universal support, the selling of organs would come to be accepted over time. " advantages of accepting payment for organs would eventually become clear, and people will wonder why it took so long for such an ovious and sensible remedy to the organ shortage to be implemented.

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Some related earlier posts:

Another take on compensating donors:

Tuesday, August 16, 2022

Kim Krawiec interviews Frank McCormick on the kidney shortage (and how to end it)

Commentary on the  legal monetary market for kidneys in Iran (and how it differs from illegal black markets):

Monday, June 27, 2022

A Forum on Kidneys for Sale in Iran, in Transplant International

The Pontifical Academy of Science says that compensating donors is a crime against humanity:

Friday, February 17, 2017

Vatican statement on organ transplantation

All my posts on compensation for donors (not just kidney donors) are here.

And here's my 2007 paper on repugnance (that came out in the same issue of JEP as the Becker and Elias paper), and was a first attempt at understanding some of the obstacles that face proposals to compensate donors of kidneys (and other things):

• Roth, Alvin E. "Repugnance as a Constraint on Markets", Journal of Economic Perspectives, 21:3, Summer, 2007, pp. 37-58.

I'm slowly writing a book that will expand on it.