Growth of kidney donation by unrelated donors

Kidney exchange has allowed more people to receive kidneys from unrelated donors, but that isn't all that's going on, it has also become more acceptable for people to receive a kidney from friends and even people who they met on the internet.

George Taniwaki--a prospective donor who publishes a very interesting blog--has a post on this, The rise of unrelated donor transplants.

It includes admirably clear data graphics and analysis.

"Even more interesting is the extremely rapid rise of alternative sources of living donors. The last three lines from the figure above are rescaled in the figure below. The fastest growing source of living donors is paired exchanges. ... Kidney exchanges have the potential of becoming the leading source of live donor kidneys within a few years."

In addition, he has some insights into some of the complicated politics of kidney transplantation, in which there is some over-claiming of "firsts."

"The final fast-growing source of donors are people who donate without a specific recipient in mind. They are called nondirected or altruistic donors. Johns Hopkins Medicine claims to have performed the first nondirected live donor transplant in September, 1999. However, UNOS data shows two earlier donors in 1998 and one in 1988, the first year data is available. In addition to increasing the total number of donations, nondirected donors also play an important role in starting donor chains in kidney exchanges. Donor chains reduce the risk to recipients of their matched donors backing out an exchange after the first transplant takes place. Thus, nondirected donors reduce the need to perform the transplant surgeries simultaneously. This simplifies scheduling personnel and operating rooms for kidney exchange transplants."

Grade inflation in law schools

The NY Times report that some law schools are retroactively raising the grades they have given to their students, in an effort to improve their prospects in the difficult market for many law grads: In Law Schools, Grades Go Up, Just Like That.

"[Loyola Law School in Los Angeles] is retroactively inflating its grades, tacking on 0.333 to every grade recorded in the last few years. The goal is to make its students look more attractive in a competitive job market.
In the last two years, at least 10 law schools have deliberately changed their grading systems to make them more lenient. These include law schools like New York University and Georgetown, as well as Golden Gate University and Tulane University, which just announced the change this month. Some recruiters at law firms keep track of these changes and consider them when interviewing, and some do not.
Law schools seem to view higher grades as one way to rescue their students from the tough economic climate — and perhaps more to the point, to protect their own reputations and rankings. Once able to practically guarantee gainful employment to thousands of students every year, the schools are now fielding complaints from more and more unemployed graduates, frequently drowning in student debt.
They have come up with a number of strategic responses. Besides the usual career counseling measures, many top schools have bumped up their on-campus interview weeks from the autumn to August, before the school year even starts, because they want their students to have a chance to nab a job slot before their counterparts at other schools do. "
...
"Harvard and Stanford, two of the top-ranked law schools, recently eliminated traditional grading altogether. Like Yale and the University of California, Berkeley, they now use a modified pass/fail system, reducing the pressure that law schools are notorious for. This new grading system also makes it harder for employers to distinguish the wheat from the chaff, which means more students can get a shot at a competitive interview. "


For a paper on grade inflation and job markets, see

Michael Ostrovsky and Michael Schwarz, 2010, "Information Disclosure and Unraveling in Matching Markets." American Economic Journal: Microeconomics, 2(2): 34–63.

It's behind a subscription wall, but here's the abstract:

"This paper explores information disclosure in matching markets. A school may suppress some information about students in order to improve their average job placement. We consider a setting with many schools, students, and jobs, and show that if early contracting is impossible, the same, "balanced" amount of information is disclosed in essentially all equilibria. When early contracting is allowed and information arrives gradually, if schools disclose the balanced amount of information, students and employers will not find it profitable to contract early. If they disclose more, some students and employers will prefer to sign contracts before all information is revealed."

Future organ replacement

I expect that your grandchildren will have the luxury of viewing all the work on kidney exchange and transplantation generally as primitive medicine ("Grandpa, they used to take an organ from one person and sew it into another??").

At the XXIII International Congress of the Transplant Society next month there will be some discussion of Stem Cells and Regeneration, along with more prosaic, current clinical issues.

A small step towards that future is reported in Science: Rats Breathe With Lab-Grown Lungs
and in the Boston Globe: N.E. researchers create functioning lung tissue--A vital step in the quest to build organs.

From the Globe: "Two teams of researchers from New England have built living, breathing lung tissue in the laboratory — feats of engineering that could speed up the development of new drugs and bring researchers a step closer to the tantalizing dream of growing replacement lungs for patients."

In the meantime, I'm cheered by the progress we're making in primitive medicine, back in these days at the dawn of the 21st century (see here and, more generally, here, or my post last summer at which a prize was awarded to Mike Rees for some of that progress).

HT: Steve Leider

Ribald 4th of July: memories of July 1970

The title of this post comes from a typo in an article about the 4th of July celebrations that have been conducted since 1912 at Rebild National Park in Denmark, after the land for the park was donated by Danish-Americans. Here's the story that gets the name right:
"Every July 4 since 1912, except for the two world wars, large crowds have gathered in the heather-covered hills of Rebild in Jutland, Denmark to celebrate US Independence Day.
The site of the celebration is the beautiful Rebild National Park (20 kilometers south of Aalborg), presented to the Danish nation by Danish-Americans in 1912. "

This reminds me that in July of 1970 I was in Fredericia Denmark, briefly employed by the J.P. Schmidt cigarfabrik (sold in 1982 to the Scandinavian Tobacco Group). I wasn't rolling cigars, but programming computers, or rather a computer, an IBM 360 model 20, that used a language called Report Program Generator (RPG) that apparently has descendents still in use today. (To compile, a giant stack of punchcards had to be turned upside down to be placed on the card reader...I know that some of you don't know what punchcards were...)

On July 1, 1970, the second Vietnam War draft lottery was conducted back in the United States, to determine the draft order of men born in my year. This was long before the internet, and so I waited a day for the International Herald Tribune to report on the story, but they only reported the first number chosen, and the last. I called the American consulate in Copenhagen to try to find out my lottery number, but they didn't have the whole list either (I got the impression they thought that most Americans living in Denmark at the time may have already decided not to respond to the draft...). I had to wait for a letter from my parents to arrive, telling me that I had a number that might have made me an infantryman had I been a year older, but that with the war winding down left me free to remain a student.

Two days after July 4 I heard cannon (or maybe fireworks) on the old town wall, and came in to work to hear that this was an annual celebration of the Danish victory in The Battle of Fredericia 6th of July 1849, in which the Danes had beaten back a German siege of the fortified town. I recall my colleagues told me that it had been celebrated each year since, "except when we are occupied by the Germans."

Let's all celebrate independence with a boisterous (if not ribald) 4th of July.

The market for fireworks, July 4th 2010

“Happy Fourth of July—made in China.”
"“there are virtually no fireworks being manufactured in the U.S.,” says John Rogers, who travels to China three to four times a year with the American Fireworks Standards Laboratory, a Bethesda, Md.–based nonprofit focused on consumer safety. Rogers says 90 percent of the world’s fireworks originate in China"
...
"As for the other 10 percent, James Widmann, president of Connecticut Pyrotechnic Manufacturing, says some originate in India, Spain and other parts of Europe. Mexico, he says, could eventually become a major supplier to the U.S. because of its ability to send fireworks here by truck rather than shipping them overseas—a process fraught with obstacles. “Most shipping companies don’t want to risk sacrificing 99 percent of their cargo” for the sake of the “1 percent that can blow it all up”

Sidney Siegel and Psychology & Economics

That's the subject of a recent article: Innocenti, Alessandro, "How a psychologist informed economics: The case of Sidney Siegel," JOURNAL OF ECONOMIC PSYCHOLOGY,31, 3, 421-434, JUN 2010

"Abstract: In the 1950s before Kahneman and Tversky showed how behavioral economics could bring economics and psychology into a unified framework, a social psychologist, Sidney Siegel, entered the realm of economics and laid the foundation of experimental economics. This paper gives an assessment of Siegel's effort to meld psychology and economics and shows that Siegel was not only a contributor to the methodology of experimental economics but also a pioneer of behavioral economics. Although his legacy was paramount in the work of the Nobel Prize winner Vernon Smith, Siegel endorsed a very different approach to making interdisciplinary research effective. "

White House aides aren't lured by their current salaries

White House salary information released, including a database by name.

Advertising versus data on dating web sites

Advertising is easier to come by than data: apparently no one really knows much about the effect of online dating sites on producing marriages and relationships. A recent story in the Washington Post points this out (while suggesting the numbers may have peaked):Are dating Web sites past their prime?

And here is an older WSJ story:Marriage-Maker Claims Are Tied in Knots--Online Dating Sites Say Hordes of People Ultimately Marry, but Their Methods Have Plenty of Hitches of Their Own,along with an online post pointing out that there may be special selection problems facing online surveys of online activity: How Many Marriages Started Online?

School choice in Spain

Flip Klijn writes:

"Hey Al,
Recently, a letter in the Spanish newspaper "La Vanguardia" questions the new mechanism to assign students to universities in Spain.

Link to the letter in Catalan:http://www.lavanguardia.es/lv24h/20100623/53951521785.html

The writer of the letter (a high school student) wonders whether the introduction of *multiple* access grades (the novelty) is desirable. He discusses a hypothetical scenario in which multiples access grades may in fact lead to an undesirable assignment.

I was happily surprised with his analysis. Basically, he implicitly describes the deferred acceptance mechanism through a simple but very nice example that has a priority structure with a cycle (as in Ergin, Econometrica 2002). Then, he makes the point that the assignment is fair (or stable) but not very desirable (since it is inefficient).

It was impossible for me to not react to the letter. My response (in Spanish) was published in the Blog section of the same newspaper:http://www.lavanguardia.es/lv24h/20100624/53951867284.html

In my response, I first mention that with a single access grade there is indeed no incompatibility between stability and efficiency. Next, I argue that in certain situations it might be convenient, however, to have multiple access grades in which case the deferred accepted mechanism is a natural candidate mechanism (referring to the original work of Gale and Shapley, 1962, and the application in the National Resident Matching Program). I also point out that the incompatibility between stability and efficiency in the situation with multiple access grades cannot be solved by using some other mechanism. Finally, I mention that the deferred acceptance mechanism is "hassle-free" (i.e., strategy-proof) and that the experience in Boston and New York (high schools) has been very positive. Therefore, there are reasons to believe that the deferred acceptance mechanism with multiple access grades will work satisfactorily in the assignment of students to Spanish universities."

Heads of government for and against same-sex marriage

Two of yesterday's news stories from very different parts of the world caught my eye.

Icelandic Leader in Milestone Gay Marriage
"Iceland's prime minister made history last week when she wed her longtime girlfriend, becoming the world's first head of government to enter a gay marriage. But fellow Nordic nations hardly noticed when 67-year-old Johanna Sigurdardottir tied the knot with her longtime partner -- a milestone that would still, despite advances in gay rights, be all but inconceivable elsewhere. Scandinavia has had a long tradition of tolerance for alternative lifestyles -- and cross-dressing lawmakers and homosexual bishops have become part of the landscape. ''There is some kind of passion for social justice here,'' respected cross-dressing Swedish lawmaker Fredrick Federley said. ''That everybody should be treated the same.'' "

While in Australia, this from the new prime minister:
Gillard against gay marriage
"Prime Minister Julia Gillard says she does not support legalising gay marriage in Australia.Labor policy on gay marriage will remain the same under her prime ministership, Ms Gillard told Austereo show today."We believe the marriage act is appropriate in its current form, that is recognising that marriage is between a man and a woman, but we have as a government taken steps to equalise treatment for gay couples," Ms Gillard said."

The market for kidneys in Iran

The Iranian economist Farshad Fatemi at the Sharif University of Technology sent me this link to his very interesting working paper The Regulated Market for Kidneys in Iran.

Among other things, it is full of institutional detail and comparisons. Here are a few things that caught my eye.

Comparing total (live plus deceased) kidney donation across countries, per million population, the most recent figures (from 2007) are Iran 27.1%; UK 33.5%; Spain 49.5%; US 54.7%. (His source is the Barcelona-based Transplant Procurement Management Organization, whose international database I have yet to fully explore.)

His description of the market for kidneys in Iran includes the following

"After the donor passes the initial tests, the administrators contact the first patient in the same waiting list as the donor’s blood type [and other components of a match]...
If the patient who is on the top of the waiting list at the moment is not ready for the transplant ..., the next patient will be called... until a ready patient will be found. Then a meeting between the two parties is arranged (they are provided with a private area within the foundation building if they want to reach a private agreement) and they will be sent for tissue tests. If the tissue test gives the favourable result, a contract between the patient and the donor will be signed and they will be provided with a list of the transplant centres and doctors who perform surgery.
When the patient and the donor are referred to transplant centre, a cheque from the patient will be kept at the centre to be paid to the donor after the transplant takes place. The guide price has been 25m Rials (≈ $2660) until March 2007 for 3 years and at this time18 it has been raised to 30m Rials (≈ $3190). This decision has been made because the foundation was worried of a decreasing trend in number of donors.

"In some cases, the recipient will agree to make an additional payment to the donor outside the system; it is not certain how common this practice is, but according to the foundation staff the amount of this payment is not usually big and is thought to be about 5m to 10m Rials (≈ $530 to $1060). The recipient also pays for the cost of tests, two operations, after surgery cares, and other associated costs (like accommodation and travel costs if the patient travels from another city). Insurance companies cover the medical costs of the transplant and the operations are also performed free of charge in state-owned hospitals.
"In addition, the government pays a monetary gift to the donor for appreciation of her altruism (currently, 10m Rials), as well as automatic provision of one year free health insurance, and the opportunity to attend the annual appreciation event dedicated to donors...
"The minimum monthly legal wage for 2007 was Rials 1,830k (later raised to 2,200k for 2008). The minimum payment of Rials 45m is around 2 years of minimum wage. "
...
"[T]o prevent international kidney trade, the donor and recipient are required to have the same nationality. That means an Afghan patient, who is referred to the foundation, should wait until an Afghan donor with appropriate characteristics turns up. This is to avoid transplant tourism. "
...
"the donors are mostly men (Table 7). This can be because of the two facts. Firstly, the ages between 22 and 35; when the donation is accepted; is the fertility age; and women are less likely to be considered as potential donors. Secondly, as we mentioned before since men are supposed as the main breadwinner of the family, it is more likely that they sell their kidneys in order to overcome financial difficulties. Female donors count for around 18% of traded kidneys in our data; it is in contrary with the Indian case where 71% of the sold kidneys were from female donors (Goyal et al. 2002)."

In his sample of 598 transplants (Table 6), 539 were "traded kidneys," 10 "non-traded" and 49 "Cadaver", i.e. the vast majority of kidney transplants were live donor transplants with compensation to the donor.

Market for prayers in Iran

It's not just kidneys; selling prayers in Iran isn't repugnant either.

In Islamic Iran prayer sellers' trade is booming
"TEHRAN (Reuters Life!) - In Islamic Iran where clerics rule, unofficial "prayer sellers," who promise to intercede with the divine to solve all manner of life's problems, are seeing their business boom."
...
"Iran's clerics also believe in the power of prayer but they advise people against using prayers that lack a religious basis. Magic and superstition are both illegal under Islamic law.

"Writing prayers quoting Shia's immaculate Imams and receiving money for that has no legal obstacle," said Grand Ayatollah Lotfollah Safi Golpaygani when asked about the religious legitimacy of the prayer sellers. "

"But referring to prayers written by hustlers without reliable sources is not permitted, and getting money for those kinds of prayers is (religiously) forbidden," he told news website hawzah.net.

"Despite what Iranian clerics say, none of YaAli's customers ask him about the basis of his knowledge, which he says is founded on the Koran.

"It is not important where his knowledge comes from, I just want my problems to be solved," said Marjan, 24, who complains it is getting harder to see YaAli as customer demand increases."

A degree is a degree

"A degree is a degree! Whether fake or genuine, it's a degree! It makes no difference!" Baluchistan province chief minister Nawab Aslam Raisani, who claims a master's in political science, shouted at a gaggle of reporters Tuesday.

This insight is from the news report Fake degree scandal roils Pakistani politics.

(See my earlier post on the Market for bogus colleges.)

Espionage: the market for secret information

The newspapers this morning are full of stories about the arrest of eleven accused Russian spies, e.g. the NY Times reports In Ordinary Lives, U.S. Sees the Work of Russian Agents.
"They had lived for more than a decade in American cities and suburbs from Seattle to New York, where they seemed to be ordinary couples working ordinary jobs, chatting to the neighbors about schools and apologizing for noisy teenagers.
"But on Monday, federal prosecutors accused 11 people of being part of a Russian espionage ring, living under false names and deep cover in a patient scheme to penetrate what one coded message called American “policy making circles.” "

The story in the Harvard Crimson adds an interesting detail: Kennedy School Grad Arrested in Russian Spy Raid.
"Called the “Boston Conspirators” in a complaint filed in the U.S. District Court for the Southern District of New York, Heathfield and Foley are alleged to have met with a “former legislative counsel for US Congress” and a “member of faculty in economics.” The documents redacted the affiliation of the faculty member."

It's true that the publication process in Economics is ridiculously slow, but I thought the internet had removed the need for cells of long term sleeper spies to find out what's in our working papers...

Live kidney donation: how to ask in Chicago

Harvey Mysel, a kidney recipient who went on to found the Living Kidney Donor Network, writes to ask me to let readers know of two workshops he is offering in Chicago in July on Having your donor find you

Signaling you're not 'overqualified' in a recession

The Globe reports on Deflating credentials to land a job.

"As the tight job market forces the unemployed to apply for lower-level positions, more job seekers are “dumbing down’’ credentials, wiping graduate degrees and high-level experience off their resumes, recruiters say. Applicants say the idea is to get hiring managers to at least look at their resumes, instead of figuring someone with extra qualifications will demand a bigger salary or leave for a higher-level opportunity once the economy turns around."

...

“Somebody finds out you know that much more than they do, they get nervous,’’ Carroll said.

"That’s true, says Robert Akerlof, a post-doctoral associate at the MIT Sloan School of Management, who is working on a theory about how it can be difficult to maintain authority over overqualified workers if they think a job, or a boss, is beneath them.

"Dumbing down a resume is a way for job seekers to show that they are going to be respectful, said Akerlof, citing the “20 percent rule,’’ which states that bosses should be 20 percent smarter than their employees.

“I think it’s not so much that you’re lying about what your resume is, it’s that you’re trying to convey an appropriate attitude,’’ he said."

Misc. organ transplant links

A Review of Organ and Tissue Donation Procedures by the Royal Australasian College of Physicians nicely summarizes some of the different ways deceased donor organs are dealt with around the world.

The ‘blood group O problem’ in kidney transplantation—time to change? discusses the Eurotransplant Kidney Allocation System, which apparently allows some O kidneys to go to patients who aren't type O.

Mike Rees' revolution of non-simultaneous non-directed donor chains continues to bear fruit in unexpected ways: LOYOLA PROGRAM A RADICAL SHIFT IN LIVING DONOR KIDNEY TRANSPLANTS
"In a first, four people step forward to donate kidneys to complete strangers across the country with no strings attached."...
"It's extremely rare when someone asking for nothing in return steps forward at a hospital and offers to donate a kidney to a complete stranger.
What's rarer still is what has happened at Loyola University Medical Center -- four people have stepped forward and offered to donate kidneys to four complete strangers and none have asked for a thing in return.
"This is completely unique and totally unheard of," said Garet Hill, founder of the nonprofit National Kidney Registry, which coordinated the donations. "We have never had four donors from one institution come forward at one time to offer up kidneys for donation with no strings attached."
The selfless acts by the four have helped Loyola launch its Pay-it-Forward Kidney Transplant Program, the first of its kind in the Midwest, and the largest number of altruistic donors to ever begin such a program in the United States."

Here's a collection of kidney exchange stories and videos from MSNBC, some rather old: http://article.wn.com/view/2010/05/04/Kidney_swap_program_posts_high_success_rate/

And here's a live donor story: From Fear To Elation: Prepping To Be An Organ Donor

Deceased donor allocation policies are also a very big deal. Alex Tabarrok at MR has a thought provoking post on one aspect of the debate: Optimizing Kidney Allocation: LYFT for LIFE which touches on the issue of how it's often difficult to make changes in health care policy that aren't Pareto improvements, even if they are improvements by other measures.

Decent work research prize

When I read that the International Labour Organization had a Decent Work Research Prize, my initial thought was "finally, a research prize for the rest of us." (It's hard to do exceptional work, but doing decent work seems like an achievable goal...)

But that turns out to be a mis-reading: here's the beginning of the prize description.

"The ILO’s International Institute for Labour Studies has created a research prize to annually reward outstanding contributions to the advancement of knowledge on the ILO’s central goal of decent work for all."

That seems like a good goal too:)

Changing sexual mores in China

Swinger Tests China’s Sex Morals
"On Thursday, a court sentenced Mr. Ma to three-and-a-half years in prison, a severe penalty for a crime that the Chinese government calls “crowd licentiousness.” Mr. Ma, now China’s most famous swinger, remains defiant and plans to appeal, saying his sex life is his own business, not subject to the law as long as he causes no social disturbance, according to his lawyer, Yao Yong’an. "
...
"The case of Mr. Ma, who was arrested last August and went on trial last month, has drawn attention across China not only for its titillating details, but also because it also raises questions about an authoritarian government’s attempts to curb sexual freedom and limit privacy in a society where rapid economic growth and the ubiquity of the Internet have upended traditional values. "
...
"The Communist Party no longer maintains the kind of tight control over people’s private lives that it did decades ago. Yet, some officials still try to prosecute citizens based on laws that seem increasingly out of step with social mores. One example is criminal law 301, under which Mr. Ma and 21 fellow swingers were prosecuted, and which can result in a five-year prison term.
Chinese Internet users and even some official news organizations have debated the case."
...
"The law against group sex, generally interpreted by judges as involving three or more people, is left over from an earlier law against “hooliganism” that was used to prosecute people who had sex outside of marriage, Ms. Li said. The hooliganism law was scrapped in 1997. One notable swingers case took place in the early 1980s, when the leader of a swingers club involving four middle-aged couples was executed, she added.
At least three recent surveys have shown that prosecution of group sex does not enjoy widespread support today.
Several Chinese news Web sites posted editorials echoing that sentiment after the verdict was announced. "

Couples match

The University of Alabama at Birmingham magazine (June 2010) writes about the couples match: Match Making--Software Helps Medical Couples Stay Together

(Here's a paper with a more technical description of how the couples match works...

Roth, A. E. and Elliott Peranson, "The Redesign of the Matching Market for American Physicians: Some Engineering Aspects of Economic Design," American Economic Review, 89, 4, September, 1999, 748-780.,

and here's a paper that's about why it works as well as it does...

Kojima, Fuhito, Parag A. Pathak, and Alvin E. Roth, " Matching with Couples: Stability and Incentives in Large Markets," working paper, April 8 2010.)