Through the looking glass of medical ethics: compatible pairs in kidney exchange

Some time ago my colleagues and I observed that there would be really large gains in terms of increased numbers of transplants from inviting compatible pairs into kidney exchange, largely because it would increase the supply of O donors.

(see Roth, Alvin E., Tayfun Sonmezand M.Utku Unver A Kidney Exchange Clearinghouse in New England American Economic Review, Papers and Proceedings, 95,2, May, 2005, 376-380.

As with many discussions of organ transplantation, discussions of efficiency are interspersed with discussions of ethics, and almost no good deed goes unquestioned (recall the story of the kidney doc who donated a kidney to a patient*). The current issue of Transplantation has a comment that takes issue with some of the prior discussion of ethics.

Compatible-Incompatible Live Donor Kidney Exchanges, by David Steinberg,Transplantation, 91(3):257-260, February 15, 2011.

Abstract: "The participation of an immunologically compatible donor-intended recipient pair in a kidney exchange that is unnecessary for them can significantly increase the number of kidneys available for transplantation. Despite their utilitarian value transplant ethicists have condemned this type of organ exchange as morally inappropriate. An opposing analysis concludes that these exchanges are examples of moral excellence that should be encouraged."


*Doctor's unique donation prompts ethical concerns: A Chicago-area nephrologist's gift of a kidney to her patient raises the question of whether doctors should be living organ donors.

Nonsimultaneous kidney exchange chains produce more transplants than simultaneous chains

That's the conclusion of a new paper,
Ashlagi, Itai, Duncan S. Gilchrist, Alvin E. Roth, and Michael A. Rees, ''Nonsimultaneous Chains and Dominos in Kidney Paired Donation -- Revisited,'' American Journal of Transplantation, forthcoming, 2011.


The "revisited" in the title comes from the fact that the reverse conclusion was reached by an earlier paper in the same journal, due to a modeling error that unnecessarily constrained the length of non-simultaneous chains to be the same as simultaneous chains. (In practice, one of the main attractions of non-simultaneous chains is that they can be longer than chains in which all surgeries are performed simultaneously, since it is no longer necessary to have a different surgical team and operating room for each surgery.)


Here's the abstract of the paper:
"Since 2008 kidney exchange in America has grown in part from the incorporation of non-directed donors in transplant chains rather than simple exchanges.  It is controversial whether these chains should be performed simultaneously (“domino paired donation”, DPD) or nonsimultaneously (“nonsimultaneous extended altruistic donor chains”, NEAD). NEAD chains create “bridge donors” whose incompatible recipients receive kidneys before the bridge donor donates, and so risk reneging by bridge donors, but offer the opportunity to create more transplants by overcoming logistical barriers inherent in simultaneous chains. Gentry et al. simulated whether DPD or NEAD chains would produce more transplants when chain segment length was limited to three transplants, and reported that DPD performed at least as well as NEAD chains.  As this contrasts with the experience of several groups involved in kidney paired donation, we performed simulations that allowed for longer chain segments and used actual patient data from the Alliance for Paired Donation.  When chain segments of 4-6 are allowed in the simulations, NEAD chains produce more transplants than DPD. Our simulations showed not only more transplants as chain length increased, but also that NEAD chains produced more transplants for highly sensitized and blood type O recipients."


One of the most exciting recent events in kidney exchange has been the revolution in using chains of transplants, inaugurated by Mike Rees and the Alliance for Paired Donation, which has really taken off since the publication in 2009 of the account of his first non-simultaneous extended altruistic donor (NEAD) chain:
Rees, Michael A., Jonathan E. Kopke, Ronald P. Pelletier, Dorry L. Segev, Matthew E. Rutter, Alfredo J. Fabrega, Jeffrey Rogers, Oleh G. Pankewycz, Janet Hiller, Alvin E. Roth, Tuomas Sandholm, Utku Ünver, and Robert A. Montgomery, “A Non-Simultaneous Extended Altruistic Donor Chain,” New England Journal of Medicine, 360;11, March 12, 2009 


The new paper helps explain why this new kidney exchange technology has caught on so quickly.

Can we make school choice more efficient?

A new paper by Eduardo Azevedo and Jacob Leshno addresses a recent puzzle in school choice: Can we make school choice more efficient? An Example

Here's their abstract:
"The deferred acceptance mechanism, currently used in the New York City and in the Boston public school systems, can produce Pareto-dominated assignments. When students are non-strategic a Pareto-dominating and efficient mechanism can be achieved by allowing some students to trade schools (e.g. Stable improvement Cycles, Erdil and Ergin 2008). We find that when students are strategic the equilibrium assignments of these mechanisms can be unstable with respect to the true preferences and can be Pareto inferior to the deferred acceptance equilibrium assignment."

The paper follows up on the Erdil and Ergin 2008 AER paper, and also on the paper by Atila Abudlkadiroglu, Parag Pathak and me which discusses the NYC high school match and shows that about a thousand NYC high school students could in principle be made better off
Abdulkadiroglu, Atila , Parag A. Pathak, and Alvin E. Roth, "Strategy-proofness versus Efficiency in Matching with Indifferences: Redesigning the NYC High School Match,'' American Economic Review, 99, 5, Dec. 2009, pp1954-1978.

That paper sets the stage for Azevedo and Leshno by observing that about 1,000 of the approximately 90,000 new high school students each year could have been given better matches if strategy-proofness were not a desiderata, and if their true preferences could be recovered without strategy proofness. So that raises the open question of what kind of preferences would be submitted to a system that tried to get these apparent welfare gains, and whether welfare gains could be achieved at equilibrium:
"Nothing is yet known about what kinds of preferences one could expect to be strategically submitted to such a mechanism, or what their welfare consequences would be. Consequently, there is room for more work to further illuminate the tradeoff between efficiency and strategy-proofness."

Azevedo and Leshno show that there's at least a possibility that attempting to improve welfare while sacrificing strategy-proofness could, in equilibrium, reduce welfare.

One of the exciting things about the modern school choice literature is how it has given rise to questions about matching that didn't arise in other applications (like to labor market clearinghouses). The special feature of school choice is the importance of how ties are broken, between between students who have equal priority for a given school that doesn't have capacity for all of them.

Azevedo and Leshno advance the discussion of how we should evaluate school choice algorithms, in the complex settings in which we're asked to design them. Their paper shows how strategy-proofness and welfare can be intertwined in subtle ways at equilibrium. There's a lot more to learn about this, so their short paper answers one question and raises many others.

Coalition Theory Workshop in Barcelona

Today and tomorrow: The 16th Coalition Theory Network Workshop Barcelona, February 4-5, 2011

Matching and market design are well represented.

Friday, Feb. 4

9:30 - 10:15 In-Uck Park "Internal Hierarchy and Stable Coalition Structures" (with Massimo Morelli)

10:15 - 11:00 Messan Agbaglah "Informal insurance: an approach by overlapping coalitions as merging of networks and groups"

11:30 - 12:15 Rémy Oddou "The effect of spillovers and congestion on the segregative properties of endogenous jurisdiction structure formation"

12:15 - 13:00 Francis Bloch "Endogenous formation of alliances in conflicts"

14:30 - 15:15 Emiliya Lazarova "Dynamic Multilateral Markets" (with Arnold Polanski)

15:15 - 16:00 Guillaume Haeringer "Learning to match" (with Hanna Halaburda)

16:30 - 17:15 Lars Ehlers "Strategy-proof Tie-breaking" (with Alexander Westkamp)

17:15 - 18:00 Florian Biermann "A Measure of Instability for Matchings in Marriage Markets"

Saturday, Feb. 5

9:00 - 9:45 Kalyan Chatterjee "Word of Mouth Advertising, Credibility and Learning in Networks" (with Bhaskar Dutta)

9:45 - 10:30 Agnieszka Rusinowska "Iterating influence between players in a social network" (with Michel Grabisch)

11:00 - 11:45 Sunghoon Hong "Strategic Network Interdiction" (with Myrna Wooders)

11:45 - 12:30 Andrea Galleotti "Network Trading Games" (with Daniele Condorelli)

14:00 - 14:45 Timo Hiller "The Friend of My Enemy is My Enemy: Alliance Formation and Coercion in Networks"

14:45 - 15:30 Alexandru Nichifor "Stability and Competitive Equilibrium in Trading Networks" (with John William Hatfield, Scott Duke Kominers, Michael Ostrovsky and Alexander Westkamp)
16:00 - 16:45 Jaromir Kovarik "(Anti-) Coordination in Networks" (with Friederike Mengel and José Gabriel Romero)

16:45 - 17:30 Ana Mauleon "Myopic or Farsighted ? An Experiment on Network Formation" (with Marco Mantovani, Georg Kirchsteiger and Vincent Vannetelbosch)

Shift swapping in the Boston fire department

The Globe has an illuminating article on a system originally intended to allow Boston fire fighters to trade shifts with one another without money changing hands, that seems to have gotten out of control, possibly turning into a cash system.

Trading the call of duty for a call of convenience: A system that lets Boston firefighters swap shifts has turned into a costly free-for-all. Some barely work for years and never make up the time. The city does almost nothing about it.

"It is a familial courtesy as intrinsic to the culture of Boston firehouses as shared chicken dinners. When a firefighter can’t make his shift, a colleague steps in, on condition the favor will be returned.
"But there are scores of Boston firefighters whose shifts have been covered by others for weeks or months at a time, with no record they have ever reciprocated and worked off the debt.
"One firefighter, Gregory L. Burton, owes his firehouse comrades 554 shifts — nearly three years of work — for shifts he borrowed over five years while he was tending to a successful real estate business, according to department records.
...
"The lack of accounting — and the absence of limits that other fire departments routinely impose on shift swaps — has nurtured a subterranean culture in which some firefighters pay cash to others to work their shifts, or repay the obligation by doing outside work like home renovation projects for their firehouse creditors, according to interviews with several firefighters, who asked that they not be identified by name.
...
"One telltale sign that much of the debt has been settled privately: Fraser and Keating said not a single firefighter who is owed shifts has ever filed a complaint. Under-the-table cash payments would violate tax laws if the income is unreported.
...
"Shift-swapping is common in fire departments, but so are stringent controls on the practice, according to a Globe survey of big-city fire departments across the country. And the Boston Police Department, which permits its officers to swap shifts, turned over to the Globe records showing deficits to be virtually nonexistent."

College admissions in Texas: unintended consequences of the 10% rule

Under the headline Strategic Displacement, Inside Higher Ed covers the recent NBER paper
Jockeying for Position: Strategic High School Choice Under Texas' Top Ten Percent Plan, by  Julie Berry Cullen, Mark C. Long, and Randall Reback.

Here's the abstract of the paper:
"Beginning in 1998, all students in the state of Texas who graduated in the top ten percent of their high school classes were guaranteed admission to any in-state public higher education institution, including the flagships. While the goal of this policy is to improve college access for disadvantaged and minority students, the use of a school-specific standard to determine eligibility could have unintended consequences. Students may increase their chances of being in the top ten percent by choosing a high school with lower-achieving peers. Our analysis of students’ school transitions between 8th and 10th grade three years before and after the policy change reveals that this incentive influences enrollment choices in the anticipated direction. Among the subset of students with both motive and opportunity for strategic high school choice, as many as 25 percent enroll in a different high school to improve the chances of being in the top ten percent. Strategic students tend to choose the neighborhood high school in lieu of more competitive magnet schools and, regardless of own race, typically displace minority students from the top ten percent pool. The net effect of strategic behavior is to slightly decrease minority students’ representation in the pool."

HT: Victor Shnayder

Kidney exchange when hospitals are the players

Itai Ashlagi and I have a new paper, motivated by recent developments in kidney exchange. Now that exchange is often proceeding through multi-hospital clearinghouses, we are going to have to think about how to give hospitals the incentive to participate fully, and enroll all of their patient-donor pairs into the exchange, and not just the ones that are difficult to match.

Ashlagi, Itai and Alvin E. Roth, "Individual rationality and participation in large scale, multi-hospital kidney exchange," working paper, January 2011.


Abstract: As multi-hospital kidney exchange clearinghouses have grown, the set of players has grown from patients and surgeons to include hospitals. Hospitals have the option of enrolling only their hard-to-match patient-donor pairs, while conducting easily arranged exchanges internally. This behavior has already started to be observed.
We show that the cost of making it individually rational for hospitals to participate fully is low in almost every large exchange pool (although the worst-case cost is very high), while the cost of failing to guarantee individually rational allocations could be large, in terms of lost transplants. We also identify an incentive compatible mechanism."

Carbon markets

The U.S. Dept. of Agriculture's Economic Research Service is running a conference today and tomorrow on the design of carbon markets: Carbon Market Design: Issues and Opportunities


Monday, January 31, 2011 Morning Session

9:00 a.m. Welcome remarks Kitty Smith, USDA, Economic Research Service, Administrator

9:10 a.m. Kickoff speaker Richard Sandor, Environmental Financial Products, Chairman and CEO; Chicago Climate Exchange, Founder

9:45 a.m. Carbon Markets Marketing, Jim Kharouf, Environmental Markets Newsletter, Editor

10:15 a.m. Lessons from Existing Environmental Markets for the Design of Climate Policy, Dallas Burtraw, Resources for the Future, Senior Fellow

10:45 a.m. Morning break (coffee and snacks)

11:00 a.m. Implementation of Regional Carbon Markets in the United States Jonathan Schrag, Regional Greenhouse Gas Initiative, Inc., Executive Director

11:30 a.m. The Role of Exchanges in Global Environmental Markets: Confidence, Stability, Transparency,Tom Lewis,Green Exchange, CEO

Afternoon Session

1:15 p.m. Moderating Price Volatility, Andrew Stocking, Congressional Budget Office, Analyst and Market Design Economist

1:45 p.m. Participation in the Carbon Market Albert S. “Pete” Kyle, University of Maryland, Robert H. Smith School of Business, Charles E. Smith Chair Professor of Finance

2:15 p.m. Discussion of Moderating Price Volatility and Participation in the Carbon Market Matthew Harding, Stanford University Department of Economics

2:30 p.m. Alternatives to Quantity-based Climate Policy, Peter Cramton, University of Maryland, Professor of Economics

3:00 p.m. Discussion of Alternatives to Quantity-based Climate Policy Henrik Hasselknippe, Green Exchange

Tuesday, February 1, 2011, Morning Session

9:00 a.m. Oil Prices and the Carbon Market, Perry Sadorsky, York University, Schulich School of Business, Associate Professor of Economics

9:30 a.m. Discussion of Oil Prices and the Carbon Market Nela Richardson, Commodity Futures Trading Commission

9:45 a.m. Agricultural Carbon Credits: Lessons Learned from the AgraGate Experience, Dave Miller
Iowa Farm Bureau, Research and Commodity Services, Director

10:15 a.m. Tradeoff Between Permits and Offsets, Adele Morris, Brookings Institution, Fellow

10:45 a.m. Discussion of Agricultural Carbon Credits: Lessons Learned from the AgraGate Experience and Tradeoff Between Permits and Offsets John Horowitz, Economic Research Service

11:00 a.m. Regulatory Perspective on Carbon Markets Eric Juzenas, Commodity Futures Trading Commission, Senior Counsel to the Chairman

Fishing as an endangered but protected transaction

Here in New England, the plight of the fishing industry, and particularly of independent fishermen who operate small "day boats" from local harbors, is in the news. Three issues compete for attention: how to sustainably manage vulnerable fish populations, while keeping fishing profitable, particularly for the small independent fishermen who are seen as needing protection from larger, corporate fishing fleets.  Small fishermen are to New England what small family farms are in other areas of the country.

Here's a story from the Globe.

Change in fishing rules altering storied industry: Regulators to look at ways to protect fleet
"PLYMOUTH — Scores of fishermen have stopped going to sea in the past year as controversial new rules take hold that could fundamentally alter the storied fishing economy, culture, and communities of New England.

"The region’s scenic harbors already shelter hundreds fewer fishing boats than a decade ago, but some worry that smaller boats may vanish altogether: There are some signs the new rules, which assign groups of fishermen a quota on their catch of cod and other bottom-hugging fish, could accelerate a trend of consolidating those boats into far fewer, more efficient vessels. Some small-boat fishermen are selling or leasing their allotment to others under the new rules because they cannot turn a profit.

"“This may not be the end of fishing, but it is the end of fishing as we know it,’’ said Steve Welch, as he tinkered on one of his two boats, the Holly & Abby, in Plymouth. Nearby, his dog Hudson ate mussels that seagulls dropped on an icy dock.

Welch leased the fishing privileges on both his boats and laid off three workers this year. “We are talking jobs, tradition, culture,’’ he said. “All that will be left are large boats owned by corporations with deep pockets.’’ 

...
"However, it is inevitable, Grant said, that some fishermen will be pushed out of business for good because there are still not enough fish for all the fishermen. And that is a hard thing to take.

“Fishing is not what [these fishermen] do; it is who they are,’’ Grant said. “It helps define the community. You can’t say that about selling tires. They are a cultural icon.’’
...
"Still, there are some bright spots with the new rules. Some $5 million in federal funds has been allotted to New England states to buy fishing permits and lease them back, often at a reduced price, to vulnerable fishermen. Some fishermen say the new rules are successful, allowing them to keep catching bottom-dwelling fish while others are diversifying to go after more abundant species.

But some fishermen, like Welch, wonder whether there will be small fishermen left when the fish finally come back.

“I’ve been fishing for 33 years,’’ Welch said, proudly pointing out how he overhauled the electrical and hydraulic system on the Holly & Abby. “I’m a small, independent business owner. That should have value.’’"

HT: Tim Gray

SBE 2020: Future Research in the Social, Behavioral & Economic Sciences

The NSF has made available all 244 papers received in response to its request SBE 2020: Future Research in the Social, Behavioral & Economic Sciences


I earlier blogged about the  subset of 48 Economics "Grand Challenge" white papers posted by the American Economic Association, which includes some related to market design.

The market for used books

There have always been markets for used books, and it's one of the markets that has been most changed by the internet. I recently received an email that seems to indicate another change, this one aimed at increasing the supply of used books. The email was from Amazon.com, and the subject line referred to a book I bought a few months ago: "Sell Back "36 Arguments for the Existence of God: A Work of Fiction"

The message went on to say

Dear Amazon.com Customer, Customers who purchased textbooks from Amazon.com may be interested in an easy way to get great prices for used titles through our Textbook Buyback Store.    Visit the Textbook Buyback Store

Unraveling of pathology fellowships

A forthcoming paper in the journal Human Pathology gives a detailed account of the unraveling of the market for Pathology subspecialty fellowships, including the now familiar path towards earlier offers more diffuse in time, and to the increased hiring of internal candidates. It's an unusually thorough report that details some of the special pathologies of the Pathology labor market, and also compares it to the experience of other subspecialties such as Gastroenterology.

"Unlike the application process for first-year Pathology Residency, which is run through the National Resident MatchingProgram, applications for Subspecialty Pathology Fellowships are not coordinated by any consistent schedule. Competition for Subspecialty Pathology Fellowships has consistently resulted in undesirable drift of the fellowship application process to dates that are unacceptably early for many fellowship applicants. Responding to widespread dissatisfaction voiced by national pathology resident organizations, in 2007, the Association of Pathology Chairs began evaluation and potential intervention in the fellowship application process. Three years of intermittently intense discussion, surveys, and market analysis, have led the Council of the Association of Pathology Chairs to recommend implementation of a Pathology Subspecialty Fellowship Matching program starting in the 2011 to 2012 recruiting year, for those Applicants matriculating in fellowship programs July 2013. We report on the data that informed this decision and discuss the pros and cons that are so keenly felt by the stakeholders in this as-yet-incomplete reform process."

That's from the abstract of

"Pathology subspecialty fellowship application reform 2007 to 2010" by James M. Crawford MD, PhD,  Robert D. Hoffman MD, PhD, W. Stephen Black-Schaffer MD, in Human Pathology (2010)

Sales by museums

The NY Times reports on a Philadelphia museum's sales of parts of its collection to finance renovations, and on the controversy this has caused: Museum Sells Pieces of Its Past, Reviving a Debate

"A galloping horse weather vane sold for about $20,000, and the cigar store Indians brought in more than $1 million. A Thomas Sully oil painting of Andrew Jackson netted $80,500, and a still life by Raphaelle Peale, part of the family that put portraiture in this city on the map, was auctioned at Christie’s for $842,500.

"These were just a few of more than 2,000 items quietly sold by the Philadelphia History Museum over the last several years, all part of an effort to cull its collection of 100,000 artifacts and raise money for a $5.8 million renovation of its 1826 building.

In doing so the museum stepped into the quicksand of murky rules, guidelines and ethical strictures meant to discourage museums everywhere from selling collections to pay bills. It is one of the hottest issues in the museum world today. With budgets shrinking in a bad economy, the pressure to generate revenue is growing along with fears that museums are squandering public trusts meant to preserve the artifacts of the past for future generations.

The National Academy Museum in New York, Fisk University and Brandeis have all recently drawn fire — and even sanctions — for selling or planning to sell artworks, and none of them sold as many works as the museum here.

"In general art and objects are supposed to be sold only to finance acquisitions, though different museums are governed by different standards. Art museums, regulated by a formal code of the Association of Art Museum Directors, may not sell work for any other reason.

"As a history museum, though, this institution — formally called the Philadelphia History Museum at the Atwater Kent — is subject to separate, less stringent guidelines put forward by other associations. So museum officials say the installation of new carpet, paint and lighting were all legitimate expenses to be paid from the proceeds under the guidelines of the  American Association of Museums, which say that sales can be used for the “direct care” of a collection. Adding to the confusion, there is a third set of standards maintained by theAmerican Association for State and Local History permitting proceeds to go toward the “preservation” of a collection, a similarly broad term.

"The New York State legislature, confronting this maze of precepts, recently considered passing a law that would make selling collections — the art world term is deaccessioning — to pay operating expenses illegal. It never made it to the Assembly floor because museums opposed it."

And here's another story about a librarian who submitted her resignation over deaccessioning: Small Town, Big Word, Major Issue
"Deaccessioning is the kind of word that makes eyes glaze over and can seem to be the preserve of dusty intellectuals and large museums. But it’s just a fancy name for the sale or giving away of art and artifacts by museums and other cultural organizations, and the dust-up here in this city of about 5,000 demonstrates that such debates occur in all kinds of places, big and small, where people feel protective about materials in their care.
With her personal gesture of protest in late September, Ms. Phillips stepped into a growing public controversy surrounding institutions that have sold or considered selling parts of their collections, which have been entrusted to them for the public’s benefit. Some say such sales can compromise collections, and others argue that museums, libraries and historical societies have to cull their collections periodically, particularly if there is pressure to pay their bills.
In Little Falls, library officials said they were selling things to raise money, not to cover operating costs, which institutions try to avoid, but to preserve other artifacts.
“We don’t have the space to take care of some of these items,” said Chester P. Szymanski III, the library’s president. “We’re not a museum. We’re a library.”

Call for papers: Game Theory in Trade and Development

Avinash Dixit writes: "  I am organizing a two-day (July 19-20) workshop on applications of game theory in the fields of international trade and economic development, as a part of the  Game Theory Society's summer festival this year. I would be grateful if you would publicize the attached call for papers among your colleagues and thesis-writing graduate students."

Call for papers

Game Theory Society’s 2011 Summer Festival

Two-day workshop (Tuesday-Wednesday July 19-20) on

Applications of Game Theory in Trade and Development

               The two-day workshop will consist of four sessions. Each session will have three papers: one invited overview paper, and two contributed new research papers. The themes of the sessions, and the invited presenters of the overview papers, are as follows:

1. International negotiations on international trade and related issues

(investment, intellectual property rights, environment etc)

     Kyle Bagwell, Stanford  University

2. Foundations of constitutions and their implications for development

     Roger Myerson, University of Chicago

3. Trade and investment in developing countries and transition economies

               with poor governance

     Avinash Dixit, Princeton University

4. Design of incentives and organizations for provision of public services

               in developing countries

    Timothy Besley, London School of Economics

               Submissions for contributed papers should be sent to me as PDF files attached to e-mail messages. Complete papers are preferred but detailed abstracts are acceptable. In the e-mail message please state for which of the four sessions you are submitting your paper.  Partial travel support for authors of accepted papers is available.

             The deadline for submissions is March 15, 2011 and decisions will be conveyed by April 15.

Avinash Dixit, workshop organizer

dixitak@princeton.edu

Kidney transplantation in Canada

A new report, Treatment of End-Stage Organ Failure in Canada; 2000 to 2009 draws on data from CIHI's Canadian Organ Replacement Register (CORR). (The report can be accessed directly here.) A news report focusing on kidney transplantation is here: Kidney transplants can save millions in dialysis costs: organ transplant report.

From the news summary:
"The number of people living with kidney failure more than tripled in Canada in the last 20 years, new statistics show, but experts hope to save lives and millions of dollars in dialysis costs by expanding organ donor programs.


"A report released Thursday by the Canadian Institute for Health Information shows that at the end of 2009, there were 37,744 people being treated for end-stage renal disease, with 59 per cent of them on dialysis and 41 per cent living with a functioning kidney transplant.

"Kidney failure rates appear to be stabilizing, but the supply of organs available for transplant has not kept pace with growing demand.
About 3,000 people were on waiting lists for a transplant in 2009. If they all received a transplant, it could result in annual savings of $150 million, the institute estimated.
...
"As for transplants, Nickerson said deceased donation tends to be better than average in Quebec and Atlantic Canada, at between 16 and 19 donors per million population.


"If you look at the U.S., the average donation rate is around 26 to 28 donors per million; if you look at Spain, it's up in the 30 donors per million range," Nickerson said.
"Donation rates can be significantly higher than what they are currently in Canada. And we've been stuck at this sort of 14 to 15 national average for a number of years now."
...
"CIHI estimated the annual cost of hemodialysis treatment at $60,000 per patient, compared to a one-time cost of $23,000 for a transplant plus $6,000 per year for medication.

Nickerson said savings are about $250,000 over five years.

"Sixteen to 20 years is the average expectancy of a living donor kidney transplant," he said, adding that deceased donor transplants would probably last 10 to 12 years.
Between 2000 and 2009, there were 10,641 kidney transplant procedures registered in the Canadian Organ Replacement Registry. Of these, 11 per cent were re-transplants. Of the 9,430 kidney-only first transplants, 61 per cent used deceased donor kidneys.
Since 2006, the number of living donor kidney transplants has been stable, fluctuating between 440 and 461 transplants per year.
...
"Canadian Blood Services recently launched a paired kidney exchange registry, which allows pairs to receive and donate a kidney from among other registered pairs even if they're not matches for each other.

Nickerson said 185 pairs are registered, and 65 kidney transplants have been done that otherwise wouldn't have occurred.
"And we know that this is only the beginning," he said.

"We estimate that we should have on an annual basis another 200 to 250 pairs joining annually and that we can facilitate about half of them finding transplants on a yearly basis."

Swiss parliament proposes to decriminalize incest

Switzerland considers repealing incest laws
"The upper house of the Swiss parliament has drafted a law decriminalising sex between consenting family members which must now be considered by the government.

"There have been only three cases of incest since 1984.

"...children within families will continue to be protected by laws governing abuse and paedophilia.

"Daniel Vischer, a Green party MP, said he saw nothing wrong with two consenting adults having sex, even if they were related.
"Incest is a difficult moral question, but not one that is answered by penal law," he said.

"Barbara Schmid Federer of The Christian People's Party of Switzerland said the proposal from the upper house was "completely repugnant."
"I for one could not countenance painting out such a law from the statute books."
The Protestant People's Party is also opposed to decriminalising the offence which at present carries a maximum three year jail term.
A spokesman for the party said: "Murder is also quite rare in Switzerland but no one suggests that we remove that as an office from the statutes."

See also Wen schützt das Inzestverbot? ("Who is protected by the prohibition against incest?")

HT: Sven Seuken

My previous posts on incest as a repugnant transaction are here, including this one which concerned a similar repeal in Romania: ''Not everything that is immoral has to be illegal'
.

Sniping on eBay, in Australia (radio interview)

Apparently eBay users in Australia are concerned about sniping (last minute bidding). I was interviewed for a radio report on the subject by Hagar Cohen, which you can hear here (in Australian): Snipe bidding: the dark side of online shopping.

My papers on the subject, with Axel Ockenfels and Dan Ariely are here.

Colbert on school choice in Wake County

Stephen Colbert explains the logic behind returning to a system of local schools (video, funny).

HT: Tim Gray

Jobs in kidney exchange

Methodist Specialty and Transplant Hospital in San Antonio is advertising for a Vice President, Transplant Services

In their ad they highlight their active kidney exchange program:
"Methodist Specialty and Transplant Hospital Recognition
"•# 1 SWAP Program in the country

"•# 1 kidney exchange program and 3-way paired kidney exchange program. Most recently performed the world’s largest kidney exchange transplant chain at a single center on November 11-13, 2010 with 16 recipients and 17 Donors involved and the transplant.

"•Performed 25 heart transplants year to date with a 95% success rate and completed 13 ventricular assist devices.

"•For additional information about the transplant program visit: www.texastransplant.com “METHODIST SPECIALTY AND TRANSPLANT HOSPITAL”

Homophobia: gay sex remains a repugnant transaction for many

If a repugnant transaction is one that some people want to engage in and others don't want them to, then sex is surely the most ancient. Some of this comes from the desire to control procreation (and be able to identify the father of each child), but that doesn't account for the repugnance of homosexual sex.

Elsewhere I've posted how this ancient repugnance seems to be crumbling, as same sex marriage slowly becomes legal in more places (and as the U.S. armed services have been slowly pushed to more clearly welcome the service of gay soldiers). But two recent articles make the point that homosexual sex is still a widely repugnant transaction.

Gays in Africa face growing persecution, human rights activists say
"In Uganda, a bill introduced in parliament last year would impose the death penalty for repeated same-sex relations and life imprisonment for other homosexual acts. Local newspapers are outing gays, potentially inciting the public to attack them, activists say."

"In Uganda, we look at homosexuality as an abomination. It is not normal," said Nsaba Butoro, Uganda's minister on ethics and integrity and a vocal supporter of the bill. "You are talking about a clash of cultures. The question is: Which culture is superior, the African one or the Western one?"

"More than two-thirds of African countries have laws criminalizing homosexuality. In May, a judge in Malawi imposed a maximum prison sentence of 14 years with hard labor on a gay couple convicted of "unnatural acts" for holding an engagement ceremony. Malawi's president pardoned the couple after international condemnation, particularly from Britain, Malawi's largest donor.

"Gays have also been attacked this year in Zimbabwe, and in Senegal their graves have been desecrated. Gays in Cameroon have been attacked by police and targeted in the media. In Gambia, President Yahya Jammeh has vowed to expel gays from the country and urged citizens not to rent homes to them.

"One exception is South Africa, whose constitution was the first in the world to outlaw discrimination based on sexual orientation and is among a few countries in the world that have legalized same-sex marriages."

And here's an article closer to home: Gay Bashing at the Smithsonian, about an artwork removed from the exhibit by the National Portrait Gallery recently.

European carbon markets suspended

The suspension of trading on European carbon emissions markets has been covered fairly widely, with the most interesting (and critical) story I've seen being this one from the Telegraph. European carbon market suspended over fraud fears: "The European carbon market has been thrown into turmoil after the scandal-hit scheme was suspended for a week over suspicions of fraud."


"More than €2bn (£1.7bn) of trade is likely to be disrupted after the European Commission said it would prevent transactions until January 26.
"The suspension follows allegations that 475,000 carbon credits worth €7m were stolen in a hacking attack on the Czech carbon register. It appears that the intangible allowances were bounced between eastern European countries before disappearing without a trace."
...

"This is not the first challenge to the credibility of the €90bn annual market in carbon allowances
"Under the flagship scheme, companies need permits to emit carbon dioxide as part of the global fight against climate change and polluters are granted a certain number of emissions allowances that can be traded.
"But it has been plagued by fraud, with Europol estimating that carbon trading criminals trying to play the system may have accounted for up to 90pc of all market activity in some European countries during 2009. Fraudulent traders mainly from Britain, France, Spain, Denmark and Holland pocketed an estimated €5bn. Carbon allowances are particularly susceptible to fraud because they are high value, intangible and easily moved between different countries."

Kidney chains in India, and a millionaire nondirected donor

Kidney chains are coming to India, and one of the first (maybe the first) non-directed donors is a millionaire businessman: Kidney donation chain bank set up in Trichur

"19 January 2011 TRIVANDRUM — A leading industrialist in Kerala has set into motion a novel kidney donation chain by deciding to donate one of his kidneys to a stranger.

"Kochouseph Chittilapally, owner of V-Guard group of companies, signed the papers to donate his kidney to 48-year-old Joy from Palai on the occasion of the launch of a kidney bank at Trichur on Monday.

"The bank was set up by the Kidney Federation of India (KFI), founded by Fr Davis Chiramel, who had shown the way by donating one of his kidneys to a stranger one-and-half-years ago. The kidney chain — the first of its kind in India — is possible because of a new type of organ donation called a paired donation, in which a person who needs a kidney can get one by bringing up a donor.

"Joy became eligible to get the kidney after his wife, Jolly, agreed to donate her kidney to one Shamsuddin. His wife, Sainaba, will give her kidney to one John, and whose mother in turn will donate her kidney to Baiju.

"The chain ended here as Baiju could not get a donor among his close relatives. Fr Chiramel is not disappointed. He said he will be able to launch another chain shortly as there were people willing to donate their kidneys. “I was flooded with calls after the kidney bank was launched. Out of 150 callers I had till Tuesday afternoon, 10 were willing to donate their kidneys. We will get them medically examined and put them in the chain if they are fit to donate their kidneys,” the priest said."

Here's another story: Crorepati’s kidney in donor chain

HT: Nikhil Agarwal

Barter in a recession

In a Tight Holiday Season, Some Turn to Barter

"The proliferation of Web sites with names like Swap.com and SwapMamas have moved swaps from the home and the community center to online bazaars with millions of users. No industry figures exist on the number of for-profit startups, but officials at one of the largest, Swap.com, said they have over a million registered users and an inventory of 15 million items at any given time.

"ThredUP opened business in April as a clothing exchange site and expanded this month to toys. Mrs. Spitzer signed up as a member in August.
She said that she used to buy new clothes for her three children, all under age 7, every couple of months and then give them away as her children outgrew them. But after she joined ThredUP, she began viewing her children’s hand-me-downs as currency."

Swap.com and ThredUP charge a small fee for each trade ($1 and $5). I didn't see such a fee on SwapMamas, which also encourages people to offer their used goods as gifts when they don't find a coincidence of wants, and has a reputation system that is intended to make frequent givers also favored recipients of gifts.

Greg Lewis' market design course at Harvard

My colleague Greg Lewis will be teaching a market design course this semester, and sends this email:

"I just wanted to advertise the market design course I'm teaching this semester (Econ 2056b).  The syllabus can be found here.  It's designed to be a complement to both Al and Peter's class (Econ 2056) and Ariel's IO class (Econ 2610), and it's a mix of theory and structural empirical techniques.

I've mixed up the style of the course a bit from past years: from pretty much the second week on, we'll be alternating between lecture and discussion --- which means the students will have to work a little harder and participate more, and hopefully get more out in the end.

Hope to see you there!

Cheers
Greg"

Organ donation in Tucson tragedy

9-year-old shooting victim's organs help save child

"Christina-Taylor Green, the 9-year-old girl killed in Saturday's shootings in Tucson, donated her organs.

"She was one of six people killed in the shooting that targeted U.S. Rep. Gabrielle Giffords outside a Safeway store northwest of Tucson. Giffords remains in critical condition.
...
"And a friend helping the Green family said they received a call yesterday from the organ donation network, telling them that Christina-Taylor's donation had already saved the life of a child on the East Coast."

HT: Bernie Keller

Economics job market in Europe

The big marketplace for new Ph.D. economists is the one that takes place in North America each year in early January (see this recent paper), but in recent years the Royal Economic Society has attempted to get one going in Europe.

The 6th PhD Presentation Meeting of the Royal Economic Society  is going on this weekend, on Saturday 15th and Sunday 16th January 2011 at City University London.

"The aim of the event is to provide a service both for UK and European university economics departments wishing to recruit lecturers, and for PhD students seeking academic jobs in the UK or elsewhere in Europe. This annual meeting has grown to be an extremely successful event, well supported by both students and potential employers. The event consists of two days of students’ presentations and poster sessions. Participating institutions (pdf) attend these presentations and are also allocated a room at the conference site in order to arrange individual appointments with participating PhD candidates (pdf) during the course of the conference. "


Good luck to all those on the market.

(For departments interested in the theory of matching, I notice that one of the new Ph.D.s in attendance is Alex Nichifor, who is a coauthor of a very good paper: Stability and Competitive Equilibrium in Trading Networks . (His coauthors are John Hatfield, Scott Kominers, Mike Ostrovsky, and Alex Westkamp, and his Ph.D. advisor is Bettina Klaus.))

Tribal customs of academic disciplines

Some of the different ways that different academic disciplines organize their scholarship, and the signals they send about it, are discussed in a recent column in the Chronicle of Higher Education about tenure reviews.

"A fair analysis of a tenure candidate requires that the committee members know (or learn) about the culture of the relevant academic discipline, particularly with respect to norms of publication numbers, venues, authorship order, conference presentations, invited talks, and student or postdoctoral advising.

"Considerable variation in those features exists across academe, even within science and engineering fields. Whereas one academic discipline might value short publications in highly selective conference proceedings over peer-reviewed journal articles, another requires peer-reviewed journal articles (in high-impact journals) as the primary indicator of productivity. Similarly, one discipline might alphabetize author order, another always has the "brains behind the project" as the last author, and another considers the first author listed to be the most important. Some fields expect assistant professors to have advised one or more Ph.D. students through to the completion of their degree, but in other fields that would be considered unusual."

The different customs of publication order present some opportunities in interdisciplinary collaborations of the kind that arise in market design, particularly since the authors publishing outside of their disciplinary journals are freed from the burden of sending signals.

In France, civil unions aren't just for same sex couples

A pacte civil de solidarité in France is a civil union, something like a civil marriage, originally intended to help same-sex couples formalize their relationship, without expanding the official scope of marriage.  But these civil unions are easier to dissolve than formal marriages, and (the NY Times reports), opposite sex couples are also finding this less formal kind of union attractive: In France, Civil Unions Gain Favor Over Marriage

"French couples are increasingly shunning traditional marriages and opting instead for civil unions, to the point that there are now two civil unions for every three marriages.

"When France created its system of civil unions in 1999, it was heralded as a revolution in gay rights, a relationship almost like marriage, but not quite. No one, though, anticipated how many couples would make use of the new law. Nor was it predicted that by 2009, the overwhelming majority of civil unions would be between straight couples.

"It remains unclear whether the idea of a civil union, called a pacte civil de solidarité, or PACS, has responded to a shift in social attitudes or caused one. But it has proved remarkably well suited to France and its particularities about marriage, divorce, religion and taxes — and it can be dissolved with just a registered letter."

Meanwhile, in Britain, which also has civil partnerships, a lawsuit is underway to change the fact that both same sex marriage and different sex civil partnerships are illegal:

"Eight British couples will argue that the twin bans on same-sex marriages and heterosexual civil partnerships are unlawful and should be reversed.

"Over the last two months four homosexual couples have all been refused marriage licenses at register offices across England, while four heterosexual couples were turned away when they applied for civil partnership status.

"The couples will file a joint application to the court today, which is the fifth anniversary of the first civil partnership ceremonies in England."  

Pictures from a matching conference (and a new matching paper)

I returned from Milan to the following cheerful message from Atila Abdulkadiroglu:

Dear all,

I hope you have had a cheerful holiday season, happy new year to you all.

I thought it would be better late than never, so here are also some photos from the "Roth and Sotomayor: Twenty Years After" conference: http://duke.edu/~aa88/RothandSotomayorTwentyYearsAfter/

This is all of the photos I got from our media relations person, I hope she got all of us at least in the first photo.

I would also like bring your attention a recent paper of mine:

"Generalized Matching for School Choice" ( http://duke.edu/~aa88/articles/GeneralizedMatching.pdf )
This paper makes the case that neither a one-sided matching model nor a two-sided matching model is adequate enough to capture some salient features of the school choice problem. It introduces a natural generalization to the matching models, and a natural extension of the stability notion. It characterizes student optimal stable matchings and introduces a new matching algorithm, Stable Transfer Cycles, that reduces to TTC when the problem is one-sided and becomes equivalent to Gale-Shapley's student optimal stable matching mechanism when the problem is two-sided.

Comments would be most welcome."

And here's the conference website to which the pictures refer:Roth and Sotomayor: Twenty Years After, May 7-9, 2010, and the first picture...

Specialized dating sites for the disabled

Searching for a mate is hard work, and it can be hard to find a match if you have special needs. So there's a demand for specialized dating sites: Difference Is the Norm on These Dating Sites

"Several dating Web sites for singles with health problems have started up in the last few years. Ms. Nevius joined Dating 4 Disabled, a site for people with an array of disabilities, including paralysis and multiple sclerosis. Other sites include NoLongerLonely, for adults with mental illness, and POZ Personals, for people who are H.I.V-positive."
...
"He said the worst part of dating was the anxiety over disclosing his H.I.V. status. Getting to know someone in an online community of people with H.I.V. allows relationships to form without the burden of the big reveal hovering overhead.


“Here everyone knows you have H.I.V.,” he said, “so it gets that barrier out of the way.”

"Another site, Prescription4Love, has communities dedicated to sexually transmitted diseases and physical disabilities, but also to other diseases that don’t conjure images of romance and intimacy, like diabetes and Parkinson’s. The site was created by Ricky Durham, whose late brother suffered from Crohn’s disease — a condition that came with literal baggage.

“He was a good-looking boy,” Mr. Durham said. “But when do you tell a girl that you have a colostomy bag? The first date? The third? There’s no good time.”

"Awkward issues that come with an illness can be discussed frankly and openly in an online space in which everyone is dealing with something out of the ordinary.

“Sexuality, travel, mobility, pain: Everything takes on a different dimension,” said Merryl Kaplan, who is in charge of member services for Dating 4 Disabled.

"The anonymity of the Internet allows people to be forthcoming and honest about what they are truly looking for in a companion. Among the almost 12,000 members of Dating 4 Disabled, for example, many specify the types of disabilities they would be open to dealing with in a long-term relationship.

“Like anyone else, people with disabilities have different preferences,” Ms. Kaplan said. “Someone with good mobility may prefer someone also mobile; others don’t limit at all.”

Tips, Tip Pooling, and Tip Credits

Restaurant wait-staff in the United States make a significant part of their incomes in tips left by satisfied or habit-driven or social-norm-conscious patrons (but this isn't a post about the large behavioral literature on restaurant tipping, e.g. here). A consequence of this is that restaurants and certain other employers can receive "tip credits" that release them from the obligation to pay the minimum wage, since their employees will be having part of their wage paid by their customers.

There's a body of law about what employers can and cannot do with tips (e.g. require them to be pooled, shared with non wait-staff, etc.), and about what constitutes a tip (e.g. not all "service charges" go to the server): see e.g. NoLo.com's  Tips, Tip Pooling, and Tip Credits: What Service Employees Need to Know

There are presently a number of lawsuits going through the courts about this, and some new legislation, discussed in an op-ed in the NY Times by Tim and Nina Zagat of Zagat's fame: Adding Fairness to the Tip

With the new year have come some new regulations in NY: New Rules Impose Systems for Sharing of Tips
"The new regulations apply to workers in restaurants and hotels and cover a number of issues, including who should pay for laundering “wash-and-wear” uniforms, like special T-shirts. The rules also raise the minimum wage for tipped employees, to $5 from $4.65 an hour for food service workers and to $5.65 from $4.90 an hour for service workers, a category that includes coat check workers in a restaurant or porters in hotels. (There is a separate minimum for workers at resort hotels.)


"The new rules also define the job categories that are eligible for shares in tips from the dining room: food service workers only, including waiters, bartenders and bussers, as well as sommeliers and hosts, provided they are not managers.

"The new rules allow restaurants to dictate both the system and the percentage allocated to each job category. Gratuities can be combined in a pool, to be divided by all the staff members who have helped a team effort. Or, individual servers can collect their own tips and give portions, or shares, to members of the team.

"The Labor Department will require that employers keep records of tip pools and shares; the records could be examined during investigations undertaken by the department on its own or in response to complaints.
...
"Higher-end, full-service restaurants tend to favor the pooling of tips, because it breeds less squabbling over stations and shift assignments, provides an incentive for teamwork and encourages the servers to police their own performance.


"The new regulations generally limit the pool to service workers in the dining room who interact with customers directly — like waiters — or indirectly, like servers who ferry plates from the kitchen to a station where another server picks them up and delivers them to the table. But bartenders, who prepare beverages for the dining room in a role analogous to that of a cook, can also share in the tip pool, even though kitchen staff members cannot.

“A lot of this arises from custom and tradition,” Ms. Lindholm said. “If you’re looking for perfect logic in this, it isn’t there.”

Wikipedia fundraising, randomized experiments

You know those fundraising appeals that appear at the top of Wikipedia pages? They are randomized so that reliable information can be collected about which ones attract donations.

The Wikimedia team writes:

"Since August, the Fundraising Committee has been running banner & landing page tests. These have evolved from weekly Thursday afternoon tests, which helped us get all of our systems in order and determined which messages would best motivate our donors before the launch of the fundraiser - to almost daily tests introducing new banners and landing pages as we continue to tweak our current campaign.

"Check out the Fundraising Updates page where we discuss what we've learned so far and upcoming tests and challenges."

Game theory for college teachers at the AEA continuing education program

Preliminary reading list for an introduction to Game Theory at the AEA Continuing Education Program January 2011 taught by Avinash Dixit and David Reiley.

Meant for college teaching at all levels, starting with freshmen and going up to writers of senior theses,
it includes  sections taught by Reiley that include mateial that will be familiar to readers of this blog, on VI. MARKET DESIGN AND ALGORITHMS
IV. AUCTIONS AND FIELD EXPERIMENTS


It also includes the first draft of a new book by Michael Suk-Young Chwe,
Folk Game Theory: Strategic Analysis in Austen, Hammerstein, and African American Folktales

Slavery in the U.S.

At the conference I'm attending in Finland, there's been a good deal of discussion (with more to come) of repugnant transactions, with an undercurrent of concern that globalization and other kinds of encroachment of markets on traditionally non-market ways of allocating resources will inevitably cause things presently regarded with repugnance to become more customary.

It's good to remember that our repugnance at certain transactions doesn't have to diminish over time (as does happen with many formerly repugnant transactions like same sex marriage).  Slavery (and indentured servitude, and other forms of servitude) were once regarded with much less repugnance--certainly much less nearly universal repugnance--than they are today.

The NY Times recently published a Civil War era map of where slaves were in the United States in 1860:
Visualizing Slavery

"South Carolina, which led the rebellion, was one of two states which enslaved a majority of its population, a fact starkly represented on the map."
                                              
                                               http://www.nytimes.com/interactive/2010/12/10/opinion/20101210_Disunion_SlaveryMap.html

Markets, broadly defined

I'm in Helsinki, participating in the second workshop of the Markets & Marketization program, that will bring together philosophers and philosophers of science with economists, sociologists, political scientists and others interested in markets very broadly defined.

Workshop II  Friday-Saturday, 7-8 January, 2011; Tentative program

Friday 7.1.

10.00 - 11.00 Alvin Roth (Harvard): "What does market design teach us about markets?"

11.10 - 11.30 Comment: Patrik Aspers

11.30 - 11.50 Comment: Emrah Aydinonat

11.50 - 12.30 Discussion

14.00 - 15.00 Ronald Noë: On biological markets (title TBA)

15.00 - 16.00 Risto Heiskala: "Coordination of human interaction: the BTCIEMP scheme"
(’BTCIEMP’ stands for: biology, traditions, cultural categorization, ideology, economy, military power and political power)

16.30 - 17.30 Jens Beckert: On the sociology of markets (title TBA)

Saturday 8.1.

10.00 - 11.00 Debra Satz (Stanford): The Moral Limits of Markets

11.10 - 11.30 Comment: Adrian Walsh

11.30 - 11.50 Comment: John O’Neill

11.50 - 12.30 Discussion

Blasphemy law in Pakistan

One of the oldest repugnant transactions, different worship, is as repugnant as ever in Pakistan: Pakistanis Rally in Support of Blasphemy Law

"ISLAMABAD, Pakistan — A crippling strike by Islamist parties brought Pakistan to a standstill on Friday as thousands of people took to the streets, and forced businesses to close, to head off any change in the country’s blasphemy law, which rights groups say has been used to persecute minorities, especially Christians.
...
"In fiery speeches across all major cities and towns, religious leaders warned the government on Friday against altering the law, which carries a mandatory death sentence for anyone convicted of insulting Islam.
...
"The human rights commission has documented scores of cases in which men have been harassed for being Christian or for being members of the Ahmadi sect, a minority group within Islam, and then accused of blasphemy. The mere fact of being a Christian or an Ahmadi in Pakistan makes a person vulnerable to prosecution, the commission says. Often the mere accusation of blasphemy has led to murders, lynchings and false arrests."


It turns out that the accusation of being against the blasphemy law isn't good for you either: Salman Taseer assassination points to Pakistani extremists' mounting power

"Taseer's apparent killer cited his boss's stance against a controversial anti-blasphemy law in justifying his actions. As the embattled, pro-U.S. PPP sought in recent days to win back defecting allies that also include a small Islamic party, it had already said it would not support a proposal to change the blasphemy statutes. That left Taseer one of the few vocal champions of the move, which hard-line religious organizations had labeled a Western conspiracy.

The laws have drawn scrutiny since a Christian woman was sentenced to death in November for allegedly criticizing the Muslim prophet Muhammad. Taseer had called for her pardon, leading religious groups to denounce him as an "apostate" and burn effigies of him during a nationwide strike last week in support of the law. One Muslim cleric has offered $6,000 to anyone who kills the woman, who remains in jail."

More on the debate over kidney sales: transcript of interview

In my earlier post, Dubner interviews me about kidney sales, I promised to link to a transcript when it became available, and now it has: there's a link at the bottom of the Freakonomics post You Say Repugnant, I Say … Let’s Do It!

Dubner interviewed me for about an hour and a half, so he and his producer Chris Neary had to do lots of editing to produce the half hour or so podcast. I recall a pair of questions, one of which made it into the show and one of which was left on the cutting room floor (or wherever unused electronic files are left).  The question that made it in was about what makes many people view kidney sales as repugnant. The question that didn't make it was, if I were asked to help design a market in which kidneys could be sold, what would be my primary concerns.

Regarding what is behind the repugnance of kidney sales, here's the text of my reply included in the transcript:
"Al Roth: The late Pope John Paul wrote about this and he objects strongly to the sale of kidneys but thinks the donation of kidneys is a very good thing, though if we do it for money is a very bad thing...I think his feeling is that it turns people from ends into means which is a bad thing in itself. So that’s one nature of objection. 
Another kind of objection is that it might be OK if I offered to buy your kidney because you’d be a hard guy to exploit, you’re a successful, financially solvent person, but pretty soon we’d start seeing the desperately poor and maybe they would in some sense be acting against their self interest, they would be being exploited or coerced even, by the temptation of the money in ways that if they could use their better judgement they wouldn’t want to be.  So that’s sort of a coercion argument. 
And then there’s a slippery slope argument that says if we started allowing people to sell their kidneys, it would be primarily poor people who would sell their kidneys, and pretty soon we would start hearing political discussion that said, ‘you know, we don’t really need unemployment benefits, we don’t really need aid to families with dependent children because after all, everyone’s got two kidneys and they can take care of themselves by selling a kidney if they need to’...and that makes us a much less desirable society to live in."


I don't have a transcript to consult about what I said when they asked what I would do if asked to help design a kidney market, but as I recall, my answer went something like this.
The first thing I'd want to think about is what kind of review we would want to use to judge if the market had been a success ten years (or longer) after it had been started. The criteria we'd surely want the market to be evaluated on would include:
 How had the donor/vendors fared?: were they healthy and well treated, and respected, and did they encourage new potential donor/vendors to make the same choices they had?
How had patients with kidney disease fared?: were they receiving healthy kidneys, had the waiting list for transplants largely disappeared, were kidneys being allocated in ways that were widely seen as equitable?


To focus thoughts for future debate, we might want to think about a system in which only the federal government could legally pay for a live kidney, and would have a mandate to set the price (and associated benefits like follow-up medical care) high enough so that there would be a waiting list of donor/vendors, who could e.g. be expected to undergo regular health and suitability tests (suitability being a broad term meant to include physical and mental health, deeply informed consent, etc.)  for a year before being accepted as donor/vendors, and that the kidneys obtained in this way would be allocated anonymously through some regulated procedure that might resemble the current procedures for allocating deceased-donor organs.

In terms of how I've interpreted the ongoing debate between those in favor of sales and those against, I  think that a good deal of the coercion concern can be addressed by an appropriately designed one year waiting period, although I say that without having recently talked to someone who makes that argument with conviction.
I don't see any easy way to bridge the gap between those who think that selling kidneys is a bad thing in and of itself, not to be traded off with possible benefits of other sorts (e.g. to patients and perhaps to donor/vendors), and those who don't see it that way, or who feel that the current dire circumstances of many thousands of those with kidney disease gives legitimate counterweight to this concern.
And the slippery slope concern is the one that personally gives me the most pause. I can see how appropriate legislation would prevent e.g. your bank from asking for a kidney as collateral, but I can't see any way to be sure that making kidneys a potential financial asset wouldn't make us a less sympathetic society (even though a one year waiting period and other qualification tests would limit how much kidney sales could be used as a justification for cutting unemployment insurance in particular).

My work on kidney exchange has largely avoided being enmeshed in this debate, since the "in kind" kidney exchange doesn't seem to arouse repugnance. Thus for example Debra Satz' recent book Why Some Things Should Not Be For Sale: The Moral Limits of Markets, Oxford University Press, 2010, finds little to object to about kidney exchange, but largely disapproves of kidney sales. (I expect to meet Professor Satz for the first time this weekend, at a philosophy of economics conference in Helsinki...)

Polygamy in the Negev

Haaretz highlights some ads that have been appearing in the Negev:
Over 30 and single? Try polygamy
"Local Bedouin newspaper sparks calls on single Bedouin women who are over 30 to consider polygamous marriages, saying 'it's the Sharia solution'"

A related story concerns underage marriages ("Barely sixteen and married"), and includes this  observation
"The girls themselves, explains ElKranawi, are willingly marrying at such a young age: "Girls only 15 years old dream of getting married, because they understand it to be the way to independence. After all, if you are 20 or older, you may be married as a second wife. Even if a woman has obtained an education, she will not be independent. Her parents will continue to make decisions for her."

Unraveling of loan maturities: inefficiency in borrowing and lending

The Maturity Rat Race by Markus K. Brunnermeier and Martin Oehmke

Abstract: "We develop a model of endogenous maturity structure for financial institutions that borrow from multiple creditors. We show that a maturity rat race can occur: an individual creditor can have an incentive to shorten the maturity of his own loan to the institution, allowing him to adjust his financing terms or pull out before other creditors can. This, in turn, causes all other lenders to shorten their maturity as well, leading to excessively short-term financing. This rat race occurs when interim information is mostly about the probability of default rather than the recovery in default, and is most pronounced during volatile periods and crises. Overall, firms are exposed to unnecessary rollover risk."

The paper goes on to note:


"The maturity rat race is inefficient. It leads to excessive rollover risk and causes inefficient liquidation of the long-term investment project after negative interim information. Moreover, because creditors anticipate the costly liquidations that occur when rolling over short-term debt is not possible, some positive NPV projects do not get started in the first place. This inefficiency stands in contrast to some of the leading existing theories of maturity mismatch.

Baroque kidney donation story from Mississippi

Sister's kidney donation condition of Miss. parole

"JACKSON, Miss. (AP) — For 16 years, sisters Jamie and Gladys Scott have shared a life behind bars for their part in an $11 armed robbery. To share freedom, they must also share a kidney.

"Mississippi Gov. Haley Barbour suspended the sisters' life sentences on Wednesday, but 36-year-old Gladys Scott's release is contingent on her giving a kidney to Jamie, her 38-year-old sister, who requires daily dialysis.

"The sisters were convicted in 1994 of leading two men into an ambush in central Mississippi the year before. Three teenagers hit each man in the head with a shotgun and took their wallets — making off with only $11, court records said.

"Jamie and Gladys Scott were each convicted of two counts of armed robbery and sentenced to two life sentences."

And here's the unsurprising reaction to linking parole to kidney donation: Mississippi Gov "unethical" over jail release: surgeon

"Mississippi Governor Haley Barbour acted unethically when he suspended a woman's life sentence on condition she donate a kidney to her sister, a prominent transplant surgeon said on Thursday.
...
"A condition of Gladys Scott's release is that she donate a kidney to her sister in an operation that should be performed urgently, Barbour said in a statement on Wednesday. She had agreed to be a donor for her sister, who requires dialysis.
...
"Michael Shapiro, chief of organ transplantation at Hackensack University Medical Center in New Jersey, criticized the decision to impose a condition for the release.

"While Governor Barbour probably meant nothing nefarious by this decision, what he did was unethical and possibly illegal. He is unaware of the procedures of transplantation that include making sure donors are not coerced," Shapiro said.

"There were also medical reasons why such a condition was inappropriate, not least that Barbour may not know whether Jamie Scott is suitable or healthy enough for a transplant, said Shapiro, chair of the ethics committee of the nonprofit United Network for Organ Sharing.

"Shapiro also questioned whether Barbour ordered Scott released because her treatment was a financial burden on the state.

"If either party could be turned down for medical concerns, the transplant team would feel pressured to continue with the transplant or send them back to prison. It is a position they should not be put in," he said."


HT: Mike Ostrovsky

Peter Cramton's Market Design blog

Welcome to fellow market designer and now fellow blogger Peter Cramton, who has just initiated his Market Design blog.

Experiments by psychologists and economists (on happiness)

From The Economist: an article on happiness leads indirectly to a very important conclusion about experiments (see below):The U-bend of life: Why, beyond middle age, people get happier as they get older

"Happiness doesn’t just make people happy—it also makes them healthier. John Weinman, professor of psychiatry at King’s College London, monitored the stress levels of a group of volunteers and then inflicted small wounds on them. The wounds of the least stressed healed twice as fast as those of the most stressed. At Carnegie Mellon University in Pittsburgh, Sheldon Cohen infected people with cold and flu viruses. He found that happier types were less likely to catch the virus, and showed fewer symptoms of illness when they did. So although old people tend to be less healthy than younger ones, their cheerfulness may help counteract their crumbliness.

"Happier people are more productive, too. Mr Oswald and two colleagues, Eugenio Proto and Daniel Sgroi, cheered up a bunch of volunteers by showing them a funny film, then set them mental tests and compared their performance to groups that had seen a neutral film, or no film at all. The ones who had seen the funny film performed 12% better. This leads to two conclusions. First, if you are going to volunteer for a study, choose the economists’ experiment rather than the psychologists’ or psychiatrists’. Second, the cheerfulness of the old should help counteract their loss of productivity through declining cognitive skills—a point worth remembering as the world works out how to deal with an ageing workforce.