Quality control of transplant centers, and the choice of who to transplant (and which organs to accept)

Transplant centers are regulated by measures such as their one-year graft-survival rate, so they feel pressure not to transplant patients, or organs, that have too high a risk to meet the required measure of success.

Here's a recent paper from the Journal of the American College of Surgeons that discusses some of the consequences:

Decade-Long Trends in Liver Transplant Waitlist Removal Due to Illness Severity: The Impact of Centers for Medicare and Medicaid Services Policy

Presented at the 96th Annual Meeting of the New England Surgical Society, Newport, RI, September 2015.

Natasha H. Dolgin, PhDPress enter key for correspondence informationPress enter key to Email the author

,

Babak Movahedi, MD, PhD

,

Paulo N.A. Martins, MD, PhD

,

Robert Goldberg, PhD

,

Kate L. Lapane, PhD, MS

,

Frederick A. Anderson, PhD

,

Adel Bozorgzadeh, MD, FACS

DOI: http://dx.doi.org/10.1016/j.jamcollsurg.2016.03.021

 |

Article Info

• Abstract

• Full Text
• Images
• References

Background

The central tenet of liver transplant organ allocation is to prioritize the sickest patients first. However, a 2007 Centers for Medicare and Medicaid Services regulatory policy, Conditions of Participation (COP), which mandates publically reported transplant center performance assessment and outcomes-based auditing, critically altered waitlist management and clinical decision making. We examine the extent to which COP implementation is associated with increased removal of the “sickest” patients from the liver transplant waitlist.

Study Design

This study included 90,765 adult (aged 18 years and older) deceased donor liver transplant candidates listed at 102 transplant centers from April 2002 through December 2012 (Scientific Registry of Transplant Recipients). We quantified the effect of COP implementation on trends in waitlist removal due to illness severity and 1-year post-transplant mortality using interrupted time series segmented Poisson regression analysis.

Results

We observed increasing trends in delisting due to illness severity in the setting of comparable demographic and clinical characteristics. Delisting abruptly increased by 16% at the time of COP implementation, and likelihood of being delisted continued to increase by 3% per quarter thereafter, without attenuation (p < 0.001). Results remained consistent after stratifying on key variables (ie, Model for End-Stage Liver Disease and age). The COP did not significantly impact 1-year post-transplant mortality (p = 0.38).

Conclusions

Although the 2007 Centers for Medicare and Medicaid Services COP policy was a quality initiative designed to improve patient outcomes, in reality, it failed to show beneficial effects in the liver transplant population. Patients who could potentially benefit from transplantation are increasingly being denied this lifesaving procedure while transplant mortality rates remain unaffected. Policy makers and clinicians should strive to balance candidate and recipient needs from a population-benefit perspective when designing performance metrics and during clinical decision making for patients on the waitlist.

It drew this headline in the news:
Hospitals are throwing out organs and denying transplants to meet federal standards

Who Gets What and Why shortlisted for German Business Book Prize (to be announced in October)

Deutscher Wirtschaftsbuchpreis 2016: Die Shortlist

Google translates: Dusseldorf (ots) - The finalists of the German Business Book Prize have been announced: Ten books have made ​​it to the final round for 2016th A distinguished jury selected this year for the tenth time from the titles shortlisted the best business book of the year. The Executive Jury has Gabor Steingart, publisher of Handelsblatt. The prize will be awarded on 21 October at the Frankfurt Book Fair.

The German Business Book Award is themed "Understanding Business".Handelsblatt, the Frankfurt Book Fair and the investment bank Goldman Sachs award the prize to promote the economic literature. The three partners aim to emphasize the distinction the importance of economy section in mediating economic relationships. The selection criteria therefore include not only innovative agenda-setting or a new perspective and understanding and readability. The prize is endowed with 10,000 euros.

The ten books shortlisted provides Handelsblatt in the weeks prior to the literature page in the weekend edition. All other information on the award, the jury and of the initiators can be found at: www.deutscher-wirtschaftsbuchpreis.de

Die Shortlist 2016:

George Akerlof, Robert Shiller: Phishing for Fools. Manipulation und Täuschung in der freien Marktwirtschaft. Econ, Berlin 2016, 416 Seiten, 24 Euro

Adam Grant: Nonkonformisten. Warum Originalität die Welt bewegt. Droemer, München 2016, 384 Seiten, 22,99 Euro

Christoph Keese: Silicon Germany. Wie wir die digitale Transformation schaffen. Knaus, München 2016, 368 Seiten, 22,99 Euro

Paul Mason: Postkapitalismus. Grundrisse einer kommenden Ökonomie. Suhrkamp, Berlin 2016, 430 Seiten, 26,95 Euro

Alec Ross: Die Wirtschaftswelt der Zukunft. Plassen, Kulmbach 2016, 400 Seiten, 24,99 Euro

Alvin E. Roth: Wer kriegt was und warum? Bildung, Jobs und Partnerwahl: Wie Märkte funktionieren. Siedler, München 2016, 304 Seiten, 24,99 Euro

Wolfgang Schäuble (und Michel Sapin): Anders gemeinsam (im Gespräch mit Ulrich Wickert). Hoffmann und Campe, Hamburg 2016, 256 Seiten, 22 Euro

Mark C. Schneider: Volkswagen. Eine deutsche Geschichte. Berlin Verlag, 2016, 304 Seiten, 22 Euro

Hans-Werner Sinn: Der Euro. Von der Friedensidee zum Zankapfel. Hanser, München 2016, 560 Seiten, 24,90 Euro

Sahra Wagenknecht: Reichtum ohne Gier. Wie wir uns vor dem Kapitalismus retten. Campus, Frankfurt 2016, 292 Seiten, 19,95 Euro

Differential privacy at Apple

The MIT Technology Review has an article about Apple's use of differential privacy, that caught my eye for several reasons: Apple’s New Privacy Technology May Pressure Competitors to Better Protect Our Data: The technology is almost a decade-old idea that’s finally coming to fruition.

"On a quarterly investor call last week, Apple CEO Tim Cook boasted that the technology would let his company “deliver the kinds of services we dream of without compromising on individual privacy.” Apple will initially use the technique to track trends in what people type and tap on their phones to improve its predictive keyboard and Spotlight search tool, without learning what exactly any individual typed or clicked.
...
“It’s exciting that things we knew how to do in principle are being embraced and widely deployed,” says Aaron Roth, an associate professor at University of Pennsylvania who has written a textbook on differential privacy. “Apple seems to be betting that by including privacy protections, and advertising that fact, they will make their product more attractive.”

In the version of differential privacy Apple is using, known as the local model, software on a person’s device adds noise to data before it is transmitted to Apple. The company never gets hold of the raw data. Its data scientists can still examine trends in how people use their phones by accounting for the noise, but are unable to tell anything about the specific activity of any one individual.

Apple is not the first technology giant to implement differential privacy. In 2014 Google released code for a system called RAPPOR that it uses to collect data from the Chrome Web browser using the local model of differential privacy. But Google has not promoted its use of the technology as aggressively as Apple, which has this year made a new effort to highlight its attention to privacy (see “Apple Rolls Out Privacy-Sensitive Artificial Intelligence”)."

Interview with a kidney buyer and seller in Syria

Here's an interview with a displaced person in Syria (an internal refugee) and the Syrian woman to whom he sold his kidney:
The woman in need of a kidney and the man willing to sell one to her: ‘I’m at the end of the line’

Here's the prolog:
"Regime forces burst into a village in the east Homs countryside last November to drive the Islamic State out. Fadi a-Salamah, 36, fled Mahin with his family and headed 160 km south to Damascus.

When he arrived in the capital, a-Salamah began working the graveyard shift in a fast food restaurant. After four months, he was stopped and interrogated one night at a checkpoint.

Fearing for his life, a-Salamah quit his job.

Unable to find work, he exhausted his SP400,000 savings (about $2,000). His landlord threatened to kick him, his wife and his three young children out of their house.

Desperate to keep his family off the streets, a-Salamah turned to what he considers all he has left to sell—his kidney, for $4,000.

A-Salamah went to a nearby hospital where he conducted a kidney screening and tissue-type test. He left his number with the doctor in the event a patient with compatible blood and tissue types needed a kidney.

On June 20, a-Salamah received a call from a 50-year-old Damascene woman with failing kidneys. The woman is the aunt of Syria Direct’s Bahira al-Zarier, and asked that her name not be published.

After 20 years of kidney disease, the woman says her doctor told her that weekly dialysis treatments were no longer effective.

When the doctor told her that her and a-Salameh’s tissue were 100 percent compatible, “I almost couldn’t contain my joy.”

“At the same time, I feel guilty because I’m taking advantage of someone’s financial need.”

At the time of the interview, a-Salamah and the woman were waiting for the doctor to set an appointment for the operation."

HT: Jonathan Spencer

Transplant surgeons meet in Hong Kong amid questions about China's continued use of organs from executed prisoners

The NY Times has the story: Debate Flares on China’s Use of Prisoners’ Organs as Experts Meet in Hong Kong

It discusses a recent article in the American Journal of Transplantation:
Transplant Medicine in China: Need for Transparency and International Scrutiny Remains by T. Trey, A. Sharif, A. Schwarz, M. Fiatarone Singh, and J. Lavee

Here's the abstract of the article:
"Previous publications have described unethical organ procurement procedures in the People's Republic of China. International awareness and condemnation contributed to the announcement abolishing the procurement of organs from executed prisoners starting from January 2015. Eighteen months after the announcement, and aligned with the upcoming International Congress of the Transplantation Society in Hong Kong, this paper revisits the topic and discusses whether the declared reform has indeed been implemented. It is noticeable that China has neither addressed nor included in the reform a pledge to end the procurement of organs from prisoners of conscience, nor have they initiated any legislative amendments. Recent reports have discussed an implausible discrepancy of officially reported steady annual transplant numbers and a steep expansion of the transplant infrastructure in China. This paper expresses the viewpoint that, in the current context, it is not possible to verify the veracity of the announced changes and it thus remains premature to include China as an ethical partner in the international transplant community. Until we have independent and objective evidence of a complete cessation of unethical organ procurement from prisoners, the medical community has a professional responsibility to maintain the academic embargo on Chinese transplant professionals."
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The NY Times story includes this:
"In an interview conducted on the messaging app WeChat, Huang Jiefu, a senior Chinese transplant official and a former deputy minister of health, appeared to defend the changes but simultaneously acknowledge they were far from perfect.

“We have finished walking the first step of a long march of 10,000 li, the task is heavy and the road far, but we are walking on a path of light,” he wrote. "

Salary negotiation: some Massachusetts market design

The NY Times has the story: Massachusetts Bans Employers From Asking Applicants About Previous Pay

"In a groundbreaking effort to close the wage gap between men and women, Massachusetts has become the first state to bar employers from asking about applicants’ salaries before making them job offers.

"The new law will require hiring managers to offer a compensation figure upfront — based on what the applicant’s worth is to the company, rather than on what he or she made at a previous position.
...
"No longer will job seekers be compelled to disclose their salary or wages at their current or previous jobs — which often leaves applicants with the nagging suspicion that they might have been offered more money if the earlier figure had been higher. Job candidates will still be allowed to volunteer their salary information.

"The Massachusetts law, which will take effect in July 2018, takes aim at the subtle factors that often play into compensation decisions. Companies will not be allowed to prohibit their workers from telling others how much they are paid, a move that advocates say can increase salary transparency and help employees uncover disparities."
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It will be interesting to see how this plays out. The intention is to free people from being forever constrained by their salary history. Employers will be worried about the winner's curse...

Who Gets What and Why, in Russian

Here is the Russian translation of Who Gets What and Why...

There is a port in Oakland

In Pittsburgh it was sometimes said that Gertrude Stein's famous line about Oakland: "there's no there there," is about the Oakland neighborhood of Pittsburgh, where Andy Warhol grew up. (But there seems to be good evidence the quote is about Oakland CA: Gertrude Stein’s Oakland.)  These days there's plenty of there in Oakland California, and the port there is active lately in, of all things, empty containers.

The WSJ has the story: Port of Oakland Reports Record Container Volumes in July--Movement of empty TEUs sparks upsurge

"The Port of Oakland, Calif., reported record container volumes in July, driven by a surge in empty containers on both the export and import side.

Dockworkers handled nearly 30% more empty containers—48,521 20-foot equivalent units for export and 17,017 import TEUs—in July. Empty containers are usually moved, in anticipation of trade growth, to places where they’re expected to be filled with goods before shipping back.

“With holiday shipments set to commence, this could be the start of something good,” said the port’s maritime director, John Driscoll.
...
Oakland is a major hub for U.S. agricultural exports other shipments destined for Asian markets.
...
Officials said July was the port’s busiest month in 10 years. During the month of July, the port received 153 visits from container ships, up from 136 during the same period in 2015."

Conversations about Who Gets What and Why (now in paperback)

After my book Who Gets What and Why came out in paperback, I did several radio interviews about it. Three of them have shown up on the web:

6/16/16: Alvin E. Roth – Economist – “Who Gets What – and Why” (14 minutes)
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This youtube is another audio conversation, on June 20 (about 20 minutes)

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Monday, June 27, station WISR in Pittsburgh (starts right before minute 1:02, and with a brief break for ads around 1:13, continues until 1:22)

http://wisr680.com/turn-guests-mon-627/

Gaming the waiting list for a heart transplant

The heart transplant waiting list is game-able, since your place on the list depends on what treatment you are getting. So your doctor can "treat your priority" as well as treat your medical condition.  Here's the story from NPR:
Should Doctors Game The Transplant Wait List To Help Their Patients?
 July 24, MATTHEW MOVSESIAN

And here's an old (2013) editorial on the subject in The Journal of Heart and Lung Transplantation:
The urgent priority for transplantation is to trim the waiting list by Lynne Warner Stevenson:

"Current definitions of priority levels have been based both on medical rationale and the attempt to protect the system from being “gamed.” When the requirements for inotropic therapy for Status IB and pulmonary artery catheters for Status IA were adopted in the USA, it was with optimism that they would be used only when absolutely necessary to prevent imminent death, because continuous inotropic infusions and indwelling pulmonary artery catheters are inconvenient and costly and have been associated with serious complications. Although individual cases trigger heated controversy in regional committees, it is generally agreed that these therapies are being overused in patients awaiting transplantation.

If high priorities defined by therapies are the only route to access donor hearts, we face conflicted incentives as advocates for our patients. This is serious enough with incentives to inflate the description of severity of illness, but even more serious with incentive to impose interventions with complications, such as indwelling pulmonary artery catheters. One of the major conditions currently cited as justification for Status IA exceptions is vascular complications of indwelling catheters that preclude further catheterization. This complication on the list was virtually never seen before pulmonary artery catheters became an index of priority (although arrhythmia device leads have also added to the vascular complication rate).

The strength of inverse incentives in care of our waiting patients is indexed to the concern that they will die before a transplant, or will develop unnecessary risk such as from cachexia before they finally enter into transplant. The priority status will more truly reflect patient illness when the listing physicians have reasonable confidence that patients will receive a heart in a timely manner, a confidence eroded by the lengthening waiting times, which in turn reflect the anasarca of the waiting list."

HT: Marc Melcher

Market Design, and NSF support of economics

Market design plays a role in the arguments both pro and con, in the recent symposium in the Journal of Economic Perspectives:

Symposium: NSF Funding for Economists

In Defense of the NSF Economics Program (#11) Robert A. Moffitt

Full-Text Access (Complimentary) | Supplementary Materials

A Skeptical View of the National Science Foundation's Role in Economic Research (#12) Tyler Cowen and Alex Tabarrok

Full-Text Access (Complimentary) | Supplementary Materials

 Moffitt mentions auction design, kidney exchange and school choice (with a more general reference to deferred acceptance clearinghouses) as beneficiaries of NSF funding. Cowen and Tabarrok single out auction design as something whose private benefits might argue against government funding: "Indeed, few areas in economics have been as privately remunerative as auction theory."

Matt Jackson, profiled in the Proceedings of the National Academy of Sciences

Matt Jackson in the PNAS: Profile of Matthew O. Jackson

Here's the 'Extract' (the full article seems to be gated but this gives you the idea):

During a lunchtime chat in 1993, Matthew Jackson first became interested in social and economic networks. Jackson and a colleague were discussing how power depends on networks of relationships. As an economist, Jackson had always been interested in modeling and analyzing social interactions and human decision-making. Soon, he and his colleague followed up on their lunchtime discussion by building game theoretic models of how people choose to form relationships (1). “Once I started getting interested in the subject, there were lots of different angles on it that became interesting, and I just started working on it more and more,” he says.

Jackson, the William D. Eberle Professor of Economics at Stanford University, has spent most of his distinguished career studying networks and game theory. He has studied how networks form in varied settings, including research on the root of racial biases in high school friendships and how microfinance spreads in rural Indian villages (2, 3). Jackson’s research has illuminated the role of networks in influencing access to jobs and information (4). “Understanding networks can really help us understand a lot of persistence in inequality and differences across groups in labor markets,” he says. More recently, Jackson has examined why nations go to war (5) and how social structure affects beliefs (6). For his many contributions to the field, Jackson was elected to the National Academy of Sciences in 2015.

Role of Social and Economic Networks

During the course of Jackson’s career, social and economic networks have become a prominent focus of study for economists. Through the work of Jackson and others, it has become clear that understanding networks has wide-ranging applications.

“One area in which it has become obvious to people that networks of interactions matter lately is understanding financial …

[Full Text of this Article]

House swapping in the UK

Neil Thakral writes:

Regarding ... public-housing residents switching units, I mentioned that this happens in the UK (https://www.gov.uk/apply-swap-homes-council). 

["You can swap your council or housing association home with another tenant if you follow certain rules and get permission from your landlord. This is often called ‘mutual exchange’."]

I thought there was something like this on Al's blog, and I found posts on buying/selling private homes (http://marketdesigner.blogspot.com/2009/01/house-swaps.html) and trading homes for vacations (http://marketdesigner.blogspot.com/2012/04/home-exchanges.html).

Here is a recent article: http://www.yorkshireeveningpost.co.uk/news/leeds-is-revealed-as-the-house-swapping-capital-of-the-uk-1-8028444

["The House Exchange website automatically matches house-seekers with properties that meet their needs. Once a social housing provider signs up with House Exchange, all its tenants can use the service for free. In Leeds, 100 per cent of social landlords have signed up, meaning all 102,000 social households across the city are able to use the service."]

and an example of a six-way swap from a while back:  http://www.mirror.co.uk/money/personal-finance/we-swapped-homes---get-moving-if-you-358806

Here are two platforms that seem to arrange this:

- http://www.houseexchange.org.uk

- https://www.homeswapper.co.uk

Repugnance watch: Deaccessioning art (i.e. selling it)

Some time ago I had a set of posts on Brandeis University's plan to sell some of its art. Apparently the professional ethics of museums allows art to be sold to buy other art, but not to fix the roof or pay for other things.  Sometimes a sale would violate the terms of the gift of the art, but apparently the repugnance applies even when it would not. Now comes a story (in the NY Times) about similar considerations at Fisk University: A Prized Stettheimer Painting, Sold Under the Radar by a University

"When Fisk University, the historically black school in Nashville, tried to sell two paintings several years ago from its storied Alfred Stieglitz art collection, a firestorm erupted. The proposed sale violated conditions of the gift of the collection from Stieglitz’s widow, Georgia O’Keeffe, according to her foundation.

"A drawn-out legal challenge ended in a compromise in 2012 that allowed Fisk to share its collection with Crystal Bridges, the Arkansas museum founded by Alice Walton, the Walmart heiress, bringing the struggling university an infusion of $30 million.

"But what was not revealed at the time, and has only recently come to light, is that before the agreement was completed — and with the debate over the future of Fisk itself swirling around her — Hazel O’Leary, then the university’s president, on behalf of the school quietly sold off two other paintings owned by Fisk.

"The institution was “under duress,” said Patrick Albano of Aaron Galleries, an art dealer from Illinois whom Ms. O’Leary asked to broker the sale.
...
"According to Mr. Albano, Fisk decided to sell work by Stettheimer and the painter and illustrator Rockwell Kent, which had been donated to the university with “no strings attached.”

“Shame on them,” said Lyndel King, director of the Weisman Museum at the University of Minnesota and a chairwoman of the Task Force for the Protection of University Collections, referring to Fisk’s actions. “It’s very much against the ethics of our profession.”

"Though the task force does not have legal authority over universities, its members, who represent several museum associations, can censure those who sell art to pay operating expenses, putting pressure on them not to treat art as an A.T.M. That practice “alienates donors and undermines the purpose of having a museum on campus,” Ms. King said.

"Various museum associations say that deaccessioning art, if not in violation of the original gift, is justified if the proceeds are used to buy more art. It is the cherry-picking of a painting here and a painting there to bolster an endowment or support operating expenses that is frowned upon.

"Universities, however, have argued in several settings that they must consider such sales when the fiscal alternatives — cutting programs or staff — are untenable."

Alex Teytelboym and Scott Kominers wrap up the conference on Market Design Perspectives on Inequality

Two intense days of Market Design Perspectives on Inequality summarized in a slide:

Alex Teytelboym and Scott Kominers

Organ Donation after euthanasia, in the Netherlands

The American Journal of Transplantation discusses the fraught issue of patients who wish to end their lives with medical assistance, and then become deceased donors.

Organ Donation After Euthanasia: A Dutch Practical Manual

1. J. Bollen^1,*, 
2. W. de Jongh², 
3. J. Hagenaars³,
4. G. van Dijk⁴, 
5. R. ten Hoopen⁵, 
6. D. Ysebaert⁶, 
7. J. Ijzermans⁷, 
8. E. van Heurn⁸ and
9. W. van Mook¹

Version of Record online: 10 MAR 2016

DOI: 10.1111/ajt.13746

© Copyright 2016 The American Society of Transplantation and the American Society of Transplant Surgeons

Issue

American Journal of Transplantation

Volume 16, Issue 7, pages 1967–1972, July 2016

Abstract: "Many physicians and patients do not realize that it is legally and medically possible to donate organs after euthanasia. The combination of euthanasia and organ donation is not a common practice, often limited by the patient's underlying pathology, but nevertheless has been performed >40 times in Belgium and the Netherlands since 2005. In anticipation of patients' requests for organ donation after euthanasia and contributing to awareness of the possibility of this combination among general practitioners and medical specialists, the Maastricht University Medical Center and the Erasmus University Medical Center Rotterdam have developed a multidisciplinary practical manual in which the organizational steps regarding this combined procedure are described and explained. This practical manual lists the various criteria to fulfill and the rules and regulations the different stakeholders involved need to comply with to meet all due diligence requirements. Although an ethicist was involved in writing this paper, this report is not specifically meant to comprehensively address the ethical issues surrounding the topic. This paper is focused on the operational aspects of the protocol."

"Introduction: In September 2013, an article addressing organ donation after active euthanasia was published in the Dutch Journal of Medicine (1). A patient suffering from a progressive neurodegenerative disease was able to donate his liver and both kidneys. Organ donation after euthanasia has been described previously, with excellent transplant outcome (2).

"Prior to December 2015, organ donation after euthanasia was performed 15 times in the Netherlands and resulted in donation of eight pairs of lungs, 13 livers, 13 pancreases and 29 kidneys. These developments necessitated the creation of a practical manual addressing the combination of both procedures because of the unique and complex legal and ethical issues, together with the appropriate medical care (3). This manual can be used as a framework for hospitals that wish to facilitate such successive procedures. The essential components of the practical manual, developed by the collaborative efforts of the Maastricht University Medical Center and the Erasmus Medical University Medical Center Rotterdam, are discussed below.

"Although the manual addresses euthanasia and organ donation in the Netherlands, many of the issues raised and discussed may be similar or comparable to those in any country that allows organ donation in the setting of euthanasia. A discussion of ethical considerations is not included in this paper, but this is not intended to dismiss the necessary ethical discussions to be held in this domain."

Market Design Perspectives on Inequality--conference at HCEO, Chicago, Aug 6-7

The Human Capital and Economic Opportunity Global Working Group at Chicago is holding a conference on Market Design Perspectives on Inequality

The discussants look exciting:)

Matching refugees and landlords in Sweden, by Tommy Andersson and Lars Ehlers

 After refugees have found a country of asylum, there's still work to do. Here's some help on how to do it in Sweden:

Assigning Refugees to Landlords in Sweden:Stable Maximum Matchings
 Tommy Andersson and Lars Ehlers
June 2016

Abstract In Sweden, asylum seekers are either deported or granted a residence permit. Refugee families with a residence permit are assigned to the different local municipalities. Since almost all accommodation options are exhausted in Sweden, households in some municipalities are asked to state their willingness to accommodate refugee families. In line with the European NGO “Refugees Welcome”, a refugee family and a landlord (household) are mutually acceptable if they have a language in common and if the number of offered beds of the household exceeds the number of beds needed by the refugee family. This paper proposes an algorithm that finds a maximum matching (filling the maximal number of beds) which in addition is stable.


Theorem 1. For any profile R, there exists a stable maximum matching

Dr Jeff Veale in the WSJ on vouchers for living donor kidneys

Give a Kidney, Get a Kidney--An innovative voucher program started in 2014 at UCLA is spreading across the country.  By JEFFREY VEALE Aug. 3, 2016

"The good news is that there were 17,878 kidney transplants in the U.S. last year, the most in a single year, according to the United Network for Organ Sharing. And the numbers may keep growing thanks to an innovative voucher program that started in 2014 at Ronald Reagan UCLA Medical Center and is spreading across the country.

Here’s how it works: If you donate a kidney now, you will receive a voucher that a loved one could use to secure a kidney in the future. The Advanced Donation program is coordinated through the National Kidney Registry, which uses a national database to quickly and efficiently match donors and recipients.

The idea was approved by the Ethics Committee of the American Society of Transplant Surgeons in June, and has been sent to that group’s executive committee for formal approval. Ten hospitals across the country have so far joined UCLA to honor the voucher program. Donors currently need to go to one of these hospitals to receive a voucher but many other centers are expected to join."

Here's my earlier post on this:

Donating a kidney today, and getting a promise of a living donor kidney in the future for someone you specify

I'm no lawyer, but I anticipate that there may be contract design details to work out. This will be well worth watching.

Reverse college admissions scramble in British clearing

In Britain, students get admitted to university (sometimes contingently) before their grades are known. So some students don't get the grades they need to fulfill their admissions requirement, and have to scramble for a position at a less selective school. But some students do much better on their exams than they anticipated, and find themselves in a position to go to more selective schools than they applied to (or were admitted to). But they need to scramble to find a place.

The Telegraph has the story: What are my options if I do better than expected at A-level?

First kidney exchange in Nepal

A change in the law removed the last obstacle. The Himalayan Times has the story: Paired kidney exchange first time in Nepal

"Kathmandu, August 1

"The first Paired Exchange of kidneys between two families has taken place in Nepal.

"Khem Raj Niraula, 49, of Phulavari, Taplejung and Bishnu Babu Shrestha, 40, of Manakamana, Gorkha received a kidney at the Human Organ Transplant Centre in Bhaktapur. Both families donated a kidney to a recipient from the other family.
...
“This is the first such kidney transplant in Nepal. It became possible after the amendment of the Organ Transplant Act 1998 in 2015,” said Dr Shrestha. “Such transplants were regarded as illegal in Nepal, which compelled many patients to travel to the India for treatment,” he added.

"The constitution of Nepal has revised the law related to organ transplant in which a family member can donate a kidney to husband, wife, siblings, maternal relatives, in-laws, relatives, step father, mother, grandparents or other family members.

"If the kidney doesn’t match, one can exchange a kidney with other families through mutual understanding. “This is done in western countries while in Nepal this is the first time such transplant has taken place,” Dr Shrestha informed.

“The Act has made it very easy for us to transplant kidney,” said Khem Raj Niraula, a patient. “If the law had not been in place, we would have to suffer a lot. I was even ready to go to India for treatment,” he added."

Mergers of taxi-hailing services in Europe, and China

Europe is preparing to defend itself against Uber. Bloomberg has the story:
Daimler Targets Uber by Merging Mytaxi With U.K.’s Hailo

"Daimler AG will challenge Uber Technologies Inc.’s ride-hailing dominance by merging its Mytaxi unit with one of the U.K.’s most popular cab-calling services, Hailo, to create Europe’s biggest taxi app.
The combined company will operate under the Mytaxi brand, with 100,000 registered drivers in more than 50 cities across nine countries, and be headquartered in Hamburg, the companies announced
...
"Car manufacturers have been investing heavily in apps to keep pace with changing consumer habits that have seen ride-sharing companies such as Uber and Lyft Inc. proliferate. General Motors Co. has invested $500 million in Lyft, Volkswagen AG put $300 million into Israel-based Gett Inc., and Toyota Motor Corp. backed Uber for an undisclosed amount. Uber has raised at least $12.5 billion in funding to date.
Daimler, the maker of Mercedes-Benz cars, also owns the Car2Go car-sharing service and purchased Mytaxi in September 2014. It bought U.S. ride-booking service RideScout LLC at the same time. "
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China appears to have been too much for Uber to swallow. The NY Times has the story: Uber to Sell to Rival Didi Chuxing and Create New Business in China

"In a stark signal of how difficult it is for American technology companies to thrive in China, Uber China said it was selling itself to Didi Chuxing, its fiercest rival there.

The sale, which would create a new company worth about $35 billion, would end the great ride-hailing battle of China. A person with knowledge of the deal said Uber investors had been pushing for such a transaction.

The companies have been fighting relentlessly for market share in mainland China for two years, spending tens of millions of dollars every month to attract riders and drivers. The merger would end that competition and create significant scale, but it would also be a repudiation of Uber’s ambitions to take on local Chinese competitors in their huge home market."

and this:

"...Mr. Kalanick helped Uber overcome the biggest obstacle in China: the Communist Party. By traveling frequently to China, meeting with officials and speaking in language often used by party cadres, Mr. Kalanick helped the company avoid the regulatory tripwire that has led many companies to stumble in the market. Last week, Chinese officials said ride-hailing apps were legal and laid out a framework to license drivers.

"But entry is just the first obstacle to the Chinese internet market. Competition is fierce, and the focus is less on the product than on big spending to lure customers or on tricks to harm competitors. Fraudsters and opportunists also abound.

"Uber’s engineers, operating from San Francisco, had to deal with drivers who simulated or faked rides to get commissions. At the same time, the company was blocked from marketing on China’s biggest social network, WeChat, because the internet giant Tencent was an early investor in Didi. All of that made it much harder to compete with a company that already had an advantage in scale, not to mention the backing of Tencent, Alibaba and Apple. When it raised $7 billion in June, Didi made it clear it was willing to continue the fight for a long time."

An interview with the late Lloyd Shapley, on incentives, in Spanish

In Argentina's La Nacion

Para aliviar la suba de tarifas, el camino son los incentivos

SEGUIR

Juan Carlos de Pablo

LA NACION

DOMINGO 24 DE JULIO DE 2016

Scalping Hamilton

The NY Times has the story: How Scalpers Make Their Millions With ‘Hamilton’

"For most of May, the median price of a ticket on the secondary market was around $850. Between the Tonys and the July 9 performances, it pushed toward $1,600. Before Mr. Miranda’s announcement of his departure, ticket holders were offering a seat for the July 9 performance at an average of $2,700. With the news of his exit, the average asking price quickly climbed to $10,900 a seat.

"Mind you, the average face value of a “Hamilton” ticket was $189.
...
"Scalping can be explained with high school textbook economics. When ticket prices are set too low to balance demand against the supply of seats, any person holding a ticket can find a sea of buyers willing to pay more than asking price for the seat.

"Increasingly, that ticket holder is not a guy at the theater door with an extra ticket. It’s a person employing sophisticated software, a so-called ticket bot, to buy a huge number of tickets moments after the theater releases them. In the time a human buyer can find the calendar feature on a ticket site, a scalper’s network of hundreds of bots has already bought the maximum limit of tickets for multiple days of shows.
...
"Because the secondary market is scattered across dozens of websites and storefront services, its size is hard to establish. Overlapping ticket inventories also make prices hard to track. Websites like StubHub, SeatGeek and Ticketmaster re-list more than 35 percent of the 1,321 seats sold in the Richard Rodgers Theater, on average, for each of the eight “Hamilton” performances a week. By placing initial box office sales and secondary market resales side by side, they provide a veneer of legitimacy (and an illusion of regulatory transparency) for scalpers.

"Such a strong scalper-driven secondary market is relatively new to Broadway, though sports fans and concert goers have long encountered inflated prices for big games or Beyoncé concerts.

Every performance of “Hamilton” is a miniature Super Bowl, in terms of demand and resale activity. Fans can still get a seat at “Hamilton” for less than a thousand dollars, if they are willing to wait for it — either buying months in advance from the theater or just hours before a performance, as scalpers drop their asking price.

"Looking across nearly 100 days of “Hamilton” performances, we found that the median resale ticket price was nearly $1,120 a seat. By our analysis, scalpers were earning more than six times what they paid for their tickets.

"The “cheap” seats in the mezzanine and orchestra sides sell for more than 10 times their face value on average. Premium orchestra seats sell for nearly six times their face value on average.
...
"For a website that is trying to detect scalping, the challenge is finding the bots among the humans. It is not as easy as it sounds. To avoid detection, sophisticated scalpers use bots designed to look like humans, although they use the website far more efficiently. Bots don’t misclick or need to use the delete key, though they may do that as well, in order to further obscure the evidence of a nonhuman purchase.

"The masquerade is important because “Hamilton” cancels what it deems to be bulk ticket purchases. The lead producer, Jeffrey Seller, has described canceling the purchases of one bot that had accumulated 20,000 tickets for “Hamilton.”

It is an uphill battle. Bot-driven ticket buying has been illegal in New York since 2010, yet its use is still widespread. When they are networked, bots can play a big role in distorting ticket prices. Bots can drive significant traffic on Ticketmaster.com, up to 90 percent of ticketing-purchasing activity at times."

Exorcism: "Mistress dispellers" in China

The NY Times has the story: China’s Cheating Husbands Fuel an Industry of ‘Mistress Dispellers’

"Mistress-dispelling services, increasingly common in China’s larger cities, specialize in ending affairs between married men and their extramarital lovers.

"Typically hired by a scorned wife, they coach women on how to save their marriages, while inducing the mistress to disappear. For a fee that can start in the tens of thousands of dollars, they will subtly infiltrate the mistress’s life, winning her friendship and trust in an attempt to break up the affair. The services have emerged as China’s economy has opened up in recent decades, and as extramarital affairs grew more common.
...
"Mistress dispelling typically begins with research on the targeted woman, said Shu Xin, Weiqing’s director. An investigation team — often including a psychotherapist and, to keep on the safe side, a lawyer — analyzes her family, friends, education and job before sending in an employee that Weiqing calls a counselor.

“Once we figure out what type of mistress she is — in it for money, love or sex — we draw up a plan,” Mr. Shu said.

"The counselor might move into the mistress’s apartment building or start working out at her gym, getting to know her, becoming her confidante and eventually turning her feelings against her partner. Sometimes, the counselor finds her a new lover, a job opening in another city or otherwise convinces her to leave the married man. Weiqing and other agencies said its counselors were prohibited from becoming intimately involved with the mistress or from using or threatening violence.
...
"The companies say it typically takes about three months to dispel a mistress. Yu Feng, director of the Chongqing Jialijiawai Marriage and Family Service Center, said his team has dispelled 260 mistresses in the last two years."

British immigration: more time combating clandestine immigrants means less time investigating scams

What do immigration inspectors do?

The Telegraph has the story: Overwhelmed border guards diverted from other immigration scams to deal with threefold increase in migrants arriving by lorry and Channel Tunnel

“It's worrying that problems at the border meant that that organised crime and sham marriages were not properly investigated. In addition overstayers were not returned and illegal working was not tackled."