Two interviews by the Minneapolis Fed with two Stanford economists: me -- and Raj Chetty

The Minneapolis Fed publishes a magazine called The Region that features long interviews with economists, accompanied by nice photos. Their current issue, just out, has an interview with me.

You can read the whole thing here:

Interview with Alvin Roth

Stanford economist on matching theory, kidney markets and the importance of coffee

Douglas Clement | Editor, The Region  Published June 15, 2015   |  June 2015 issue

Here's the final exchange, about Pittsburgh and coffee:

"Region: One last question, if I might. Many of your major breakthroughs occurred when you were at Pittsburgh. What was it about the research environment there that was so conducive to Nobel-winning work?

Roth: Well, Pittsburgh was a lot of fun. The living was easy. I walked to work. I’d walk with my kids to school and drop them off and walk on into work. My colleagues and I spent a lot of time drinking coffee and talking about economics.

The mathematician Alfréd Rényi is said to have said that a mathematician is a machine for turning coffee into theorems. Maybe economists turn decaf into models.

There were lots of people to talk to at Pittsburgh. It was a fruitful time. And it was a very good department. I think a lot of what makes a department a good place to work is that when you’re onto something you’re excited about and you walk out the door of your office and tell one of your colleagues about it, he’s excited to hear about it, too. He says “That’s great. Let’s go have a cup of coffee, and you can tell me about it.” So there’s the positive reinforcement you get just from having people think, “Isn’t that great you’re excited about something. You’re thinking about something interesting.” It makes places fun to work.

Here at Stanford, I try to organize regular coffees—I did this at Harvard and I do it here—regular coffees with students interested in different things. We have a Tuesday morning coffee for experimental economics and a Thursday morning coffee for market design. I think that a lot of intellectual interaction arises out of social interaction. You have to be talking to people before you’re talking about work.

Region: Wonderful. It’s been a pleasure talking with you. Thank you."

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

The December 2014 issue had an interview with an even better-looking economist

You can read it here:

Interview with Raj Chetty

Harvard economist explores work on income mobility, education, taxation and labor supply

Douglas Clement | Editor, The Region Published December 10, 2014   |  December 2014 issue

Raj and I were colleagues at Harvard, and if my experience moving to Stanford is any guide, he is going to have a fine time here at Stanford.

Welcome, Raj.

Maine hospital goes through with kidney donation despite donor raising funds online

Long story short: woman in need of kidney posts a sign on a car, seen by a stranger who agrees to donate and is compatible. Then he uses social media to raise some money to pay his expenses, and raises more than he anticipated. Hospital delays surgery, worrying that maybe he's breaking the law against getting "valuable consideration" for his donation, but eventually goes ahead. Both donor and recipientt are doing well.

Maine man sees plea on car window, to donate kidney to stranger
Maine donor says kidney transplant OK'd for next week
"Joshua Dall-Leighton of Windham said the surgery will take place June 16 at Maine Medical Center in Portland. Hospital spokeswoman Matt Paul confirmed on Monday that the living kidney donation is scheduled for that day.
 
"Dall-Leighton responded to the plea for a donor on South Portland resident Christine Royles' car. But the surgery was delayed by medical and legal hurdles, including crowdsourced donations to Dall-Leighton aimed at defraying his expenses. Paul said those concerns have been addressed.
...
"Hospital officials said in April they needed time to determine if the donation violated the National Organ Transplant Act, which forbids potential donors from profiting from a donation. A crowdfunding website set up for the donation has raised more than $49,000. Royles also organized fundraisers to pay bills and reimburse Dall-Leighton's time away from work.
 
"Paul said an external legal review confirmed that the transplant "will comply with federal laws that are designed to regulate organ transplants and protect living donors."
    ******************

From Bill of Health: Fundraising and the Delayed Kidney Transplantation: A Loophole in the Ban against Commercialization?
***************

And here's the happy ending
Car-window wish for kidney rewarded: Maine woman receives lifesaving transplant--Both patient and donor are reported to be doing well after surgery, capping an unusual story of strangers and sacrifice.

"Josh Dall-Leighton, 30, a corrections officer at the Southern Maine Re-entry Center in Alfred, saw the sign on Royles’ car last fall and immediately contacted her.

“He saw that sign and said, ‘I need to do this,’ ” his wife said.

Royles, whose kidney failure was caused by an autoimmune disease, was placed on a waiting list of more than 100,000 in need of kidney transplants in 2014, but decided to try to find a donor on her own.

The surgery was almost derailed after a GoFundMe effort raised nearly $50,000 for the couple. The account was set up by a friend of Josh Dall-Leighton with a goal of raising $6,000 to cover expenses for the six weeks he was expected to take off work to recover from the surgery.

But after a story about the transplant was published in the Press Herald and was widely picked up by other media outlets, the donations far exceeded the original goal.

Maine Medical Center put the potential transplant on hold until lawyers could sort out legal and ethical issues regarding the large sum of money. Federal and international laws prohibit the sale of organs, but hospital officials have said it was clear that there was no intent to profit from donating the organ.

Last week the hospital announced that the donation was not a legal impediment, and the surgery would go forward.

“If we didn’t have as strong a voice about this as we did, I don’t believe we would be here right now,” Ashley Dall-Leighton said.

She has said they are considering donating the money to a kidney foundation and the neonatal intensive care unit at Maine Med, where their twins were patients when they were born. They wanted to wait until after the surgery and recovery period to have a true accounting of their expenses – as opposed to an estimate – before determining how much and where to donate, she said."

Abraham Neyman's talk on Stochastic Games at the Conference in His Honor

I'm acutely aware that I'm missing two important conferences in Jerusalem during these days, in honor of Abraham Neyman, and Sergiu Hart.  The Neyman Conference is underway:

Here is Neyman's talk from the conference:

Yom Holedet Sameach, Abraham!  I'm sorry to have to miss the party.

NPR's Marketplace: Ryssdal interviews Dubner about his newest Freakonomics podcast--the four minute version

An algorithm that matches kidney patients and donors

The link above will take you to the four-minute version of the fifty minute Freakonomics podcast in which Dubner interviews me about my new book.

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Doctors from Johns Hopkins Hospital in Baltimore, Maryland, transplant a kidney. 

Interview by Kai Ryssdal, Interview with Stephen Dubner

Wednesday, June 17, 2015 - 14:49

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Matching markets are markets where money isn’t allowed to do what it usually does. For example, school admissions — colleges don’t just raise the tuition price until demand meets supply. Or how new M.D.’s get assigned to their residencies — they can’t just buy their way into the hospital they want. In each case, you have to find a way to match a candidate with an available slot.

You also can't buy a kidney, or pay for somebody's college education to get a kidney, or purchase a car for them in exchange of a kidney.

So how can you make a market for something that is indivisible and can’t put a price on? Al Roth, a professor of economics at Stanford, realized that this model could be adapted to help kidney patients find a potential donor.

"Let’s pretend you and I, Kai, we both need a kidney transplant. And that both of us have a relative who’s willing to donate one, but your relative is not a biological match for you and mine isn’t for me," says Stephen Dubner, author of "Freakonomics." "Wouldn’t it be awesome if you could enter all your data and all of the donor's data into some algorithm that could magically sort these data from all the transplant centers in the country and match up donors and patients?"

Roth’s algorithm has helped save a lot of lives. Ruthanne Leishman from the United Network for Organ Sharing says the United States has about 600 kidney paired donation transplants per year right now. In 2000, the U.S only had two.

Featured in: Marketplace for Wednesday, June 17, 2015

About the author

Kai Ryssdal is the host and senior editor of Marketplace, the most widely heard program on business and the economy in the country.

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Freakonomics podcast on Who Gets What and Why

Stephen Dubner came to visit me in Palo Alto to talk about my new book. He also interviewed some other people, including Ruthann Leishman who now manages one of the active kidney exchanges, at UNOS, but who I met when she helped launch the New England Program for Kidney Exchange. You'll also hear from an incompatible patient-donor pair who quickly found a match, and the nondirected donor who started the chain that worked for them..  We end the conversation over dinner...

(I haven't figured out how to embed the podcast itself, but you can listen to it if you click on the title below which will take you to the Freakonomics page for this show.)

Make Me a Match: A New Freakonomics Radio Episode

STEPHEN J. DUBNER
06/17/2015 | 11:00 pmPRODUCED BY: GREG ROSALSKY

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(Photo, cropped: Newtown Grafitti)

Our latest Freakonomics Radio episode is called “Make Me a Match.” (You can subscribe to the podcast at iTunes or elsewhere, get the RSS feed, or listen via the media player above. You can also read the transcript, which includes credits for the music you’ll hear in the episode.)

The gist of the episode: Sure, markets generally work well. But for some transactions — like school admissions and organ transplants — money alone can’t solve the problem. That’s when you need a market-design wizard like Al Roth.

Al Roth, an engineer by training, is a professor of economics at Stanford and won a Nobel in economics in 2012. (Roth shared the prize with Lloyd Shapley, whose research influenced Roth). What kind of work did Roth do to land the Nobel? It’s not the kind of thing that typically wins a Nobel. Roth has helped people who need a kidney transplant find a donor. He’s helped new doctors find their first jobs. He’s helped high-school students in New York City find the right high school – even though Roth himself, who grew up in New York City, dropped out of high school.

ROTH: I was, you know, a poor ungrateful student who didn’t appreciate what my teachers were trying to do for me. You should tell all your listeners they should complete high school.

Roth has also just published a very fine new book that is a great survey of his work — and his worldview, which is just as impressive. It’s called Who Gets What—and Why: The New Economics of Matchmaking and Market Design In the podcast, I visit Stanford to speak with Roth about market design, what’s it’s like to get that middle-of-the-night Nobel phone call, and why the world needs an economist-engineer like him in the first place:

ROTH: Matching markets are markets where money, prices don’t do all the work. And some of the markets I’ve studied, we don’t let prices do any of the work. And I like to think of matching markets as markets where you can’t just choose what you want even if you can afford it — you also have to be chosen. So job markets are like that; getting into college is like that. Those things cost money, but money doesn’t decide who gets into Stanford. Stanford doesn’t raise the tuition until supply equals demand and just enough freshmen want to come to fill the seats. Stanford is expensive but it’s cheap enough that a lot of people would like to come to Stanford, and so Stanford has this whole other set of market institutions. Applications and admissions and you can’t just come to Stanford, you have to be admitted.

You’ll hear how Roth and others have revolutionized the organ-donor market, and we hear the amazing story of how one particularly selfless woman kicked off a donor chain that gave life to many others. And you’ll also hear Ruthanne Leishman, from the United Network For Organ Sharing, talk about  the organ-donor algorithm developed by Roth and his colleagues:

LEISHMAN: It’s saving a lot of lives. We have about 600 kidney-paired donation transplants a year right now in the United States. In 2000, we had 2. … We would have stayed doing 2 or 4 or 6 a year without the algorithm.  

The next time you hear someone say that economists are a bunch of selfish good-for-nothings, feel free to counter by telling them about the fine work of Al Roth.

San Francisco is becoming a center for kidney exchange

UCSF Medical Center, CPMC Join Forces for 18-Patient Kidney Transplant Chain

"A unique collaboration between UCSF Medical Center and Sutter Health’s California Pacific Medical Center (CPMC) resulted in what is believed to be one of the nation’s first nine-way kidney transplant chains occurring in one city over a 36-hour period.

The chain started on Thursday morning (June 4), with an altruistic patient donating a kidney as a token of gratitude for his good health. It concluded with a recipient who has been on dialysis for several years.

The surgeries involved the above donor and recipient and an additional 16 patients – eight recipients, each paired by a friend or family member. These pairs were either blood type or immunologically incompatible with each other but were compatible with other pairs in the group.
...
"“This collaboration with CPMC enables us to broaden our pool of kidney transplant donors and recipients and treat them at two medical centers separated by only a few miles,” said John Roberts, MD, professor of surgery and chief of UCSF Medical Center Transplant Service. “The proximity of the hospitals means the donated kidney can be swiftly transplanted, minimizing risks to patients. This paired kidney exchange also benefits those on the transplant waiting list and moves up others who are still waiting.”

Alex Tabarrok reviews Who Gets What and Why in the WSJ

Who Gets What and Why is reviewed very generously by Alex Tabarrok in the Wall Street Journal :

Matchmaker, Make Me a Market--In some markets, price isn’t the determining factor. You can choose to go to Harvard, but Harvard has to choose to accept you first. (ungated link here if the one above doesn't work...)
By ALEX TABARROK, June 15, 2015 7:18 p.m. ET

Here's his first paragraph:
"The scientific pretensions of economics have been seriously questioned in recent years. Macroeconomists failed to predict the financial crisis and then failed to agree on either the causes or the solutions. It pained me when even my mother began to wonder whether economists were as useful as dentists. Alvin Roth’s “Who Gets What—and Why” is the book that I shall give to mom to redeem my profession."

And here's his final paragraph:
"“Who Gets What—and Why” is a pleasure to read. It’s also a pleasure to discover that rare species, a humble economist. Humble but useful."

(I enjoyed reading what he had to say in between, too--color me flattered:)

**************
And here are Tabarrok's comments on his review, in a blog post in MR:

The Hidden World of Matchmaking and Market Design

by Alex Tabarrok on June 16, 2015 at 7:28 am

- See more at: http://marginalrevolution.com/marginalrevolution/2015/06/the-hidden-world-of-matchmaking-and-market-design.html#sthash.5ktW1SN4.dpuf

"One of the most interesting aspects of the book is that Roth has created a new typology of market failure but a very different way of addressing such market failures. Read the whole review for more"

Same sex marriages, south of the border

The revolution in reversing an ancient repugnance is quieter there:
With Little Fanfare, Mexican Supreme Court Effectively Legalizes Same-Sex Marriage

"In ruling after ruling, the court has said that state laws restricting marriage to heterosexuals are discriminatory. Though the decisions have been made to little public fanfare, they have had the effect of legalizing gay marriage in Mexico without enshrining it in law.

“When I heard the judge pronounce us legally married, I burst into tears,” said Mr. Gonzalez, 41, who, like nearly all gays marrying in Mexico, needed a court order enabling him to exchange vows.

As the United States awaits a landmark decision on gay marriage by the Supreme Court, the Mexican court’s rulings have added the country to a slowly growing list of Latin American nations permitting same-sex unions.

Argentina, Uruguay and Brazil already allow same-sex marriage. Chile plans to recognize same-sex civil unions this year; Ecuador approved civil unions in April; and Colombia grants same-sex couples many of the same rights extended to heterosexual married couples.

“It’s a huge change from where things were 10 years ago,” said Jason Pierceson, a professor at the University of Illinois at Springfield who studies gay marriage trends in Latin America.

The shift in Mexico, the second largest country in Latin America after Brazil, is the product of a legal strategy that advocates used to bypass state legislatures, which have shown little inclination, and often hostility, to legalizing gay marriage.

In 2009, Mexico City, a large liberal island in this socially conservative country, legalized gay marriage — a first in Latin America. There have been 5,297 same-sex weddings there since then, some of them couples coming to the city from other states."

College admissions, as seen by the Chronicle of Higher Ed

The Chronicle of Higher Education has a long roundup of thoughts on college admissions: College Admissions, Frozen in Time

They describe the admissions process this way:

"Like a machine Rube Goldberg might’ve built if he’d been really, really mean. For colleges aspiring to greater selectivity, the system’s undeniable inefficiency is by design. Each year, four-year institutions everywhere spend a fortune buying tens or hundreds of thousands of high-school students’ names from testing and other companies, and bombard those "suspects" with letters and emails. The hope is that, as they move through the recruitment funnel, enough of them become interested "prospects," then, ideally, applicants, at which point the bulk of colleges, tuition-dependent and not world-famous, scramble to admit and enroll a certain number (to meet their enrollment and revenue goals), while the wealthiest, choosiest institutions use elaborate criteria to whittle down vast numbers in an intensive exercise known as crafting a class. That’s an artful term for how colleges satisfy their many interests, for this much tuition revenue and that much diversity, this many legacies and that many goalies, and enough engineering majors to keep the program strong.

These days, students file more and more applications to hedge their bets on where they’ll get in and, unknown until very late in the process, how much it’ll cost them. Meanwhile, colleges only increase the suspense for all involved by chasing more applicants and placing great numbers of them on wait lists, drawing out a months-long process even more."

...

"In the fall-2013 cycle, the average institutional yield rate was 36 percent, down from 49 percent in 2002, according to the National Association for College Admission Counseling. "

...

"Some futurists want to automate college matches. Yet the recruitment process, tedious though it is, allows for personal interactions that help applicants form crucial opinions of colleges. When institutions make it easier and faster to apply, it can be hard for one party to know how seriously to take the other. "

...

"In 2011, for instance, Washington Monthly published an article proclaiming "the end of college admissions as we know it," about ConnectEdu, a website designed to match students and colleges. The platform, with its powerful algorithm, would transform the admissions process much like Match.com has changed dating. Such a shift would benefit less-savvy applicants in particular, the article said: "Everything you’ve heard about getting in is about to go out the window."

ConnectEdu filed for bankruptcy three years later. Though the reasons were complicated, one lesson was clear: Just because an entrepreneur has a big idea and a high-tech plan doesn’t mean the status quo is crumbling. Although other companies still provide similar matching services, the traditional process endures."

...

"To deal with the uncertainty of vast applicant pools, colleges might embrace anything that helped them identify candidates with genuine interest. A company called InitialView, which conducts brief interviews of foreign students and transmits the video to U.S. colleges, now allows those applicants to assign a virtual "star" to the two institutions they most want to attend. The company is considering a similar service for the domestic market."

...

"Right now, parents complete the Free Application for Federal Student Aid in the spring of their child’s senior year of high school, after typical application deadlines have passed, often estimating their tax information for the previous year.

But a proposed policy change would allow future applicants to use two-year-old tax data to complete the form, giving families an earlier, clearer picture of their college bills. That way cost could fold into students’ college search like never before, perhaps prompting them to apply to fewer places. Mr. Boeckenstedt says. And the change could shake up the traditional admissions calendar, in which applicants find out how much they’ll have to pay at each college shortly before the May 1 deadline for choosing where to go."

Review of living kidney donor outcomes, in The Lancet

In The Lancet
Volume 385, Issue 9981, 16–22 May 2015, Pages 2003–2013

Living kidney donation: outcomes, ethics, and uncertainty
Dr Peter P Reese, MD,  Prof Neil Boudville, MD, Prof Amit X Garg, MD

Here's the summary:
"Since the first living-donor kidney transplantation in 1954, more than half a million living kidney donations have occurred and research has advanced knowledge about long-term donor outcomes. Donors in developed countries have a similar life expectancy and quality of life as healthy non-donors. Living kidney donation is associated with an increased risk of end-stage renal disease, although this outcome is uncommon  (less than .5 percent increase in incidence at 15 years). Kidney donation seems to elevate the risks of gestational hypertension and pre-eclampsia. Many donors incur financial expenses due to factors such as lost wages, need for sick days, and travel expenses. Yet, most donors have no regrets about donation. Living kidney donation is practised ethically when informed consent incorporates information about risks, uncertainty about outcomes is acknowledged when it exists, and a donor's risks are proportional to benefits for the donor and recipient. Future research should determine whether outcomes are similar for donors from developing countries and donors with pre-existing conditions such as obesity."


And this...
"In many countries, living kidney donation is the only affordable treatment for kidney failure. This is evident across large regions of India and Pakistan, for example, where chronic dialysis is rationed in units supported by government or community donations, or is only available with payments that are prohibitive for most patients. In this respect, chronic dialysis is viewed as a bridge to a life-saving kidney transplant from a living donor. In many developing countries, the infrastructure to procure deceased-donor organs does not exist.

"Unrelated and incompatible donors
Living kidney donation in unrelated donors (eg, friends, spouses, or distant relatives of the recipient) are becoming more common. In the USA, the proportion of living kidney donations from unrelated donors increased from 30% to 57% between 1999 and 2013. Similar trends are evident in Europe, Australia, and New Zealand.

"This rise in unrelated living kidney donation is largely associated with a declining emphasis on close HLA matches between donor–recipient pairs. With advances in immunosuppressive therapy, the longevity and function of the transplanted organ is now less dependent on the genetic donor–recipient relationship than in the past. The rise in unrelated donors has also been helped by so-called kidney paired donation, a strategy used to overcome donor–recipient incompatibility if the transplant candidate has antibodies to the donor's blood or HLA type. Such antibodies greatly increase the risk of donated-organ rejection and, in the case of anti-HLA antibodies, might develop because of previous pregnancies, blood transfusions, or transplants. As shown in figure 2, registries of incompatible donor–recipient pairs have enabled transplantation to proceed through paired exchanges, or donation chains in which each donor provides a kidney to an unrelated compatible recipient. Paired exchange has been helped by the transportation of living-donor kidneys between centres and by non-synchronous transplants, in which one or more donors wait to donate until new pairs enter the chain. In some cases, a transplantation chain begins when an individual with no relationship to any recipient donates a kidney (termed non-directed donation). In 2012, this type of altruistic donation enabled a 30-transplant chain to proceed."

video: “Who Gets What – and Why: The New Economics of Matching and Market Design"

For those of you who have little idea about what goes on at a book talk--which was my situation a week ago--here's a video of the first book talk I gave, last week, the day after Who Gets What and Why appeared, at the Roosevelt House of Hunter College  There's a kind introduction by Karna Basu, followed by a talk by me, and then a conversation with Michael Weinstein.
*************

Also available on C-Span: http://www.c-span.org/video/?326483-1/alvin-roth-gets-whatand 

Interview about WGWaW:

Here's the text of an interview about Who Gets What and Why, with Nancy Shute at NPR's Shots--Health News:
How An Economist Helped Patients Find The Right Kidney Donors
JUNE 11, 201512:35 PM ET

Here's a snippet:

"Market design is a very outward-facing form of economics. I'm talking with doctors. I'm talking with school administrators. ...I'm constantly talking with people who aren't economists. A big deal in market design is finding the inside champions who the economists can help. I kind of think of economists as being helpers here. We have some ideas, but we don't do any of the surgeries."

Who gets what and why interview

Here's an interview I gave last week in New York, at Quartz (qz.com):

The hidden economic rules behind Tinder, marriage, kidneys, and college admissions

"Roth swung by Quartz’s New York offices recently to chat about his new book, Who Gets What—and Why, which explains how matching markets work, why almost everyone makes it illegal to buy kidneys, and why it’s increasingly rare for people to marry their high-school sweethearts. Here are edited excerpts of our conversation."

Here's one snippet:

"You sound very excited in some parts of the book with some of the opportunities out there. [Editor’s note: Stanford University is in the heart of Silicon Valley.] For instance, some of the billion-dollar unicorn start-ups, such as Airbnb and Uber. We usually describe them as companies but you describe them as marketplaces.

Absolutely. Airbnb is a matching market between travelers and hosts. Uber is a matching market between travelers and drivers.

It seems like a boom time at least for these kinds of markets. Why now?

Well some of the reasons are technological. It’s hard to think of eBay before the internet. It’s hard to think of Uber before the smartphone. With smartphones you carry a marketplace in your pocket, so you have more access than ever to marketplaces. I think that’s a big part of the reason."

Is sniping bad for eBay? New paper by Bakus, Blak, Masterov and Tadelis

Is Sniping A Problem For Online Auction Markets? by Matt Backus, Tom Blak,  Dimitriy V. Masterov, and Steve Tadelis

Abstract: "A common complaint about online auctions for consumer goods is the presence of “snipers,” who place bids in the final seconds of sequential ascending auctions with predetermined ending times. Roth and Ockenfels (2002) and Bajari and Hortacsu (2003) conjecture that snipers are best-responding to the existence of “incremental” bidders that bid up to their valuation only as they are outbid. Snipers aim to catch these incremental bidders at a price below their reserve, with no time to respond.  As a consequence, these incremental bidders may experience regret when they are outbid at the last moment at a price below their reservation value. We measure the effect of this experience on a new buyer’s propensity to participate in future auctions. We also consider an alternative explanation, rooted in the behavioral literature on the endowment effect. Bidders may gradually develop an attachment to the object while they are the high bidder, implying that the regret should increase with time spent in the lead. We show that the two narratives are econometrically separable,
and estimate them using a carefully selected subset of auctions from eBay.com."

They find that first-time bidders who are outbid in the final seconds of an auction are less likely to return to eBay: here's a graph of the probability of not returning, as a function of how close to the end of th auction the first time bidder was successfully sniped...

They conclude: "As a result, sniping has a negative impact on the growth rate of the auction platform."

Liver transplant waiting times and MELD scores around the country (and a calculator you can use)

Here's a story in the Wisconsin State Journal: Access to liver transplants unequal in Wisconsin, nation . (Link to a liver calculator at bottom, by transplant center, etc.)

"Access to liver transplants varies in Wisconsin and around the country, with relatively healthy patients getting organs in some places while sicker patients elsewhere deteriorate or die on the waiting list.

"The geographic disparities persist even after a policy two years ago required broader access to patients most in need.

"Policymakers are proposing a more radical change: Dividing the country into four or eight districts for liver sharing instead of the 11 regions and 58 local areas used today.

"Populous states welcome the idea. It would direct livers to “patients in most urgent need, drastically reduce existing geographic disparities in access and, most importantly, save lives,” members of Congress from California, New York and other states wrote to federal officials after the proposal was released last year.

"But congressional representatives mostly from the Midwest and South said the proposal would disadvantage more rural parts of the country. “Areas with high organ donation rates would be disproportionately affected,” they wrote.
...
 "Nationwide, more than 15,000 people await livers, nearly 13,000 of them in active status, meaning they could receive an organ today. About 6,700 people got liver transplants last year.

"Roughly 1,500 people die waiting for livers each year, according to the United Network for Organ Sharing, or UNOS, which runs the transplant system.

"Patients are ranked by medical urgency scores called Model for End-Stage Liver Disease, or MELD. The scores, based on three lab tests, range from 6 for least ill to 40 for gravely ill.

"The sickest patients go to the top of their local waiting lists. But where they rank depends on where they live, as demand for and supply of livers varies around the country.

"Patients getting livers in much of Indiana, Iowa, South Carolina and Tennessee typically have MELD scores of 25 or lower. In parts of California, Massachusetts and New York, the median MELD score at the time of transplant is 33 or higher.

"In Madison’s local area, the median MELD is 28.5. In Milwaukee, it’s 34. In Chicago, it’s 30.

"When the late Apple founder Steve Jobs flew from California to Tennessee for a liver transplant in 2009, he brought attention to one way patients can circumvent the system — by going to places with lower MELD scores and shorter wait times.

"To assist the vast majority of patients who don’t have private jets, Sridhar Tayur launched OrganJet in 2011. The Weston, Massachusetts, company can help people waiting for kidneys or livers get to hospitals in other states in time for transplants, said Tayur, an operations management professor at Carnegie Mellon University in Pittsburgh.

"The cost: $17,000 to $24,000 per flight. So far, about 35 people have signed up for the service but nobody has used it, Tayur said.

He’s trying to get insurance companies to cover the fee. “That would really increase demand,” he said.
...
"Opponents of broader sharing also say more time is needed to gauge the impact of a 2013 policy requiring partial sharing of livers.

The policy, called Share 35, gives livers to patients with MELD scores of 35 or higher throughout each region before local patients with lower scores get them.

A Milwaukee patient with a MELD of 36 gets priority for a Madison donor’s liver over a Madison patient with a MELD of 28, for example. Previously, the Madison patient would have received the liver.

What most irks Madison doctors is something called MELD exception points. Extra points can be given to patients with conditions such as liver cancer, who otherwise have low MELD scores.

Use of exception points varies, with some studies showing more liberal use on the coasts.

“People have gamed the system to have livers sent their way,” said Dr. Tony D’Alessandro, a transplant surgeon at UW Hospital.

Dr. Peter Stock, a transplant director at the University of California, San Francisco, said exception points “are only given if they’re truly, truly needed.”

UNOS is looking at creating a national board to review MELD exceptions, which would replace regional boards used today."
*************

You can get information about different transplant centers around the country, for patients of different ages, blood types and MELD scores using a calculator from the Scientific Registry of Transplant Recipients (SRTR)
 Liver Transplant Waiting List Outcomes Tool Beta