Showing posts sorted by date for query china AND "organ donation". Sort by relevance Show all posts
Showing posts sorted by date for query china AND "organ donation". Sort by relevance Show all posts

Thursday, September 3, 2026

Psychology and Economics at Stanford SITE: Sept 3-4 (Program)

 Session 18: Psychology and Economics  
Thu, Sep 3 2026, 8:00am - Fri, Sep 4 2026, 7:00pm PDT

Thursday, September 3, 2026

Sep 3

8:00 am - 9:00 am PDT

Check-in and Breakfast

Sep 3

9:00 am - 9:40 am PDT

What do we really know about risk preferences for binary lotteries?

Presented by: Charles D. Sprenger (California Institute of Technology)
Camila Farres (California Institute of Technology), Ted O’Donoghue (Cornell University)

We conduct a comprehensive experiment on decision-making for binary lotteries—specifically, lotteries that yield a positive amount or zero. Such lotteries form the basis of many empirical results revealing violations of expected utility (EU) and motivating behavioral alternatives. However, the space of binary lotteries has not been comprehensively explored, and thus the predictions of various behavioral alternatives to EU have not been fully assessed even within this limited domain. We provide this exploration, and discover empirical patterns that stand in stark contrast to the predictions of existing behavioral models. In particular, the data indicate that risk attitudes are driven largely by relative probability comparisons between two options, with absolute magnitudes of probabilities playing a minor role. We show that the data is largely consistent with the model of “upside potential” proposed by McGranaghan et al. (2025).

Sep 3

9:40 am - 10:20 am PDT

The Misallocation of High-Value Work

Presented by: Jason Somerville (University of California, Santa Barbara)
Carl Meyer (Stanford University), Germán Reyes (Middlebury College)

Aggregate productivity depends on whether productive inputs are allocated to their highest-value uses. We document a novel form of misallocation within a single individual performing a cognitive task. In an online experiment, participants complete a 30-question mathematics exam with random question order and randomly timed enhanced incentives (“bonus boosts”). Performance falls by 9.5 percentage points from the first to the last question, and 82 percent of participants exhibit a decline. Yet 58.0 percent of participants report no preference over when to receive bonus boosts, and willingness to pay for these boosts is constant across timing options. This indifference is costly: assigning boosts early rather than late raises expected bonus earnings by 9 percent. The misallocation aligns with miscalibrated beliefs about productivity: pre-exam forecasts imply constant performance, and post-exam hindcasts capture only 55 percent of the actual decline. These findings identify miscalibrated beliefs about within-worker productivity trajectories as an under-recognized source of misallocation.

Sep 3

10:20 am - 11:00 am PDT

Break

Sep 3

11:00 am - 11:40 am PDT

Model-Directed Attention and the Persistence of Wrong Mental Models: Evidence from Firm Pricing

Presented by: David Huffman (Cornell University)
Yi Han (Renmin University of China), Yiming Liu (Humboldt University of Berlin)

We show a way that wrong mental models can persist even in data-rich environments, and potentially even resist encounters with peers who have the correct model: by remaining silent about data features they cannot explain, simple wrong models direct attention away from disconfirming patterns and explanations. Field evidence comes from 13,000 gas station managers, 20 percent of whom have a simple model, discounts raise sales, that is silent about intertemporal substitution (IS), evident in the data as sales dips before and after a pre-announced discount. Managers who neglect IS show measurable inattention to these dips, believe fuel demand is more elastic, set lower prices, earn lower profits, andtheir neglect persists with experience. Online experiments on Prolific provide tighter identification and causal evidence: exposure to the simple peer model reduces attention to IS patterns, while a targeted attention intervention raises recognition of those patterns and induces switching to the correct model. Encountering the correct model at a later stage helps correct beliefs, but does not fully undo the impact of having the wrong model first.

Sep 3

11:40 am - 12:20 pm PDT

Beliefs Over Contracts

Presented by: Francis Annan (University of California, Berkeley)
Collin B. Raymond (Cornell University)

We study how firms choose among incentive contracts and how accurately managers predict their e!ects. Using a survey of managerial beliefs and a large-scale field experiment, we randomly assign agents at the market level to several widely used, expenditure-equivalent incentive schemes. In the field, the best-performing contract increases agent output and firm revenue by over 20% relative to the status quo, despite being ranked lower by managers, whereas the worst-performing contract performs as predicted. Managers correctly identify underperforming contracts but systematically underestimate top- performing ones. We document the sources of performance differences—labor supply responses rather than selection or pricing and the determinants of managerial predictability: contract complexity and managerial hierarchy. Our results highlight the importance of contract design for firm performance and reveal systematic limits to managerial cognition in shaping incentives.

Sep 3

12:20 pm - 2:00 pm PDT

Lunch

Sep 3

2:00 pm - 2:20 pm PDT

Do Firms Know What Workers Want?

Presented by: Simon Cordes (University of Bonn)
Max Müller (University of Bonn)

Labor supply depends on wages and amenities, and standard models implicitly assume that firms hold accurate beliefs about workers’ amenity valuations. In a survey with firms and workers in Germany, we measure workers’ valuations of amenities and firms’ beliefs about workers’ valuations. We find that firms systematically underestimate workers’ valuations of all amenities. These misperceptions are driven by interpersonal projection: managers project their own preferences—they value amenities less—onto workers. Through the lens of a simple model of imperfect competition, we show that firm misperceptions result in (i) labor shortages and (ii) excess labor costs for biased firms, and increase the market power of unbiased firms. Empirical tests confirm these predictions: a simple calibration suggests that non-providing firms could reduce their labor costs by 5% by providing amenities.

Sep 3

2:20 pm - 2:40 pm PDT

Insuring Wisdom: Intermediaries in the Market for Medicare Advice

Presented by: Elaine Shen (University of California, Berkeley)
Margaret Kallus (University of California, Berkeley)
Sep 3

2:40 pm - 3:00 pm PDT

Knowledge Transfer and Strategic Similarity

Presented by: Joseph Feffer (Stanford University)
Filip Tokarski (Stanford University)

This paper studies when strategic understanding acquired in one mechanism can be transferred to another. We introduce a framework in which agents’ knowledge is represented as a set of payoff comparisons they can make, and use it to formalize what it means to understand that a strategy profile is an equilibrium. We first apply this framework to mechanisms that are strategically equivalent—that is, share the same game form up to relabeling of actions—and show that agents’ understanding of equilibrium transfers across such mechanisms once the relevant action correspondences are explained to them. We then define strategic analogy, a weaker notion that allows not only actions but also types to be remapped, and show that understanding of equilibrium transfers across strategically analogous mechanisms once agents recognize how actions and types correspond. Applications include single item auctions, scoring auctions, and nonlinear pricing with capacity constraints.

Sep 3

3:00 pm - 3:20 pm PDT

Geographic Price Extrapolation, Learning, and Housing Search: Evidence from Danish Movers

Presented by: Matteo Saccarola (University of Chicago)

Using population-wide Danish administrative registers on housing transactions, I document an asymmetric, hockey-stick relationship between origin market prices and overpay- ment for comparable homes. Quantitatively, the elasticity of overpayment with respect to the origin-destination price difference is 3.9 percent (p < 0.01) when movers relocate from more expensive to cheaper housing markets. In contrast, buyers moving to more expensive locations exhibit little systematic overpayment, and their purchase prices are unrelated to prices at origin. I interpret these patterns through a housing search model in which buyers enter with price beliefs anchored in their origin market and update those beliefs gradually during search. Despite homogeneous learning, endogenous stopping generates the observed asymmetry at purchase: buyers predisposed to overpay transact quickly before fully learning the local price level, while those predisposed to underpay search longer and converge toward local prices. The model yields additional predictions that I test using administrative and survey data. The evidence supports origin-based price extrapolation with subsequent learning rather than preference-based explanations such as reference dependence.

Sep 3

3:20 pm - 4:00 pm PDT

Break

Sep 3

4:00 pm - 4:40 pm PDT

Strategically Controlling Worldviews

Presented by: Danil Dmitriev (University of Georgia)
Cuimin Ba (University of Pittsburgh), Ziqi Hang (Texas Tech University), Freddie Papazyan (Texas Tech University)

This paper studies persuasive behavior when the sender can control both the information the receiver observes and the model through which it is interpreted (the narrative). Even when the receiver begins with a correctly specified model and understands the sender’s strategic incentives, the sender can manipulate him and often secure her preferred action with probability one. The key mechanism highlights a strong complementarity between strategic communication of information and narratives, allowing the sender to strictly outperform a Bayesian persuader with commitment power. We fully characterize the sender-optimal equilibrium for a broad class of information technologies. Softer information lowers the bar for full manipulation, while harder information expands the set of environments where any manipulation is possible. The results provide a formal foundation for understanding the widespread success of disinformation.

Sep 3

4:40 pm - 5:20 pm PDT

Deception Aversion

Presented by: Evan Friedman (Paris School of Economics)
Béla Elmshauser (Paris School of Economics), Yoon Joo Jo (Texas A&M University)

In communicating private information, opportunities to lie by misreporting the truth also present opportunities to deceive by inducing inaccurate beliefs. While many studies document truth-telling despite material costs—commonly attributed to lying aversion—such behavior may also reflect aversion to deceiving others. Disentangling the two preferences is challenging because deception depends on the sender’s unobserved second-order beliefs. In a novel game, we show theoretically how to identify deception aversion from choice data alone, under minimal assumptions on beliefs. In a laboratory experiment, we find strong evidence of deception aversion: many subjects lie to avoid deception; structural estimates imply that 30% are deception-averse.

Sep 3

5:20 pm - 7:00 pm PDT

Dinner

Friday, September 4, 2026

Sep 4

8:00 am - 9:00 am PDT

Check-in and Breakfast

Sep 4

9:00 am - 9:40 am PDT

Limited Propagation and Contingent Thinking

Presented by: Ran Spiegler (Tel Aviv University & University College London)
Andrew Ellis (London School of Economics)

Abstract. We model an agent who updates her beliefs over a set of variables after observing some of them without fully propagating their implications. We provide a representation of updated beliefs that exhibit limited propagation along a directed acyclic graph, and show that it is implemented by a variant on a standard propagation algorithm. Failures of contingent thinking occur when the agent’s inferences travel through fewer graph paths from hypothetical variables relative to given ones. We characterize the model’s relationship to Bayesian updating and familiar non-Bayesian benchmarks. Contingent thinking is necessary for Bayesian updating, and failures cause correlation neglect and violations of iterated expectations. Our frame- work offers a new perspective into experimental evidence on contingent thinking, reinterpreting effects such as the winner’s curse or the Monty Hall fallacy. We illustrate the framework with applications, ranging from public good contribution games to the recreational puzzle Kakuro.

Sep 4

9:40 am - 10:20 am PDT

Intergenerational Race-Based Trauma and Financial Market Participation

Presented by: Vicki Bogan (Duke University)
Lisa A. Kramer (University of Toronto), Chi Liao (University of Manitoba), Alexandra Niessen-Ruenzi (University of Mannheim)

This paper examines whether historical race-based financial trauma shapes current household financial market participation. Our analysis exploits geographic exposure to the Freedman’s Savings Bank (FSB), established in 1865 to encourage Black Americans to save. The bank collapsed in 1874 due to fraud and mismanagement. Using restricted-use Panel Study of Income Dynamics (PSID) data, we link present day stock ownership to historical FSB branch locations. Own, paternal, and grandpaternal FSB-county exposure is associated with lower stock market participation among Black individuals. These effects persist after controlling for socioeconomic and geographic differences, migration, and broader patterns of racial exclusion. Our findings reveal intergenerational transmission of race-based financial trauma and a robust mechanism perpetuating the racial wealth gap.

Sep 4

10:20 am - 11:00 am PDT

Break

Sep 4

11:00 am - 11:40 am PDT

Deadly Stigma

Presented by: Manasvini Singh (Carnegie Mellon University)

How harmful is stigma in the “real world”? Answers are elusive because stigma is difficult to measure in observational data, and isolating its effects requires exogenous variation in stigma without variation in the stigmatized trait. This study addresses these challenges by focusing on a widespread form of stigma — weight stigma — in the high-stakes setting of inpatient healthcare. BMI categories are displayed prominently to providers in electronic medical records, and obesity is heavily stigmatized socially. The “obese” cutoff may thus discretely shift stigma while keeping constant the underlying trait. Using a regression discontinuity design that exploits this institutional feature, I find a discontinuous increase in in-hospital mortality at this cutoff, though patient health does not change. Two patterns suggest stigma-based discrimination as the mechanism. First, just-obese patients receive lower diagnostic effort than almost-obese patients. Second, a physician-validated LLM identifies a rise in stigmatizing language in clinical notes at the cutoff — specifically, statements that impose moral judgment, undermine patient credibility, and stereotype patients — that closely tracks mortality effects. Overall, this paper establishes stigma as a powerful social force that can have life-or-death consequences.

Sep 4

11:40 am - 12:20 pm PDT

Opt in? Opt out?

Presented by: Alex Chan (Harvard University)
Ayush Gupta (Boston University), Yetong Xu (Harvard University)

Cadaveric organ shortages leave thousands without life-saving transplants each year. Countries differ in using opt-in (informed consent) or opt-out (presumed consent) systems for donor registration. Using newly assembled cross-country panel data and an event-study design, this paper provides evidence that presumed-consent laws increase organ donation only when strictly enforced and family veto power is limited; weak opt-out regimes show negligible or even negative effects. A theoretical signaling model provides a plausible mechanism when opt-in or opt-out yields more donations, emphasizing the roles of donation propensity, signaling costs, and the family’s ability to overturn defaults. A large laboratory experiment further tests these mechanisms, showing that opt-in generally produces equal or higher donation rates unless signaling is costly and family veto power is minimal. The results underscore that defaults alone rarely increase donations unless paired with strong institutional enforcement.

Sep 4

12:20 pm - 2:00 pm PDT

Lunch

Sep 4

2:00 pm - 2:40 pm PDT

State Dependence and Commitment: Experimental Evidence from Crop Insurance in Uganda

Presented by: Sili Zhang (Ludwig Maximilian University of Munich)
Lorenzo Casaburi (University of Zurich), Jack Willis (Sciences Po)

According to standard economic arguments, state dependence generates the value of flexibility. This paper proposes that it can instead generate demand for commitment when individuals anticipate that future states will distort their decisions. A conceptual framework models two broad channels—state-dependent valuations (e.g., projection bias) and state-dependent decision mistakes (e.g., scarcity effects)— and shows that sophistication about such future distortions can generate demand for commitment. We test this prediction in a field experiment in Uganda, where we exclude present bias as a source of commitment demand by design. Farmers are offered pay-at-harvest crop insurance for two seasons and can choose upfront whether to commit to second-season insurance or maintain flexibility. Forty percent of farmers choose commitment. An intervention increasing sophistication raises commitment by 11 percentage points. Additional evidence suggests that both channels matter with substantial heterogeneity across farmers. Our results highlight the importance of individuals’ sophistication about future state dependence for welfare analysis and policy design, particularly in environments with high state variability.

Sep 4

2:40 pm - 3:20 pm PDT

Behavioral Inequality: The Contribution of Decision-Making Frictions to Inequality

Presented by: Stefano DellaVigna (University of California, Berkeley)
Tim de Silva (Stanford University), Rohan Jha (University of California, Berkeley)

We provide the first systematic quantification of how decision-making frictions—such as failing to claim government benefits, choosing dominated insurance plans, not saving for retirement, and not quitting smoking—aggregate to affect inequality in income, consumption, and wealth. We review the existing literature and combine it with original analysis of survey data to estimate the prevalence and financial impact of 18 frictions across the income distribution. To make these frictions comparable, we develop a framework in which each friction is characterized by three parameters: the share of the population at risk, the share affected by the friction, and the average loss conditional on being affected. Aggregating across the frictions with dollar-loss estimates, the estimated impact on annual income is 7.8% for the bottom quartile of the income distribution relative to 4.2% for the top quartile; the total loss for low-income households is approximately 7.5 times larger than the impact of a major EITC expansion. We then incorporate these frictions into a life cycle model with realistic institutional features, including tax-advantaged retirement accounts, progressive taxation, portfolio choice, and a social insurance system. The model reveals that removing frictions tends to reduce inequality in lifetime consumption, with the largest effects coming from smoking and attending for-profit colleges. Our results suggest that decision-making frictions are a quantitatively important contributor to inequality in income, consumption, and wealth.

Sep 4

3:20 pm - 4:00 pm PDT

Break

Sep 4

4:00 pm - 4:40 pm PDT

A Practical Approach to Robust Policy Evaluation with Behavioral Agents

Presented by: Dmitry Taubinsky (University of California, Berkeley)
B. Douglas Bernheim (Stanford University)
Sep 4

4:40 pm - 5:20 pm PDT

What Motivates Partisan Selective Exposure? Experimental Evidence from the 2024 US Presidential Election

Presented by: Matt Gentzkow (Stanford University)
Peter Robertson (Stanford University), Michael Thaler (University College London)

Why do partisans prefer like-minded information sources? They may want to learn the truth and believe these sources are the most accurate. Or, they may prefer them for non-accuracy psychological forces such as confirmation bias. We evaluate these motives in two large-scale experiments in which 3,785 participants choose sources to help them predict swing-state winners in the 2024 US presidential election. Partisans exhibit substantial selective exposure, choosing like-minded sources both among real news outlets and among synthetic sources we construct. This behavior remains essentially unchanged under two treatments: (i) increasing incentives for accuracy and (ii) shutting down confirmation motives by having participants delegate their predictions to sources without seeing sources' content. In contrast, participants respond strongly to experimentally-varied source accuracy, even absent incentives. Our results, interpreted in reduced form and through a discrete-choice model, suggest the selective exposure in our experiment can be almost entirely explained by demand for accuracy.


 

Tuesday, August 18, 2026

Public attitudes towards deceased organ donation and allocation in china

 Deceased  organ donation in China does not  yet have overwhelming public support although receiving a deceased donor organ transplant does:

Hu, D., Wang, Y., Hu, Q. et al. Public attitudes and preferences on organ donation and allocation in china: a cross-sectional study. Sci Rep 16, 24995 (2026). https://doi.org/10.1038/s41598-026-54903-4 

 

 

 

Wednesday, December 24, 2025

Interview about the new edition of the Chinese translation of Who Gets What and Why

 Last month I was interviewed in connection with the new edition of the Chinese translation of my 2015 book Who Gets What and Why.  

Here is the interview in Chinese, and translated back to English. (You can also click "translate to English" from the Chinese version, to get a more creative translation that among other things renders my name as variations on "Erwin Ross.")

 Below are some excerpts from the better back-translation (from interview in English translated into Chinese, and then back to English):

"In November 2025, LatePost conducted a video interview with Roth. The interview began at 7 a.m. local time, and the 74-year-old had already arrived at his office, walking on a treadmill desk while conversing with us. A white beard, furrowed brow when deep in thought, a smiling expression, and concise communication—these are the impressions Roth gave during the conversation.

'Market design is economics confronting the external world,' Roth told us. A month earlier, his popular book on market design, Who Gets What―and Why, was republished in Chinese under the title Matching. Designing, improving, and maintaining well-functioning matching mechanisms is the work of market design. In Matching, Roth demonstrated how market design could be applied in practice to change people's destinies and the way societies operate. 

...

"Alvin Roth: Significant changes have occurred in both kidney transplantation and kidney exchange. By the way, since 2015, there has been a major transformation in the approach to transplant surgeries in China. Prior to that, most organs used in transplants came from executed prisoners; now, China is developing a voluntary organ donation program, which represents a significant shift. However, China has yet to initiate kidney exchange programs.

"A new global trend is that we are beginning to experiment with cross-border kidney exchanges. This is particularly crucial for smaller countries or regions with limited numbers of kidney transplants, where some patients struggle to find compatible donors. 

...

"Q: In your "Market Design" blog, you previewed a new book to be published next year titled Moral Economics: From Prostitution to Organ Sales, What Controversial Transactions Reveal About How Markets Work. Why did you write this book? What issues do you discuss and how do you address them?

"Alvin Roth: One issue that economists have yet to fully understand is which markets gain societal support and which ones do not. For instance, I have explored the surrogacy market. Surrogacy is legal in the United States but illegal in China. After the Chinese government relaxed its one-child policy, many people desired to have a second child, but age became an obstacle. In California, where I reside, there are agencies offering surrogacy services where Mandarin is spoken, and many clients come from China.

"This is one of the core questions I attempt to address: why are certain genuinely beneficial practices legal in some places but illegal in others? "

#######

When I search for the new edition on Google I get the following AI overview:

Alvin Roth's book, originally titled
Who Gets What―and Why: The New Economics of Matchmaking and Market Design, has been published in Chinese under two different titles. 
The two Chinese titles are:
  • 《共享经济:市场设计及其应用》 (Simplified Chinese: Gòngxiǎng jīngjì: Shìchǎng shèjì jí qí yìngyòng, meaning "Sharing Economy: Market Design and Its Application").
  • 《配对:诺奖得主艾文・罗斯教你赢得博弈,突破市场经济赛局的思维》 (Traditional Chinese: Pèiduì: Nuò jiǎng dé zhǔ Ài wén luō sī jiào nǐ yíng dé bó yì, tū pò shìchǎng jīngjì sài jú de sī wéi, meaning "Matching: Nobel Laureate Alvin Roth Teaches You to Win the Game and Break Through Market Economy Game Thinking"). 
The simplified Chinese characters edition was published by Machinery Industry Press in 2015. 
 
Earlier: 

Thursday, January 28, 2016  Who Gets What and Why in Chinese

 

 

Saturday, July 27, 2024

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.

Monday, January 8, 2024

"Scraping poison off the bone": Transplants in China without organs from executed prisoners

 Following a long period in which the bulk of China's organ transplants used organs from executed prisoners, there have been steady efforts to create a system of voluntary deceased donation comparable to that in most of the world where transplants are done.

Global Times has the latest bit of that evolving story:

China’s organ donation to be more transparent under newly issued rules By Zhao Yusha and Zhang Yuying   Dec 15, 2023

"Chinese Premier Li Qiang has signed a decree of the State Council to unveil rules on human organ donation and transplantation, media reported on Thursday, with Chinese experts noting that the country’s organ donations will be more transparent under the regulation, which reflects great determination in China's organ donation reform. 

The newly issued rules, which will take effect on May 1, 2024, have been refined from the ones on human organ transplantation issued in 2007 to meet the demands of changing situations and ensure the healthy development of the cause, according to the Xinhua News Agency.

The rules strengthen the publicity and guidance of organ donation. Besides, the regulations stipulate that organ donation must adhere to the principles of voluntary and unpaid participation, and the conditions and procedures of donation should be improved based on the Civil Code. 

...

"China’s organ donations will be more transparent under the newly issued rules, Huang Jiefu, chairman of China Human Organ Donation and Transplantation Committee and chair of the China Organ Transplant Development Foundation Advisory Board, told the Global Times on Thursday.

"Huang noted that the revision of the rules shows the great determination in China's organ donation reform, which he described as scraping poison off the bone. “The regulations reflect the importance the Party and country attach to organ donation, which provides a strong legal guarantee for the high-quality development of organ donation cause.” 

"According to the rules, the application management of organ transplantation technologies should be improved to ensure medical quality. Specifically speaking, the rules define the conditions that medical institutions and practicing physicians must possess when engaging in organ transplantation, and require regular evaluation of the clinical application capabilities of relevant technologies in medical institutions. 

...

"In addition, the rules improve related provisions on legal liabilities and strengthen the punishment of malpractice in the field, Xinhua reported.

"Experts said the new rules call for more people to get involved in organ donations and transplants, and it is hoped that China's organ transplantation technology will spread to more countries in the future."

********

Here (in Chinese, but with Google Translate) is the announcement from Xinhua News Agency

李强签署国务院令 公布《人体器官捐献和移植条例》"Li Qiang signed a State Council order announcing the "Regulations on Human Organ Donation and Transplantation"

[The new regulations] "stipulate that patients whose spouses, direct blood relatives and other relatives have donated deceased organs can apply for organ transplantation , priority is given to them under the same conditions. 

...

"Ethical review requirements before organ harvesting will be refined, and the witnessing procedures for harvesting organs from deceased persons will be stipulated. Improve the cadaver organ distribution system, stipulate that the distribution of cadaver organs should meet medical needs, follow the principles of fairness, impartiality, and openness, and distribute uniformly through the distribution system established by the health department of the State Council. It is required to regularly announce the donation and distribution of cadaver organs and accept social supervision.

...

"In addition, relevant provisions on legal liability have been improved, penalties have been increased, and illegal activities in the field of organ donation and transplantation have been severely cracked down on.

  "(Authorized release) Order No. 767 of the State Council of the People's Republic of China

  "(Authorized release) Regulations on Human Organ Donation and Transplantation"


HT: Michelle Miao

Tuesday, September 19, 2023

Organ transplantation in China: in transition--and controversy about paying funeral costs

 I recently spoke at the CAST transplant conference in Hong Kong (see picture), and the underlying theme of my talk, and of many talks there, was the transition of transplantation in China, and what its future might hold.

Jie-Fu HUANG is the other speaker on Zoom (to my right and your left), and Haibo Wang is on the far left on stage.

Here are two of my opening slides (using 2021 data from the Global Observatory on Donation and Transplantation)


On the left, you see that, today, China and India already perform more kidney transplants than any country in the world except the U.S.  On the right, you see that, by virtue of their large populations, they accomplish this despite their quite low rates of transplants per million population, compared to the U.S. and countries in Europe.  So if China and India can raise their transplant rates to rates comparable to the U.S. and Europe, most of the transplants in the world will be done in Asia, and many many additional lives will be saved.

Note that China mostly transplants kidneys from deceased donors, while India mostly transplants kidneys from living donors. So they have different paths (and plenty of untapped potential) for raising donation and transplantation rates.  And their paths to their current positions have also been very different.

Here is a recent account reflecting China's recent progress:

Chen, Zhitao, Han, Ming, Dong, Yuqi, Zeng, Ping, Liao, Yuan, Wang, Tielong, et al. (2023). First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China: 5-year Experience at a High-volume Donor and Recipient Liver Transplant Center. Transplantation, 107, 1855-1859. https://doi.org/10.1097/TP.0000000000004561

" In 1972, our center performed the first living donor kidney transplantation in China. Since then, kidney and liver transplant programs have evolved. By the beginning of the 21st century, organ transplantation had advanced, and clinical liver transplants have been performed successfully at the First Affiliated Hospital of Sun Yat-sen University.1

"Organ shortage has been a prominent feature at our institution as it has been around the world. Starting in the early 1980s, many organs had been procured from inmates on death rows. This unethical approach has been rightfully criticized by the worldwide community. As a consequence, the source of organs for transplants has solely been replaced by voluntary donations from Chinese citizens since January 1, 2015.

...

"Moreover, policies and methods for humanitarian aid to donor families were established. Those policies follow WHO guidelines while recognizing specific aspects of the Chinese culture. The State Ministry of Health and the Red Cross Society of China launched a pilot project on organ donation after the death of citizens in 2010 and established the China Organ Donation Committee. The principle of this pilot project was to learn from the experiences and standards in developed countries while recognizing national conditions and the social reality in China aiming to build an ethical and effective scientific organ donation and transplantation system.2

**********

In the same issue of Transplantation as the above article is this invited commentary by Ascher and Delmonico, both former Presidents of The Transplanation Society (of which Transplantation is the official journal). They largely approve of the effort China has made in transplants, but they have a big reservation.

Ascher, Nancy, MD, PhD & Delmonico, Francis. (2023). Organ Donation and Transplantation in China. Transplantation, 107, 1880-1882. https://doi.org/10.1097/TP.0000000000004562

"The date of 2015 is important for the review of any organ transplantation report from China because of the public proclamation in the media in 2015 prohibiting the use of organs from executed prisoners. Clinical transplantation articles antecedent to 2015 have been consistently rejected by Transplantation and the international community because the source of the transplanted organs was most often an incarcerated prisoner. China took a major step to condemn this practice publicly in 2015. However, because there is no law or regulation that prohibits this unethical practice, there has been ongoing concern that this practice may be continuing. Notwithstanding such a reality, there have been regulations that are citable and may be reflective of the changing experience of organ donation and transplantation in China that are consistent with the World Health Organization (WHO) Guiding Principles.

...

"WHAT CONTINUES TO BE OBJECTIONABLE

"The Chinese Red Cross is prominent in the organ donation process and a center of support for deceased donor families designated by the Red Cross as humanitarian aid to donor families.7 However, such humanitarian aid, although not limited to China, should not be misinterpreted to be an effort because it includes payment to elicit consent for donation. The Sun Yat-sen publication suggests that the Red Cross policies follow WHO guidelines while recognizing specific aspects of Chinese culture without elaboration as to the cultural details. A payment to donor families for funeral expenses or other monetary incentives should be recognized as a form of commercialization and would not comply with WHO guidelines."

**********

Some background may help put this objection in perspective. Doctors Delmonico and Ascher are prominent signatories of a declaration that payments to families of organ donors are crimes against humanity (as are payments to living donors, and both are declared comparable to transplanting organs from executed prisoners, and to be organ trafficking. See my 2017 post.)

So, they raise the question of whether saving many lives by increasing deceased donation in China will be justified if it involves paying funeral expenses of donors.  

My guess is that Chinese health authorities, thinking of the many lives to be saved, will think that this act of generosity to families of deceased donors will indeed be justified, taking account of (see above) "national conditions and the social reality in China aiming to build an ethical and effective scientific organ donation and transplantation system." 

Many people in China and elsewhere might even think that little if any justification is needed for generosity, particularly generosity to families of deceased donors, that is to families who are themselves generous.

Monday, September 18, 2023

Kidney Paired Donation in Developing Countries: a Global Perspective

 Vivek Kute and his colleagues argue that one of the lessons from the developing world is that kidney exchange can save many lives, but may need to be organized differently in some ways than in the developed world.

Kidney Paired Donation in Developing Countries: a Global Perspective by Vivek B. Kute, Vidya A. Fleetwood, Sanshriti Chauhan, Hari Shankar Meshram, Yasar Caliskan, Chintalapati Varma, Halil Yazıcı, Özgür Akın Oto & Krista L. Lentine, Current Transplantation Reports (2023)  (here's a link that may provide better access]


Abstract

...

"Despite the advantages of KPD programs, they remain rare among developing nations, and the programs that exist have many differences with those of in developed countries. There is a paucity of literature and lack of published data on KPD from most of the developing nations. Expanding KPD programs may require the adoption of features and innovations of successful KPD programs. Cooperation with national and international societies should be encouraged to ensure endorsement and sharing of best practices.

Summary

KPD is in the initial stages or has not yet started in the majority of the emerging nations. But the logistics and strategies required to implement KPD in developing nations differ from other parts of the world. By learning from the KPD experience in developing countries and adapting to their unique needs, it should be possible to expand access to KPD to allow more transplants to happen for patients in need worldwide."

...

" Despite the advantages of KPD programs, they remain rare in the developing world, and the programs that exist have many differences with those of developed countries. Program structure is one of these differences: multi-center, regional, and national KPD programs (Swiss, Australia, Canada, Dutch, UK, USA) are more common in the developed than the developing world, whereas single center programs are more common

...

"kidney exchanges frequently take weeks to months to obtain legal permission in India despite the fact that only closely-related family members (i.e., parents, spouse, siblings, children, and grandparents) are allowed to donate a kidney [47].

...

"Protecting the privacy of a donor, including maintaining anonymity when requested, is common practice among developed countries but uncommon in developing nations. Anonymous allocation during KPD is a standard practice in the Netherlands, Sweden, and other parts of Europe, but this is not the case in countries such as India, Korea, and Romania [14, 48, 49]. In areas where anonymity is not maintained, the intended donor/recipient pair must meet and share medical information once a potential exchange is identified, but before formal allocation of pairs occurs. The original donor/ recipient pair may refuse the proposed exchange option for any reason and continue to be on the waitlist. In India, nonanonymous KPD allocation is standard practice and has the goal of increasing trust and transparency between the transplant team and the administrative team [14, 49]. Countries differ in philosophical approaches to optimizing trust and transparency, and objective data on most effective practices would benefit the global community."

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Tomorrow I hope to have a few words to say about the equally unique situation in China.

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Update:

Tuesday, September 19, 2023

Thursday, August 17, 2023

Organ transplants between Hong Kong and mainland China: the promise and the politics

 This is a followup post to an earlier post# about the first cross border transplant in China between the mainland and Hong Kong. That's been followed by some political tensions, as reported in this forthcoming article in the American Journal of Transplantation.

A plan to save lives: Hong Kong–mainland China second-tier mutual assistance allocation. The new program between the transplant communities plays out on a backdrop of controversy and historical tension  by Lara C. Pullen, PhD, Published:July 28, 2023DOI:https://doi.org/10.1016/j.ajt.2023.07.015

"Key points:

"The transplant communities of Hong Kong and mainland China have proposed a second-tier mutual assistance allocation program that some find controversial.

• Tensions between Hong Kong and mainland China have a long and deep history.

• In 2014, the Chinese government announced a stop to obtaining organs from executed prisoners.

• Transplantation in mainland China has rapidly evolved, and people monitoring the change report that data from 10 to 15 years ago does not reflect the country’s current system."

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The background:

In December, the South China Morning Post carried this story about a transplant involving an organ recovered on the mainland and transplanted into a baby in Hong Kong, which was apparently the first such  transplant to cross that border:

4-month-old Hong Kong girl suffering from heart failure receives successful transplant with donated organ from mainland China, in city’s first such arrangement by Cannix Yau

One of the subheadlines is "Health Bureau notes importation of organ met relevant regulations, and hospital officials say arrangement involving mainland might be repeated in future"

***

And here's the story in the China Daily:

Securing a new lease of life By Li Bingcun | HK EDITION | Updated: 2023-03-31 15:10

"Hong Kong and the Chinese mainland have successfully carried out the first-ever cross-boundary organ-sharing operation, saving the life of an infant. The feat caps the city’s strenuous efforts to create a standing mechanism in organ sharing with the mainland to save more lives. Li Bingcun reports from Hong Kong."

***

Apparently the discussion of closer cooperation between transplant authorities in Hong Kong and the mainland is politically fraught. 

Here's a story from the Global Times that refers to some pushback from the mainland:

First organ donation between mainland and HK saves 4-month old baby By Wan Hengyi

"the acceptable heart donation for Cleo requires a donor weighing between 4.5 kilograms and 13 kilograms, and the chances of a suitable donor appearing in Hong Kong are slim to none. 

...

"COTRS initiated the allocation of a donated heart of a child with brain death due to brain trauma in the mainland on December 15. As a very low-weight donor, no suitable recipients were found after multiple rounds of automatic matching with 1,153 patients on a national waiting list for heart transplants in the COTRS system. In the end, the medical assistance human organ-sharing plan between the Chinese mainland and Hong Kong was launched.

"Some netizens from the Chinese mainland asked why a baby from Hong Kong who has not lined up in the COTRS system can get a donated heart when there is a huge shortage of donated organs in the mainland.

"In response, the organ coordinator told the Global Times that the requirements for organ donation are extremely high, noting that all the prerequisites including the conditions of the donor and recipient, the time for the organ to be transported on the road and the preparation for surgery must reach the standards before the donation can be completed.

"The COTRS system has already gone through several rounds of matching, which is done automatically by computer without human intervention, said the organ coordinator. "

...

"As of the end of October 2022, a total of 42,500 donors had donated more than 126,300 large organs in China, according to Guo Yanhong, director of the medical emergency department of the NHC."

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Here's a story from the Guardian, about political concerns on the Hong Kong side:

Hongkongers opt out of organ registry ‘amid fear of Chinese donations’      by Amy Hawkins

"Thousands of Hongkongers have opted out of the city’s organ donor registry, seemingly as a form of subtle protest against proposals to establish deeper medical ties with mainland China.

...

"The trigger appears to have been a life-saving operation carried out in December on a four-month-old baby girl in Hong Kong, who was in need of a heart transplant. When a local match could not be found, a heart was transferred from a child who had suffered brainstem death in mainland China.

...

"Since the baby’s heart transplant, authorities have discussed the idea of establishing a mutual assistance registry with mainland China to facilitate future donations. That would be yet another erosion of the boundary between China and Hong Kong, which was supposed to remain largely autonomous from Beijing until 2047.

"Earlier this month, local news outlet Ming Pao reported that there had been discussion on social media among Hongkongers who did not want their organs donated to patients in mainland China."

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China has a population approaching 1.5 Billion people, and Hong Kong is a city of about 7.5 Million people, so my guess is that HK is too small to have an efficient self-contained transplant system, and could benefit from being integrated into the mainland's system.

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#Here's my earlier (contemporaneous) post:

Tuesday, January 10, 2023