Kidney exchange between Portugal and Spain, and prospects for global kidney exchange

 Here's an article from a Portuguese hospital that has engaged in kidney exchanges with Spanish hospitals that have resulted in three transplants for Portuguese patients since the program was initiated in 2017.  The paper considers how international kidney exchange can be expanded globally, so as to have significant effects on the health of Portuguese and other patients.  

The concluding  two paragraphs of the paper speak about global kidney exchange, and the controversy that it has aroused, particularly in Spain, where there has been opposition to significant cross-border kidney exchange.

Francisco, José Teixeira, Renata Carvalho, Joana Freitas, Miguel Trigo Coimbra, Sara Vilela, Manuela Almeida, Sandra Tafulo et al. "International Crossed Renal Donation – The Experience of a Single Center," Brazilian Journal of Transplantation, v. 26 (2023)

"Introduction: Kidney transplantation is the preferred treatment for end-stage chronic kidney disease, however, the shortage of organs can result in long waiting times. Living donor kidney transplantation offers an alternative to cadaver donor, but HLA or AB0 incompatibility can represent a significant obstacle. This study aimed to show the results achieved by a Portuguese hospital since its integration into an international cross-donation program, the South Alliance for Transplants (SAT). 

"Methods: The SAT program was founded in 2017 and is made up of ten Spanish hospitals, three Italian hospitals and one Portuguese hospital. The program takes place every 4 months and only enrolls pairs who are incompatible. Organ transport is carried out in partnership with the Portuguese Air Force. 

"Results: Three different crosses were carried out in partnership with three Spanish hospitals, culminating in the transplantation of three Portuguese patients out of a total of seven patients. The first crossing was carried out in March 2020, at the beginning of the COVID-19 pandemic, with the partnership of two Portuguese hospitals and a Spanish hospital, involving 1 donor/recipient pair from each country,... The second occurred in December 2021 with 3 donor/recipient pairs (1 Portuguese in which the recipient had anti-donor antibodies and positive crossmatch with the potential donor; and 2 from two Spanish hospitals),... The third crossing also took place in December 2021 with 2 donor/recipient pairs (1 Portuguese and 1 Spanish)

...

"A Global Kidney Exchange Program (GKEP), an idea initiated by Rees et al.,16 which involves kidney paired donation between high-income and low-income and medium-income countries (LMICs). Beyond the potential benefits associated with this type of transplantation, similar to those already addressed for international programs, there are concerns about the ethical implications of  such  programs.  They  may  perpetuate  existing  inequalities  between  high  and  low-income  countries,  which  has  motivated  a  statement  from  the  Declaration  of  Istanbul  Custodian  Group.17  Some  critics  argue  that  the  practices  of  most  PRMBs  lack  transparency, leaving room for exploitation and corruption,18 or raise ethical concerns regarding the commodification of organs.19On the other hand, proponents of the idea argue that a GKEP could help address the global shortage of donor organs and provide lifesaving  opportunities  for  patients  in  need.  They  also  note  that  such  programs  could  foster  collaboration  and  information-sharing between countries and institutions, potentially leading to improvements in transplant practices worldwide.16,20 Despite the controversy surrounding the proposal, the idea of a GKEP remains an intriguing possibility for advancing kidney transplantation on a global scale.

"CONCLUSION: Our experience and that of other locations show that programs like these offer numerous benefits, such as expanding the pool of available donors, improving compatibility between donors and recipients, and avoiding the costs and risks associated with desensitization therapies for ABO or HLA incompatible transplantations. These programs represent a valuable option for individuals who require a kidney transplant and can be an effective means of increasing transplant success rates and improving quality of life for patients. However, the success of these programs depends on the number of pairs enrolled. To ensure the success of these programs, there is a need for greater awareness, education, and promotion of their benefits and outcomes among the public, healthcare providers, and policymakers alike.

Surrogacy in Spain is hard to suppress

 In a widely reported story, a Spanish celebrity has become the surrogate mother of her grandchild, with the help of sperm from her deceased son, and an American surrogate.  This has raised controversy in Spain, where surrogacy is illegal.

Here's the Guardian on the story:

Spanish TV star says surrogate baby is actually her grandchild. Ana Obregón, 68, says her son, Aless Lequio García, expressed desire to have a child before death in 2020

"A heated debate in Spain triggered by a 68-year-old celebrity who was reported to have used a surrogate mother in Miami to have a baby took a twist on Wednesday when the woman announced in the socialite magazine ¡Hola! that the baby was actually the daughter of her son who died of cancer in 2020.

...

"Surrogate pregnancies are banned in Spain, although children from such pregnancies in other countries can be registered.

...

"Initial reports about the baby grabbed the attention of the Spanish media and the country’s political parties, sparking criticism from the leftist coalition government. Many leading politicians and outlets of Spanish media refer to surrogacy as “womb renting”.

"The equality minister, Irene Montero of the leftist United We Can coalition partner, said surrogate pregnancies were “a form of violence against women”. The coalition’s Socialist party said legislation should be tweaked to prevent Spaniards using surrogates in other countries.

...

"The main opposition conservative People’s party has said it is open to debating legalising such pregnancies if there is no payment involved."

********

Recent related post:

Wednesday, April 5, 2023

Surrogacy under siege in Italy

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.

Spain's stolen babies (from the NY Times)

The sale of babies is widely regarded as repugnant, but it has been used for political purposes in the dark days of Spain, and Argentina.  Here's a story from the Sunday NY Times recounting some of the history, focusing on one woman's search for her birth mother.

 Taken Under Fascism, Spain’s ‘Stolen Babies’ Are Learning the Truth. Thousands of Spanish children were taken from hospitals and sold to wealthy Catholic families. By Nicholas Casey, Sept. 27, 2022

"Up to the early 1930s, Spain had been among Europe’s most progressive countries, allowing for married couples to divorce and women to seek abortions. Under Franco, those rights were swiftly rescinded. Contraception was outlawed, adultery was criminalized and women lost the right to vote. Newspapers were censored, and many books were banned altogether, including those of Federico García Lorca, Spain’s most renowned poet and playwright. (Lorca had already been murdered by Nationalists during the civil war.) 

...

"But one of the most lasting abuses of the era was borne by children. ... Franco’s men soon began the abductions on a large scale. They targeted children orphaned by Franco’s firing squads and took newborns belonging to women who had given birth in jail as political prisoners. All were sent to be raised by regime loyalists. The era of the “stolen babies” had begun.

...

"Some nuns — aided by doctors, nurses and midwives — began to abduct babies to meet demand. In certain cases, the nuns still managed to persuade mothers to give up their children willingly, though many say they were coerced into surrendering their newborns. Others say they were sedated in the delivery room and then told, when they woke up, that their babies had died. In reality, the children had been sold to other families.

"Franco’s regime was not the only one to use the theft of children as a political weapon. In Argentina, as many as 30,000 people were “disappeared” by a military junta that ruled from 1976 to 1983 and gave their orphaned children to right-wing families, prompting decades of protests and demands that the government investigate. In Spain, people often refer to the Argentine cases as offering a precedent. But unlike Argentina, Spain never established a truth-and-reconciliation commission. In fact, the country did the opposite, passing a broad amnesty law in the years following Franco’s death that absolved members of the regime of most of their past crimes. While those responsible for the abductions were not explicitly granted amnesty, the policy did reflect a consensus that had emerged in post-Franco Spain — to avoid confronting the dark legacy of the dictatorship. The agreement even had a name: the Pact of Forgetting. Spain’s leaders, on both the right and left, espoused the need for peaceful democracy, even if it meant sacrificing popular calls for justice. “Let’s not disturb the graves and hurl bones at one another — let the historians do their job,” said José María Aznar, a former prime minister, in a speech years later.

...

"In 2004, the conservative government was defeated by José Luis Rodríguez Zapatero, a Socialist who came into office with plans to address the taboos of the past.... at Zapatero’s urging, Spain passed its historical memory law in 2007, which condemned the crimes of the Franco era and recognized its victims for the first time.

"A new generation of victims began to emerge — this time led not by the mothers who had lost their babies but by their children, now grown, who were seeking their biological parents. They formed grass-roots organizations like the National Association for Irregular Adoption Victims, which estimated that as many as 15 percent of the adoptions in Spain from 1965 to 1990 were performed without consent of the birth parents."

School choice in Latin America, in BBC News Mundo

 A news story with an unusually detailed account of school choice algorithms discusses some of the issues in Latin America, in Spanish, in BBC News Mundo. (Google translate does an adequate job...).  One of the issues discussed is that geographic priorities for schools give wealthier families an advantage, and perpetuate geographic segregation.

Qué es el Mecanismo de Boston y por qué expertos denuncian que hay segregación en las asignaciones de escuelas en América Latina  Analía Llorente  BBC News Mundo

[G translate: What is the Boston Mechanism and why experts denounce that there is segregation in school assignments in Latin America]

Some snippets:

"The Boston mechanism allows for a lot of parenting strategy and that means that it generates a lot of inequalities " [says] Paula Jaramillo, Associate Professor in Economics at the Universidad de los Andes in Colombia

...

"The criticism is against the Boston Mechanism because it continues to be applied, but it is also against the deferred acceptance method because it is generating segregation at the neighborhood level," says Caterina Calsamiglia, a leader in the investigation of these methods.

"The specialist refers to the fact that a student obtains more points for his proximity to the preferred school, therefore he has a greater chance of being admitted to it.

"This creates one of the main strategies is the moving neighborhood, decision can only carry out families with middle income to high, creating inequality."

...

"In many places in Latin America the selection method is not even regulated, and where it is, they are not very transparent with parents in communicating the methods.

"We know a lot about what is done by cities in the United States, in Europe, in Asia, we don't know so much about Latin America," says Paula Jaramillo.

...

"In conclusion, the experts believe that there is no magic method that can be applied uniformly in the countries of the region to avoid segregation and inequality in school selection.

"They agree that the deferred acceptance method is the "fairest" but not perfect. There are many factors to take into account from the quality of the schools to their location."

Economists support Andreu Mas-Colell

 In El Pais (plus Google translate):

33 premios Nobel de Economía y otros 20 destacados economistas escriben en defensa de Andreu Mas-Colell. Los expertos internacionales muestran con un artículo conjunto su solidaridad con el profesor y exconsejero catalán investigado por el Tribunal de Cuentas

[33 Nobel Laureates in Economics and 20 other leading economists write in defense of Andreu Mas-Colell.  With a joint article, international experts show their solidarity with the professor and former Catalan councilor investigated by the Court of Auditors]

The letter ends with:

"We hope the situation clears up promptly. We also hope that, in the absence of specific charges against him, the Court of Auditors will avoid unwanted and unfair consequences for Professor Mas-Colell."

"The letter is signed by Philippe Aghion, George Akerlof *, Manuel Arellano, Orazio Attanasio, Robert Aumann *, Abhijit Banerjee *, Richard Blundell, Partha Dasgupta, Angus Deaton *, Eddie Dekel, Mathias Dewatripont, Peter Diamond *, Esther Duflo *, Eugene Fama *, Ernst Fehr, Drew Fudenberg, Jordi Galí, Pinelopi Goldberg, Jean-Michel Grandmont, Rachel Griffith, Lars Hansen *, Oliver Hart *, James Heckman *, Elhanan Helpman, Bengt Holmstrom *, Dale Jorgenson, Daniel Kahneman *, Mervyn King, Michael Kremer *, Finn Kydland *, Eric Maskin *, Daniel McFadden *, Robert Merton *, Paul Milgrom *, Stephen Morris, Roger Myerson *, Edmund Phelps *, Christopher Pissarides *, Paul Romer *, Alvin Roth *, Myron Scholes *, Amartya Sen *, Robert Shiller *, Christopher Sims *, Robert Solow *, Hugo Sonnenschein, Michael Spence *, Joseph Stiglitz *, Guido Tabellini, Richard Thaler *, Jean Tirole *, Robert Wilson * and Fabrizio Zilibotti.

"Names with an asterisk are Nobel laureates in economics."

***********

Some background here:

Tuesday, June 15, 2021

Crisis in Catalonia, and Andreu Mas-Colell

Crisis in Catalonia, and Andreu Mas-Colell

 Catalonia's crisis has been in the news again, with different parts of the Spanish government taking different views about reconciliation.  Here's one story, from the Guardian:

Spanish right rallies against plans to pardon Catalan separatists.  Protest at Plaza de Colón in Madrid draws 25,000 people, including leaders of three rightwing parties. by Sam Jones

But outside of any news stories I've seen, there is a set of administrative actions that threaten a variety of Catalan people who have had public service jobs, including a number of economists, among them one of the world's leading economic theorists, Andreu Mas-Colell.

On twitter, his son, the economist Alex Mas, tells some of the alarming story: https://twitter.com/AlexMasPton/status/1404438475408035845

Alex Mas @AlexMasPton

"Normally I would not be posting personal developments on this website, but in this case I have a pressing concern. My dad, Spanish economist Andreu Mas-Colell, is dealing with an incredibly difficult and unjust situation.  1/

"In two weeks my parents home, his pension and his bank account may be seized by state authorities, without due process. This has to do with events in Catalonia over the last few years. That’s a lot to digest, so let me give some background.

"Following the global financial crisis my dad was called on to head the department in charge of finance and the budget in the government of Catalonia to help in the recovery from one of the worst recessions in history.

"He left his comfortable position as Secretary General of the European Research Council to take on this challenge. This was not surprising. He has been committed to public service from well before leaving Harvard in 1995 to help establish a new university in Barcelona.

"After my dad retired from public service in 2015, a new government formed. Catalonia then underwent a period of turmoil precipitated by a referendum for independence in October 2017.

...

"My dad did not have anything to do with the organization of the referendum, or the events that transpired. He has been living a retired life for years. And now, a full six year after retirement, he has been targeted for severe financial punishment.

"Last month, a politicized, non-judicial “tribunal” of controllers (“Tribunal de Cuentas”) made personally responsible 39 former government officials for the bulk of the expenses (back to 2011) of an entire section of the Catalan government: that concerned with foreign relations.

"The claim is that the Catalan government used public funds to promote Catalan independence, and specifically the 2017 referendum, abroad.

"What's my dad’s connection? The 18,000+ page document of accusations he was sent, and given ten days to respond to in writing (his only chance to defend himself in all this), does not specify.

"Though not stated, he seems to be targeted because he was, in the last resort, responsible for implementing the budgets voted on by parliament. It appears that for that he is now being held personally liable for a total amount that may add up to tens of millions of dollars.

"In what I understand is highly unusual, a member of the tribunal issued a written dissent against the decision. She says that the tribunal was not impartial, the decision was based on unproven allegations and contains exaggerations.

...

 "There will be no trial. There is simply a penalty that is handed down. The appeals will take years and can reach the EU Courts of Human Rights, but the neat trick is that in the meantime the accused will have to put up a guarantee for the full amount requested.

"Because the penalty could far exceed the combined net worth of all targeted individuals, they could have *all* of their personal property, assets and income seized. It will be complete and arbitrary expropriation. Without due process.

"This administrative body has taken this action in past cases.

...

"The penalties will be levied on June 29, coincidentally the day of his 77th birthday. Before then the best thing we can do is raise awareness. If you are able, I would be grateful if you can share what is going on with others, on social media or simply in real life. Thank you."

***********

Here's a related story, for which Google Translate works reasonably well:

https://www.lavanguardia.com/politica/20210512/7449503/consejera-tribunal-cuentas-cree-informe-diplocat-imparcial.html

***********

Professor Dora Costa has started a petition of support on Change.org, here http://chng.it/NkLRKvszpF

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."

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

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 

Global kidney exchange: continued controversies, perhaps moving towards resolution

As 2019 came to a close, several articles reminded us that global kidney exchange (GKE), while gaining increasing acceptance, still is regarded as repugnant in some quarters.

Here's an article in Forbes:
Why The Global Kidney Exchange Remains Controversial by Christine Ro, Dec. 15

"The GKE has been philanthropically funded so far, but it’s possible that US health insurance companies might assume the expenses in the future. The exchanges are cost-effective on the rich-country side because the costs of medical care are smaller in lower-income countries. As well, dialysis is an unusual medical procedure in that every US citizen is entitled to it. Kidney transplants work out to be much cheaper than years of dialysis.

"This lopsided cost-effectiveness is one of the main sources of controversy around the GKE. One argument is that, to use the example of the first GKE match, the US ultimately benefits much more than the Philippines. If the Filipino pair is already a match, but the first US pair isn’t, the Americans are receiving a kidney matching service (kickstarting a daisy chain) that the Filipinos didn’t need. What the Filipinos did require was payment of their expenses. If they had the financial resources, they wouldn’t need an exchange program at all. They, or their medical system, could have covered the costs of the transplant.
...
"The medical team involved in the first Filipino match are adamant that it was positive. In an impassioned letter to the editor of the American Journal of Transplantation, they write:

“Let us be clear: without GKE, the Filipino husband was never going to receive his spouse’s kidney. Without GKE, the husband was going to die, the wife was going to lose her spouse, and their son was going to be fatherless.”

“No alternative existed for this Filipino pair and millions more like them. GKE did not exploit this Filipino couple—it provided the mechanism for the wife to literally save her husband’s life. They could not afford dialysis.”

“For 3 years on Father’s Day, the couple’s child has written our team to thank us for saving his daddy’s life.”

********

The Forbes article also links (without pointing it out) to the recent robust defense of GKE in the Lancet (see Global Kidney Exchange in the Lancet, by Minerva, Savulescu and Singer ).

And I've written earlier about other, welcome support.

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

But in Spain, the National Transplant Organization has organized opposition against allowing patients and donors from poor countries to participate in kidney exchange.  So I was glad  to see a Spanish healthcare blog questioning their reasoning:

From the Spanish blog Avances en gestión clínica (Advances in Clinical Management):

¿Nobel de Economía o traficante de órganos? ["Nobel economist, or organ trafficker?"]
by Pedro Rey, Dec. 30

It turns out that isn't meant to be an inflammatory headline, rather it is a reaction to the inflammatory announcements that issued from the Spanish ONT (National Transplant Organization) in connection with global kidney exchange.  Below, for example, is one of many such stories, using just such words:

La ONT frena la entrada en Europa de «una nueva forma de tráfico de órganos» propuesta por un nobel de Economía  ["The ONT slows the entry into Europe of "a new form of organ trafficking" proposed by a nobel economist"

Beatriz Domínguz Gil, directora de la ONT, denuncia que la iniciativa de Alvin Roth es «una nueva forma de tráfico de órganos, pero presentada como una iniciativa buena y ética» 

[  "Beatriz Domínguz Gil, director of the ONT, denounces that Alvin Roth's initiative is "a new form of organ trafficking, but presented as a good and ethical initiative"]
******
Coming back to Professor Rey and his question ¿Nobel de Economía o traficante de órganos?. He points out that while the Spanish ONT is a world leader in recovering deceased donor organs, it doesn't have the same kind of leadership in living organ donation or in kidney exchange.  He says, in part (via Google translate):

"we may find it worrying that Spanish morals have slowed, before 28 countries, the development of an idea that could benefit many patients and reduce the economic burden to keep them on dialysis for a long time.To solve this problem, a public and serious debate that clarifies the specific interests of an ONT that has based its prestige on the proven effectiveness in transplants from deceased donors and not so much in cross-transplants and, even less, living transplants, would be desirable."
********

Professor Rey goes on to note that we shouldn't naively assume that problems in dealing with cross border issues, especially between rich and not so rich countries, can be easily navigated.  I agree, and I'm confident that the GKE chains that have been conducted so far will pass close scrutiny, and point the way towards finding global solutions to the global problem of kidney failure.

I hope this is an indication that in the coming year, some of the early, hysterical reactions to GKE in Spain may continue to give way to more reasoned discussion, that will let legitimate concerns be expressed and addressed, and separated from other personal and professional motivations that may have obscured the initial reception of GKE in Europe.

Repugnance in Spain: surrogacy and prostitution

I've relatively recently started to pay attention to repugnance in Spain, here are some useful older links.

From El Pais:
Spain struggles with surrogate pregnancy issue
Practice is illegal here but debate rages over whether surrogacy is a right or a form of exploitation


From la Asociación por la Gestación Subrogada en España
Sobre la Gestación Subrogada

GT "In our country the surrogate pregnancy is illegal: Article 10 of Law 14/2006, of May 26, on Techniques of Assisted Human Reproduction establishes that the contract by which gestation is agreed, with or without price, in charge of a woman who renounces maternal filiation in favor of the contracting party or third party is null and void. 

"However, the Instruction of October 5, 2010 of the General Directorate of Registries and Notaries has left without effective content the prohibition of surrogate pregnancy by contemplating the registration in the Civil Registry of children of this technique provided that the procedure has been carried out in a country where this technique is regulated, that one of the parents is Spanish and that there is a court order that guarantees, among other aspects, the rights of the pregnant woman. The name of this woman will not appear in the annotation made in our records.

"This creates an important discrimination between those Spaniards who can afford treatment outside our borders and those who can not."


From Bright Magazine;
Decriminalizing Sex Work in Spain Made It Safer For Women — and Traffickers
Thirty years ago, most sex workers were Spanish. Today almost 90 percent are immigrants, most under the control of organized crime networks.

Surrogacy as viewed from Spain (where it is illegal)

Not late-breaking news, but here are some El Pais reports that reflect the ongoing situation in Spain:

Spain struggles with surrogate pregnancy issue
Practice is illegal here but debate rages over whether surrogacy is a right or a form of exploitation

"The Swiss-based International Social Security Association estimates that every year, surrogate mothers give birth to around 20,000 children worldwide. Agencies and parents estimate that between 800 and 1,000 go on to live with Spanish parents, but there are no official figures. There are numbers, however, for international adoptions undertaken by Spaniards, and these have fallen from 5,541 in 2004 to 799 in 2015.

"Yet if the estimates are correct, international surrogacy has overtaken international adoption in popularity. Instead of the international adoption process, which can take up to eight years, it seems that those wanting to be parents are more frequently opting for the quicker route, and paying between €45,000 and € 60,000 in the Ukraine or Russia or up to €120,000 in California – one of 14 American states where the practice is legal.

"Every country has different legislation. Ukraine, for example, only allows heterosexual couples to use surrogates. In Canada, the United Kingdom and Portugal, surrogacy is only allowed in the altruistic sense, meaning the surrogate mother receives no direct economic benefit. And the latter two countries only let nationals use surrogacy. India, a former worldwide power in surrogacy, has vetoed it for foreign couples, and is on the verge of making it illegal for economic profit. Mexico too, particularly the State of Tabasco, has recently restricted surrogacy laws.
...
"“The best solution to avoid abuses is to legislate it. It’s like organ transplants – regulating the legal practice gets rid of organ trafficking,” says Pedro Fuentes, president of a pro-surrogacy parental association that brings together around 400 families, Son Nuestros Hijos. Fuentes is a gynecologist and alongside his husband, he is also the father of a six-year-old boy who was born in California to a surrogate mother. He gets emotional when he tells the story of how he met the surrogate mother and the warm relationship they developed. He said that her own ethics also guided the process, as she had decided to use her body as a surrogate to help a gay couple.

"The association itself has a code of ethics and recommends not trusting “agencies that don’t let you meet the mother, which guarantee results, and which offer package deals saying you won’t have to worry about anything.” Also, they suggest that parents work with a woman who has already given birth. The association certainly makes the case for altruism but it is also open to economic compensation.
...
"The association asks: “When is a women being exploited? When you pay her or when you don’t?”
**********

Also,
The dark side of Ukraine’s surrogacy boom
Lack of oversight, lax regulations and a failing economy have made the eastern European country one of the most popular destinations to find a surrogate mother
*******

And here's a story from 2014 with background on the Spanish supreme court's decision not to recognize the child of Spanish parents borne by a California surrogate:
Are you my mother? The Spanish Supreme Court and surrogacy tourism

"The majority of the judges, however, contend that the “best interests” criterion is not the sole factor to be taken into account. Judges should also ponder the State’s interest in preventing the commodification of children and motherhood. But more strikingly, the Supreme Court argues that it is not obvious that it goes in the best interests of the twins to be legally declared as the sons of Ramón and César and not of the surrogate mother. It is striking, in my view, to argue along those lines when the surrogate mother is a woman who has relinquished her motherhood and the intending parents are not only willing to be the parents, but, most importantly, are the “social” fathers."



HT: Stephanie Wang

Surrogacy in Spain

El Pais has the story:

Spanish couples undergoing surrogacy processes left in legal limbo in Ukraine
A total of 30 families are unable to secure passports for their children, after the Foreign Affairs Ministry says it has detected reports of malpractice and possible trafficking

"The Spanish Consulate in Kiev is examining the cases of 30 Spanish families currently in Ukraine and who are unable to obtain a Spanish passport for their babies after entering into what is an illegal practice back home: paying a surrogate to carry their child.
...
"The statement also warns against “entering into any surrogate pregnancy process within this context.”

"The Consulate was echoing a post on the Spanish Embassy’s website, which alerted Spanish nationals to the scams and shoddy practices of certain assisted-reproduction clinics in Ukraine, involving irregularities in the pregnancy process, induced abortions six weeks into the pregnancy so couples are forced to embark on another costly IVF treatment, and a general lack of medical attention during pregnancy.

Until July, babies born to surrogates in Ukraine were registered without fuss at the Spanish Consulate in Kiev.

... 

"While registration has not yet been point-blank refused to any of the couples, a Foreign Office spokesman said shortly before the statement was issued that they were working with the local authorities to study alternatives in the case of such an event.

Given such a scenario, one possible solution would involve applying for a Ukrainian passport for the baby, thereby allowing he or she to leave Ukraine. And, once in Spain, the parentage could be established through the courts. This is the route being suggested by some of the lawyers representing the couples in question. It was also suggested by a staff member at the Consulate to a couple who are expecting their surrogate to give birth in the next few days.

Previously, the genetic Spanish father and the Ukrainian mother would be registered as the baby’s parents. “Once in Spain, the wife would then adopt her husband’s child with the prior consent of the surrogate mother,” says Franco Antonio Zenna, a lawyer who specializes in surrogacy issues and who is representing some of the couples. “It is as though a child has been born from a husband’s affair. At least that is how it has worked for the last seven or eight years at least.”
********

HT: Kim Krawiec

Frontiers of Knowledge Awards 2018, video of the presentation ceremony

Presentation ceremony of the 10th edition of the Frontiers of Knowledge Awards

18/06/2018

Bill Nordhaus at the BBVA Award ceremony

Rob Porter, Ariel Pakes, and Tim Bresnahan

 The celebration and speech of Bill Nordhaus runs from minutes 32:15-40:00 in the above video








The celebration of Tim Bresnahan, Ariel Pakes and Rob Porter, and the speech by Pakes on the behalf of all of them, run from 46:05-51:20 in the above video.








**************
See my earlier post,

Tuesday, February 20, 2018

Tim Bresnahan, Ariel Pakes and Rob Porter win BBVA Award, for their pioneering work in industrial organization, and Bill Nordhaus wins for his work in climate change

Tim Bresnahan, Ariel Pakes and Rob Porter win BBVA Award, for their pioneering work in industrial organization, and Bill Nordhaus wins for his work in climate change

Breaking news:
The BBVA Foundation recognizes Bresnahan, Pakes and Porter for opening up the field of empirical industrial organization

"The BBVA Foundation Frontiers of Knowledge Award in the Economics, Finance and Management category goes, in this tenth edition, to Timothy Bresnahan, Ariel Pakes and Robert Porter for founding and shaping the field of empirical industrial organization, a branch of economics that has developed fundamental techniques to measure market power (understood as the ability of a firm to control prices in a given industry). “Motivated by important and policy-relevant questions in applied economics,” remarks the jury in its citation, “they developed methodologies that had a significant and long-lasting impact on subsequent work in industrial organization as well as other applied fields.”
*********

William Nordhaus, the father of climate change economics, wins the BBVA Foundation Frontiers of Knowledge Award

"The BBVA Foundation Frontiers of Knowledge Award in the Climate Change category goes, in this tenth edition, to economist William Nordhaus, of Yale University (USA) for founding the field of climate change economics, by “pioneering a framework that integrates climate science, technology and economics to address the critical question: What should the world do to limit climate change?”:

Spain continues to lead in deceased donation

I'm in Rome to talk today with the 28 EU Competent Authorities on Organ Donation and Transplantation about ways of increasing living donation through kidney exchange, by easing barriers at borders.

In the meantime, Spain remains a model for deceased donation:
Spain breaks organ transplant and donor records again
"The country's National Transplant Organisation (ONT) said 2017 saw a total of 5,259 transplant operations performed beating 2016's record of 4,818 transplants.

The majority were kidney and liver transplants.

Spain also boasts a much higher average of organ donors with 46.9 donors per million people in 2017, compared with 43.9 per million in 2016 and 39.7 in 2015.

The EU average is just 19.6 donors per million and the US average is 26.6 per million."

Interview on market design in Mundo Empresarial (in Spanish)

Recent mail brought a copy of the Summer issue (Segudo Trimestre 2017) of Mundo Empresarial to my desk, and it contains a multi-page interview with me that I only dimly remember giving. It may have been a while ago: the link below lists both Saturday, July 22, 2017 and May 14, 2015 as the date of publication. (I'm guessing the web version may have come out long ago, but I missed it.)

Entrevista a Alvin E. Roth, Premio Nobel de Economía 2012

 The last question and answer (with the help of Google Translate):

Por último, además de por haber ganado el Nobel, ¿por qué querría ser recordado Alvin E. Roth?
Me haría muy feliz ser recordado como un buen maestro que ha aprendido mucho de sus alumnos.

Finally, in addition to winning the Nobel Prize, why would Alvin E. Roth want to be remembered? 
It would make me very happy to be remembered as a good teacher who has learned a lot from his students.

Highlights from the Barcelona GSE 10th Anniversary Celebration

You can find videos and photos from the 10th anniversary celebration of the Barcelona Graduate School of Economics (BGSE) here.  (The celebration took place on March 31 and April 1.)

I took part in a set of presentations on "The Practical Influence of Economic Research," with  Richard Blundell,  Matt Jackson, Anne Krueger, me, and Chris Sims ." BGSE Director Teresa Garcia-Milà moderated the discussion.

You can watch and listen to the whole thing here.



My remarks are from minute 33:50 to minute 45:00. (Among other things, I recall one of my first talks on kidney exchange, given almost 15 years ago at the Barcelona Clinic, a leading transplant center, and discuss how kidney exchange has come to account for a large percentage of living donor kidneys in Spain, as well as in the U.S.)

Surrogacy (and transplantation) in Spain

The Director of Spain's National Transplant Organization has an article comparing transplants to surrogacy (presently illegal in Spain). He proposes that altruistic (unpaid) surrogacy be legalized in Spain, and makes a comparison with the current Spanish law allowing only unpaid kidney donation.

Trasplantes y gestación subrogada  (Transplants and gestational surrogacy).
RAFAEL MATESANZ
DIRECTOR DE LA ORGANIZACIÓN NACIONAL DE TRASPLANTES

Emanuel Vespa has kindly translated the critical paragraph as follows:

"Legislation guided by the Spanish transplant legislation, which is itself based on altruism and anonymity, would allow regulating a small portion of cases in which the surrogate is a family member of friend who is neither forced nor monetarily compensated. It may also be possible to recreate something akin to altruistic organ donation, where women who would offer themselves as surrogates would play the role of `good samaritans' in anonymous and altruistic fashion. It is admittedly hard to imagine, but not more difficult to conceive than people who donate a kidney in similar circumstances, and there are hundreds of such candidates."

Barcelona Graduate School of Economics celebrates its 10th anniversary

The Barcelona Graduate School of Economics is 10!

There are a number of events and workshops.

The main celebration of this milestone will take place in Barcelona on March 31 and April 1, 2017.

FRIDAY, MARCH 31

Roundtable with members of the Barcelona GSE Scientific Council 
"The Practical Influence of Economic Research"

12:00, UPF Auditorium

Students, alumni, faculty, and friends are invited to attend this panel discussion with distinguished members of the Barcelona GSE Scientific Council:

• 
  
  Richard Blundell
  University College London
• 
  
  Matthew Jackson
  Stanford University
• 
  
  Anne Krueger
  Johns Hopkins University
• 
  
  Alvin Roth
  Stanford University
  NOBEL LAUREATE
• 
  
  Christopher Sims
  Princeton University
  NOBEL LAUREATE

Tribute and conversation with 2016 Nobel Laureates

Oliver Hart (Harvard University) and Bengt Holmström (MIT) are both members of the Barcelona GSE Scientific Council. There will be a brief tribute and conversation with Professors Hart and Holmström immediately following the roundtable.

• 
  
  Oliver Hart
  Harvard University
  NOBEL LAUREATE 2016
• 
  
  Bengt Holmström
  MIT
  NOBEL LAUREATE 2016

Barcelona GSE 10 years review

13:30, UPF Auditorium

• 
  
  Joaquín Almunia
  Honorary President of the Barcelona GSE
• 
  
  Ramon Marimon
  Chairman of the Board of Trustees
• 
  
  Andreu Mas-Colell
  Founder of the BGSE
• 
  
  Hugo Sonnenschein
  Honorary President of the BGSE Scientific Council

Lunch and Happy Birthday Barcelona GSE

14:00, outside UPF Auditorium

Research Workshops

16:00-17:30, UPF Building 40

Faculty, researchers, and Scientific Council members will participate in three concurrent research workshops:

Applied Economics Workshop (Room 40.008):

• Libertad González (UPF and BGSE) 
• Hannes Mueller (IAE-CSIC and BGSE)
• Marta Reynal-Querol (ICREA-UPF and BGSE)

Chair: Orley Ashenfelter (Princeton University and BGSE Scientific Council)

Macroeconomics Workshop (Room 40.010):

• Davide Debortoli (UPF and BGSE)
• Luca Gambetti (UAB and BGSE)
• Alberto Martin (CREI, UPF and BGSE)

Chair: Nancy Stokey (University of Chicago and BGSE Scientific Council)

Microeconomics Workshop (Room 40.012):

• José Apesteguía (ICREA-UPF and BGSE)
• Jordi Brandts (IAE-CSIC and BGSE)
• Pau Milán (UAB and BGSE)

Chair: Ariel Rubinstein (Tel Aviv University and BGSE Scientific Council)

Download the workshop program | Register to attend a workshop

Alumni Reunion and Network Activities

See the reunion page for details and registration.

SATURDAY, APRIL 1

Scientific Council Meeting

On Saturday, the Barcelona GSE Scientific Council Meeting will take place at the Institute for Economic Analysis (IAE-CSIC) at UAB Bellaterra Campus. 

Alumni Reunion and Network Activities

See the reunion page for details and registration.

---

Share your memories from the Barcelona GSE's first ten years: #BGSE10

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Here's a news story (courtesy of Google translate):
The center of the UPF and UAB, founded by Andreu Mas-Colell has trained 2,000 students from one hundred countries and ranks as one of the best economic research institutes in the world

BGSE 10th Anniversary celebration reunites more than 350 people who have shaped our first decade