Tuesday, February 21, 2017

Travel bans and rank order lists for the resident match

Residency programs have to submit their rank order lists of applicants by Feb 22. Should they try to match with doctors from countries subject to a possible renewed US travel ban?

Travel Ban Confusion Complicates Match Day Decisions

"UPDATE:  The Trump administration announced February 16 that it would discontinue its legal push in appeals court to reinstate their travel ban, but would instead issue a new, revised immigration order next week. No other details were given.
As medical school students look ahead to Match Day on Friday, March 17, some international students have additional anxiety in light of the uncertainty surrounding President Trump's executive order banning travel for people in seven Muslim-majority countries.
Residency programs also have to decide whether they will hold spots for students from the targeted countries who may not be allowed to come to the United States if legal rulings change.
First comes decision day February 22, when preferences must be ranked by both programs and students.
"Some applicants are concerned that the program directors won't rank them and there's concern from programs on whether the students can begin training on time," Mona Signer, president and CEO of the National Resident Matching Program (NRMP), told Medscape Medical News.
Trump's executive order, issued on January 27, aims to prevent citizens of seven majority-Muslim countries — Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen — from entering the United States for 90 days. It suspended entry of all refugees for 120 days and barred refugees from Syria indefinitely. A federal judge has since imposed an emergency stay, halting the key parts of the executive order.
The administration's next step is unclear, but news sources have reported that Trump may take the fight to the Supreme Court or issue a revised order.
According to the Association of American Medical Colleges (AAMC), 260 medical students have applied to US residency programs from the seven countries the ban covers.
Questions include whether the ban will be reinstated, and, if it is reinstated, whether medical students would be exempted. Some worry the ban could spread to other countries. Last year, 3769 non-US citizens who studied medicine abroad matched into a US residency program, according to the American College of Physicians."

Monday, February 20, 2017

The European Network for Collaboration on Kidney Exchange Programmes

Here's the website of the European Network for Collaboration on Kidney Exchange Programmes (ENCKEP), whose goal is to widen and deepen kidney exchange in Europe.

It's still a work in progress, with gated areas.

For those who have registered, the slides from the recent Tallinn conference are here, with updates from Austria, Switzerland, Slovakia, Portugal, Netherlands, Poland, Czech Republic, Italy, Spain, France and the UK.


The conveners are Prof Joris VAN DE KLUNDERT at vandeklundert@bmg.eur.nl, and
Dr David MANLOVE at David.Manlove@glasgow.ac.uk .

I'm a (non-European) supporter of this effort.

Sunday, February 19, 2017

Offensive trademarks

Can repugnant speech also be intellectual property? The Supreme Court has a case that touches on this. The NY Times has this recent story: Justices Appear Willing to Protect Offensive Trademarks

"The Supreme Court on Wednesday appeared deeply skeptical about the constitutionality of a federal law that denies protection to disparaging trademarks. Almost every member of the court indicated that the law was hard to reconcile with the First Amendment.
The court’s decision in the case, concerning an Asian-American dance-rock band called the Slants, will probably also effectively resolve a separate one in favor of the Washington Redskins football team.
The law denies federal trademark protection to messages that may disparage people, living or dead, along with “institutions, beliefs or national symbols.”
Malcolm L. Stewart, a deputy solicitor general, said the trademark law does not bar any speech, as the Slants remain free to continue to use their name. The law “places a reasonable limit on access to a government program rather than a restriction on speech,” he said, and so “does not violate the First Amendment.”
Continue reading the main story
But Justice Elena Kagan said that even government programs may not discriminate based on speakers’ viewpoints.
“The point is that I can say good things about something, but I can’t say bad things about something,” she said of the law. “And I would have thought that that was a fairly classic case of viewpoint discrimination.” Viewpoint discrimination by the government, the Supreme Court has said, is presumptively unconstitutional.
Justice Anthony M. Kennedy said the law interfered with free expression.
“We have a culture in which we have T-shirts and logos and rock bands and so forth that are expressing a point of view,” he said. “They are using the market to express views.”

Saturday, February 18, 2017

Memorial conference for Professor Reinhard Selten, April 28


Memorial conference for Professor Reinhard Selten
Friday, April 28th 2017, Bonn,

Reinhard Selten was a pioneer of the analysis of strategic interaction of both fully rational players (game theory) and boundedly rational humans (experimental economics). From 1984 until his death in 2016, he was associated with the University of Bonn, where he established one of the first experimental laboratories in economics. In 1994, Selten was awarded the Nobel Memorial Prize in Economic Sciences, together with John Harsanyi and John Nash, for their pioneering analysis of equilibria in the theory of non-cooperative games.
To honor his outstanding contributions to Economics, the University of Bonn and the University of Cologne are hosting a memorial conference for Reinhard Selten. The aim is to bring together renowned speakers presenting work connected to or inspired by Selten’s research. The conference will take place on Friday, April 28th 2017 at the Günnewig Hotel Bristol in Bonn, Germany. To help us with our planning, please register as soon as possible if you plan to attend!

Organisers

Friday, February 17, 2017

Vatican statement on organ transplantation

When I posted recently about the Vatican conference on organ trafficking and transplant tourism I focused on the participation of China, and the reaction it drew.

Now I've had a closer second look at the conference statement  (whose title is Statement of the Pontifical Academy of Sciences Summit on Organ Trafficking and Transplant Tourism). (UPDATED LINK HERE: https://www.pas.va/en/events/2017/organ_trafficking/final_statement.html )

It's a very tough statement, which casts quite a broad net when talking about "crimes against humanity." Here's the opening paragraph:

"In accordance with the Resolutions of the United Nations and the World Health Assembly, the 2015 Vatican Summit of Mayors from the major cities of the world, the 2014 Joint Declaration of faith leaders against modern slavery, and the Magisterium of Pope Francis, who in June 2016, at the Judges’ Summit on Human Trafficking and Organized Crime, stated that organ trafficking and human trafficking for the purpose of organ removal are “true crimes against humanity [that] need to be recognized as such by all religious, political and social leaders, and by national and international legislation,” we, the undersigned participants of the Pontifical Academy of Sciences Summit on Organ Trafficking, resolve to combat these crimes against humanity through comprehensive efforts that involve all stakeholders around the world."

Here's the paragraph defining what those crimes against humanity are, which to my eye seems to conflate three very different things. It is number 1 in their list of recommendations.

"That all nations and all cultures recognize human trafficking for the purpose of organ removal and organ trafficking, which include the use of organs from executed prisoners and payments to donors or the next of kin of deceased donors, as crimes that should be condemned worldwide and legally prosecuted at the national and international level."

That is, if I read the full statement correctly (you should read it yourself), they are proposing that 

  1. taking organs from executed prisoners, 
  2. making payments to living donors, and 
  3. making payments to next of kin of deceased donors 

should all be considered crimes against humanity.  

Incidentally, the phrase "crimes against humanity"  is one that I hear most often in the context of genocide, although I recognize that it is also used for other horrific crimes that target populations.

I am not encouraged that this will lead to a sensible discussion about either incentives for donation or (even) removing financial disincentives.

Thursday, February 16, 2017

Doctor assisted suicide in Colorado: repugnance outlives legalization

You can figure out much of this story from the headline (but there's more): Colorado’s aid-in-dying law in disarray as big Catholic health systems opt out

...
"A third big health system in the state, HealthONE, has decided it won’t dispense life-terminating medications or allow patients to take them on the premises of its eight hospitals. But HealthONE, which is not faith-based, won’t impose similar restrictions on its doctors. A spokeswoman declined to provide details.

"The state’s law, which became effective last month, requires that such patients be 18 or older, have six months or less to live, be mentally competent, and ask for aid in dying twice over 15 days, in addition to a separate written request.

“Everyone is in a mad scramble figuring out what they’re doing to do and how they’re going to do it,” said Jennifer Moore Ballentine, president of The Iris Project, a Colorado consulting firm that is running a series of seminars on the new law over the next few weeks.

Colorado’s aid-in-dying law contains “conscience” provisions allowing physicians, nurses, and pharmacists to “opt out” of participating. Health systems can also bar the practice on their premises. Other states where aid in dying has become legal — Oregon, Washington, California, Vermont, and Montana — have similar provisions, and Catholic health care systems in those states have taken advantage of it.

But the Colorado law specifically states that health systems can’t prohibit doctors who work for them from discussing end-of-life options with patients or writing prescriptions to be taken off-site. This provision was crafted to prevent health systems from erecting barriers to access; only Vermont has a similar rule, but it doesn’t have a heavy concentration of Catholic hospitals.

Advocates for Colorado’s law say the two big Catholic health systems may be testing that provision."
************

And in Vermont: Vermont governor discloses his father used state’s end-of-life law

Wednesday, February 15, 2017

The politics of assisted suicide / death with dignity

My discussions of assisted suicide / death with dignity as a repugnant transaction included a recent post noting that in the most recent elections, Colorado joined the states (including California) that allow physicians to prescribe lethal drugs to mentally fit, terminally ill adults who want to end their lives.

It's therefore interesting to note that Supreme Court nominee Judge Neil M. Gorsuch has a 2006 book The Future of Assisted Suicide and Euthanasia suggesting that this is never justified. The publisher's website says:
 “The Future of Assisted Suicide and Euthanasia provides the most thorough overview of the ethical and legal issues raised by assisted suicide and euthanasia--as well as the most comprehensive argument against their legalization--ever published.”

In other (related) news, 
House committee moves to block D.C.’s assisted-suicide law

"In a rare step, a House committee voted 22 to 14 Monday night to block a law that would make assisted suicide legal in the District, opening a new front in the conflict between congressional Republicans and the overwhelmingly Democratic capital city.

It was one of only a handful of times in the four-decade history of D.C. home rule that members of Congress have tried to use their constitutional power to overturn a city law, and the first attempt since the GOP took control of both Congress and the White House in January.

The vote was largely along party lines, as 21 Republicans and one Democrat, Rep. Jim Cooper of Tennessee, voted yes while 13 Democrats and one Republican, Darrell Issa of California, voted no."

Tuesday, February 14, 2017

An interview about travel bans, and universities, and science...


NOBELPREISTRÄGER ALVIN ROTH ZUM EINREISEVERBOT
„Grenzschließung wäre eine große Schande“

PREMIUMStanford-Professor und Nobelpreisträger Alvin Roth sorgt sich um den Forschungsstandort USA. Im Interview spricht er über die Folgen von Donald Trumps Einreiseverboten und die Universitäten als Spiegelbild Amerikas.


Im Jahr 2012 gewann Alvin Roth den Nobelpreis für Wirtschaftswissenschaften. Der 65-Jährige, der an der Universität Stanford in Kalifornien lehrt, macht sich Sorgen um den Forschungsstandort Amerika.
It's in German, and it's gated, but the interviewer asked me what I thought the effects of travel bans and immigration bans would be on the U.S. I replied that universities are in some ways a microcosm of the US, in that both have thrived by being open to participation from people around the world.  Universities, American science, and America will all suffer if we cut ourselves off from the rest of the world.

Valentine's day

What do Valentine's day and National organ donor day have in common?  Well...hearts.  And love. And the same day...

February 14: National Donor Day
Focused on five points of life: organs, tissues, marrow, platelets, and blood. Many nonprofit health organizations sponsor blood and marrow drives and organ/tissue sign-ups across the nation. National Donor Day was started in 1998 by the Saturn Corporation and its United Auto Workers partner with the support of the U.S. Department of Health and Human Services and many nonprofit health organizations.

February 14 is National Donor Day

Each year, February 14th is significant for more than just Valentine's Day.  Today is designated as National Donor Day focusing on the "five points of life"  organ, tissue, marrow, platelets, and blood donation.  Donation drives are held throughout February nationwide.  Be a hero!  Be a donor!  And THANK YOU!








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

Valentine's day celebration is also repugnant in some places:
Pakistan bans Valentine's Day for being unIslamic
Ban on the traditional Christian celebration of love follows a similar move by Saudi Arabia
"Pakistan has become the latest country to ban Valentine's Day.
It has prohibited all public celebrations and any media coverage because the celebration is not part of Muslim traditions."

And (I'm sorry to say) this: Mob Kills Eloped Lovers After Storming Afghan Police Station

Monday, February 13, 2017

First kidney exchange in Vietnam

The first kidney exchange in Vietnam was performed last month. It was a two-way exchange in Ho Chi Minh City: VietNamNet has the story.

VN doctors perform first paired-kidney exchange transplant
Doctors at Cho Ray Hospital in HCM City have successfully performed the country’s first living paired-kidney exchange transplant.

"The surgery was successful and the four patients are in stable condition, according to Dr Thai Minh Sam, head of the hospital’s urology department.
Nguyen Thi Hue, 58, volunteered to donate one of her kidneys to her daughter Vu Thi Hue, 32, from Kien Giang province who had end-stage renal disease and has been on dialysis since June 2014.
But she and her daughter did not match well, Sam said at a press meeting held yesterday.
Another pair in the same situation, Le Thi Anh Hong, 31, from Dak Nong province with end-stage renal disease, has been on dialysis since April 2015.
Hong’s stepfather, Truong Ngoc Xuan, 51, could not donate one of his own kidneys to his daughter as they were incompatible.
Paired donation matches an incompatible donor and recipient to another pair in the same situation.
Doctors at Cho Ray Hospital carefully consulted opinions from leading experts in kidney transplant and explained the procedure to two donor/recipient pairs who agreed to undergo paired kidney exchange.
Hue’s mother gave one of her own kidneys to Hong. In exchange, Hong’s stepfather, Xuan, donated one of his own kidneys to Hue.
Doctors removed the kidneys from the donors in the morning and transplanted them in the recipients on January 11."

Sunday, February 12, 2017

Living kidney donation in Israel: a competition between two towns

Ran Shorrer points me to this story...

תחרות בין ההתנחלויות: מי יתרום יותר איברים לזרים גמורים

עשרות מתיישבים החליטו לתרום את אחת הכליות שלהם לאדם זר, ללא תמורה. המעשה האצילי הפך אפילו לסוג של תחרות בין היישובים. "ביצהר מובילים עם 10 תורמים, ואנחנו רק שלושה", מסביר תורם מאיתמר. היוזמה מדהימה, אך התרומות לא מיועדות באמת לכל אחד: מרביתן ליהודים בלבד


Google translate:

Competition between the settlements who contribute more organs to complete strangers?

Dozens of settlers decided to donate one of their kidneys to a stranger, for no consideration. Even the noblest deed became a kind of competition between communities. "Yitzhar lead with 10 donors, and we are only three," says Itamar contributor. 

Saturday, February 11, 2017

Friday, February 10, 2017

Vatican conference on organ trafficking and transplant tourism

A recent meeting at the Pontifical Academy of Sciences of the Vatican:
Summit on Organ Trafficking and Transplant Tourism resulted in a statement and a number of news stories.  Here are several that caught my eye, with divergent views on the situation in China and how it is changing:

From the NY Times: Debate Flares Over China’s Inclusion at Vatican Organ Trafficking Meeting
"China has admitted that it extracted organs from death row prisoners for decades, in what critics have called a serious violation of the rights of inmates who cannot give genuine consent. Since Jan. 1, 2015, Chinese officials have said they no longer use prisoners’ organs, though doubts persist.

“We urge the summit to consider the plight of incarcerated prisoners in China who are treated as expendable human organ banks,” wrote the 11 signatories, who included Wendy Rogers of Macquarie University in Australia; Arthur Caplan of the New York University Langone Medical Center; David Matas and David Kilgour, both Canadian human rights lawyers; and Enver Tohti, a former surgeon from the western Chinese region of Xinjiang."
*********


From Statnews.com
China moves to stop taking organs from prisoners, WHO says
"The World Health Organization says China has taken steps to end its once-widespread practice of harvesting organs from executed prisoners but that it’s impossible to know what is happening across the entire country.

At a Vatican conference on organ trafficking this week, a former top Chinese official said the country had stopped its unethical program, but critics remain unconvinced.

In an interview Thursday, WHO’s Jose Ramon Nunez Pena said he personally visited about 20 hospitals in China last year and believes the country has reformed. But he acknowledged that it was still possible “there may still be hidden things going on.” China has more than 1 million medical centers, although only 169 are authorized to do transplants.

Nunez Pena said he had seen data including organ transplant registries and was convinced the country was now shifting away from illegally harvesting organs.

“What is clear to me is that they’re changing,” he said. “But in a country as huge as China, we can’t know everything.”
...
"Campbell Fraser, an organ trafficking researcher at Griffith University in Australia, agreed the trends over the past few years have shown a drop in the number of foreigners going to China for transplants and an increase of organ seekers heading to the Middle East.

At a press conference at the Chinese Embassy in Italy following the two-day Vatican organ conference, Fraser said migrants — including Syrians, Somalis and Eritreans — sometimes resort to selling off a kidney to pay traffickers to get them or their families to Europe.

Egypt is where the biggest problem is at the moment,” he said, adding that it has the best medical facilities in the region and can perform the live donor surgeries.

He estimated as many as 10 such illicit transplants could be happening per week, though he had no statistics and said he based his research largely on anecdotal information from recipients, law enforcement, doctors and even some organ “brokers.”

Fraser said he has access to transplant patient “chat boards” because he himself had a kidney transplant in his native Australia in 2003.

Nunez Pena said it was likely that organ trafficking would find its way to conflict-plagued regions.

“We’re hearing about a lot of problems in Egypt, Pakistan and the Philippines,” he said, predicting that authorities were poised to break up an organ smuggling ring in Egypt in the next few weeks. “Wherever you have vulnerable people, you will see these kinds of problems.”

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


From Science:

Study retraction reignites concern over China’s possible use of prisoner organs

A journal has decided to retract a 2016 study because of concerns that its data on the safety of liver transplantation involved organs sourced from executed prisoners in China. The action, taken despite a denial by the study’s authors that such organs were used, comes after clinical ethicist Wendy Rogers of Macquarie University in Sydney, Australia, and colleagues authored a letter to the editor of Liver International on 30 January, calling for the paper’s retraction in the “absence of credible evidence of ethical sourcing of organs.”
For years, Chinese officials have come under fire for allegedly allowing the use of organs from executed prisoners for transplants, including for foreigners coming to the country for so-called medical tourism. In January 2015, it explicitly banned the practice and set up a volunteer donation system, but doubts persist that much has changed.
The disputed study—published online in October 2016—analyzed 563 consecutive liver transplantations performed before the ban (from April 2010 to October 2014) at a medical center in China. Suspicious, Rogers organized the protest letter to the journal. “Publication of data from prisoners is ethically inappropriate given that it [is] not possible to ensure that the prisoners freely agreed either to donate their organs, or to be included [in] a research program,” she tells ScienceInsider.

Thursday, February 9, 2017

Ethicists on compensation for blood stem cells (aka bone marrow aka hematopoietic cells) donors

The site http://donationethics.com/ hosts a letter signed by many ethicists opposing an amendment to the National Organ Transplant Act to reverse the court decision outlawing payment to blood stem cell donors. (Got that? the letter is pro compensation.)

The site is full of interesting related links.

Here's the site's front page:
This site houses an open letter to Shelley Grant of the Department of Health and Human Services regarding a proposed amendment to the National Organ Transplant Act that would effectively outlaw offering compensation for hematopoietic cells donation. The signatories are professional ethicists who believe that the proposed amendment is unethical and should be rejected.
The details of the proposed amendment can be found here.
The case that prompted the amendment, Flynn v. Holder, is explained here.





Peter M. Jaworski conceived of the letter and is its primary author.
David Faraci was a major contributor to the letter and maintains the website.
**************

Here's a link to Hemeos, a startup service for matching stem cell donors to patients, which plans to compensate donors.

Wednesday, February 8, 2017

Celebrating Adam Bingaman at Methodist Hospital in San Antonio

Working in kidney exchange has given me the opportunity to meet some remarkable surgeons, and one of them, Adam Bingaman, is being celebrated in in the San Antonio media:
Methodist Hospital Leads Nation in Live-Donor Kidney Transplants

Methodist Specialty and Transplant Hospital's Dr. Adam Bingaman

"Dr. Adam Bingaman, head of the live-donor kidney transplant program, joined the Texas Transplant Institute at Methodist Specialty and Transplant Hospital in 2007 and became the Director of Abdominal Organ Transplantation in 2012.
...
"For those awaiting a kidney transplant but lacking a live-donor match, the only chance for a kidney donation may be from a kidney-paired donor (KPD) exchange. This offers a transplant option for patients with a living donor who is both willing and medically fit but isn’t a compatible match with the recipient.
The donor’s information is entered into a nationwide database with those of other incompatible donors and recipients who are willing to exchange kidneys. It is here that the process of finding suitable exchanges occurs. Kidney-paired donation provides a means for all transplant centers to increase patient access to live-donor transplantation.
Methodist Specialty and Transplant Hospital’s Program
Launched in 2008, the paired-donor program at Texas Transplant Institute at the Methodist Specialty and Transplant Hospital has performed more kidney-paired donation exchanges than any other center. The program focuses not just on the kidney recipient, but on the donor as well. All transplants are performed in one integrated facility, with targeted care provided for the donor from initial screening to post-surgery follow-up for two years.
The program’s approach to building community partnerships enables patient access and follow-up care in less populated areas across Texas. The program’s team has forged relationships with nephrologists throughout the state and through dedicated clinics in Corpus Christi, Laredo, McAllen, Lubbock, Waco, Temple, and Austin. The transplant physicians and team members visit these locations regularly to check on patients who have either donated or received a kidney.
“We build relationships of trust,” Bingaman said. “Community partnering in underserved areas is very important to patient outcomes. Our goal is to integrate our services with those of a patient’s nephrologist, so that we provide a true umbrella of care.”
...
"The Texas Transplant Institute at Methodist offers an educational seminar three to four times a year. The series (and videos here) teach people how to “End Your Wait” with an education program explaining living kidney donation and how to go about finding a donor on their own.
“We give them tools that help their awareness about the need for a kidney transplant,” Bingaman said. “We started this program because more than 50% of kidney donations do not come from family members. They are from coworkers, church members, or someone in the extended social network.”
“We’ve already hit a crisis point,” Bingaman said. “If you have kidney disease and diabetes and maybe heart disease, after six years on dialysis, you probably won’t be healthy enough for a transplant. So your best bet is to find a living donor as early as possible.”

Tuesday, February 7, 2017

U.S. academic conferences and the travel ban. What would be the effect of a boycott? Can conferences usefully be moved?

Part of the international reaction to the recent U.S. travel ban on people from seven countries has been a call to boycott U.S. academic conferences.
Here, e.g. is one such call: In Solidarity with People Affected by the ‘Muslim Ban’: Call for an Academic Boycott of International Conferences held in the US
"Among those affected by the Order are academics and students who are unable to participate in conferences and the free communication of ideas. We the undersigned take action in solidarity with those affected by Trump’s Executive Order by pledging not to attend international conferences in the US while the ban persists. We question the intellectual integrity of these spaces and the dialogues they are designed to encourage while Muslim colleagues are explicitly excluded from them."

I have had an opportunity to think about this regarding the ASSA conference run in January by the American Economic Association, and it seems to me that such a boycott won't help the majority of academics (students and professors) from the banned countries who come to our conference, or to many American academic conferences.

In our (the AEA's) particular situation, my sense is that we have had few if any Yemeni and Sudanese economists participating in the AEA meetings, and the people potentially affected by the current U.S. entry bans are mostly Iranian.*  And the majority of Iranians who have participated seem to be working or studying in the U.S.

So…if a travel ban is in place next January, and we moved the conference to some civilized city like Toronto, we would be depriving most of the potential Iranian participants of the ability to attend, since they couldn’t leave and then reliably re-enter the U.S..

My current sense is that the AEA will decide to take care of the Iranians as best we can (which for the minority who aren’t in the U.S. may involve some electronic communication efforts), rather than cater to any economists whose scruples would require us to abandon the Iranians living and working in the U.S.  by moving the conference elsewhere.

To be clear, I think moving the AEA meetings outside of the U.S. would harm the majority of Iranians who participated in past years.

Of course I’m hopeful that we’ll have come to our senses long before then.


*see this article in the Chronicle for a wider view of who studies in the U.S.:
Why the Travel Ban Probably Hits Iranian Professors and Students the Hardest

see also the data compiled by the Institute of International Education:
 International Students: All Places of Origin 2014/15 - 2015/16, and for previous years:  2016 | 2015 | 2014 | 2013 | 2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006 | 2005 | 2004 | 2003 | 2002
Selected Years 1950-2000
and see
Universities Spoke Up in Case That Led to Ruling Halting Trump’s Travel Ban