Birthright citizenship and birth tourism

Birthright citizenship (i.e. every child born within the country is a citizen) is (perhaps unsurprisingly) a new-world phenomenon: it occurs widely in the Americas, which were populated largely by immigrants.

The map comes from:
Birthright Citizenship in the United States--A Global Comparison

Prosperous countries that give citizenship to everyone born within their borders (regardless of their parents' citizenship) can be attractive places to give birth, particularly if they have good medical care and comfortable surroundings, and particularly for families whose home may be problematic for political or economic reasons.

Birthright citizenship has become a political issue in the U.S. under the Trump administration, as part of a larger repugnance towards immigration.
NY Times: President Wants to Use Executive Order to End Birthright Citizenship
“We’re the only country in the world where a person comes in and has a baby, and the baby is essentially a citizen of the United States for 85 years, with all of those benefits,” Mr. Trump told Axios during an interview that was released in part on Tuesday, making a false claim. “It’s ridiculous. It’s ridiculous. And it has to end.”

While some of that repugnance focuses on countries in Central and South America, there is also an expensive birth tourism market, catering e.g. to families from Russia and China.

Here's a recent story from Bloomberg:
There’s No Stopping the Russian Baby Boom in Miami
But it’s not, the new mothers insist, about the U.S. passport. “Why does Trump think everyone is dying to have one?”

"Being a birth tourist in Sunny Isles Beach isn’t cheap, with agencies charging as much as $50,000 to set up housing, hire interpreters, find doctors and deal with paperwork. Those who can’t afford that level of service buy smaller packages and rent apartments in far-flung suburbs, sometimes teaming up to share lodgings and expenses.
...
"The focus of Trump’s criticism hasn’t been the abuse of the system but the fact that it exists. One of his arguments against birthright citizenship is that when the babies born on U.S. soil become adults, they can petition for their parents to live permanently in the country.

But to many of the Russians in Sunny Isles, at least, this idea sounded unappealing. The biggest deterrent: They’d have to start paying personal income taxes that are more than double what they are in Russia."
********
And a story of a different sort from Newsweek:
FEDS RAID 'MATERNITY HOTELS' WHERE TOURISTS PAID UP TO $80K TO GIVE BIRTH IN U.S.
"Though it’s not illegal to have their babies in the United States, birth tourists usually lie to immigration officials about their reasons for travel, according to an official cited by NBC. The bigger focus, however, are the organizers of websites that targeted women in China and sold the "maternity hotel" stays to them.

"For that reason, authorities did not arrest the women staying in the buildings on Wednesday, but instead will use them as witnesses in an attempt to prosecute the "handlers."
************

And here's a headline that looks like it could come from the U.S., but comes instead from Canada:

Feds studying 'birth tourism' as new data shows higher non-resident birth rates
BY THE CANADIAN PRESS
"OTTAWA — The federal government is studying the issue of “birth tourism” with a view to better understand the scope of this practice within Canada and its impacts.

"This comes as new research published by Policy Options today shows the number of non-Canadian residents giving birth in Canadian hospitals is much higher than in figures reported by Statistics Canada.
...
"Immigration Minister Ahmed Hussen ... says Canada does not collect information on whether a woman is pregnant when entering Canada, nor can a woman be denied entry solely because she is pregnant or might give birth in Canada."

High expectations for legalized marijuana in NY State next year

The NY Times has the story:

Cuomo Moves to Legalize Recreational Marijuana in New York Within Months

"Gov. Andrew M. Cuomo announced that he would push to legalize recreational marijuana next year, a move that could generate more than $1.7 billion in sales annually and put New York in line with several neighboring states.
....
"Ten other states and Washington, D.C., have legalized recreational marijuana, spending the new tax revenue on a range of initiatives, including schools and transportation."

Medical care as a U.S. export

Travel for medical care is sometimes viewed with some repugnance, as the names "transplant tourism" and "fertility tourism" suggest.  (In the case of transplants, particularly from deceased donors, there is sometimes the suggestion that scarce national resources shouldn't be squandered on foreign patients.)  But of course a lot of travel for medical care has to do with going where care is available, and the U.S. hosts many foreign patients. (The availability of pain medicine for palliative end of life care is apparently an issue for some.)  Here's a story from the NY Times that reflects that even travel for ordinary medical care is complex, and can be viewed with some suspicion:

International Patients, Seeking Cures in the States
Are they taking up beds that could be used for vulnerable domestic patients or are they bringing money that could be used toward other programs?


"Each year, tens of thousands of seriously ill people come to the United States hoping to access our acclaimed care. While we do not have exact figures, an economist from the United States International Trade Commission estimated in a 2015 report that between 100,000 and 200,000 international patients per year make this journey. They come with cancer, heart disease and a host of other medical conditions. Most are incredibly sick and see us as their last beacon of hope.

But these patients are not just showing up. Many of our largest and most elite health care institutions seek them out. This is a multimillion-dollar industry, and it is growing. With millions of uninsured and underinsured patients and uncertainty in the domestic health care markets, hospitals are increasingly reliant on patients from abroad to stabilize their bottom line.

...

"Is an international patient “taking up a bed” that could otherwise be used for a vulnerable domestic patient? Or is the international patient providing funds that can be used toward other clinical and research programs?

"While many international patients are wealthy, they too are a vulnerable population. They enter a foreign medical culture, which may have different standards and expectations for doctor-patient communication, especially around sensitive issues like serious illness and death.

"Furthermore, international patients, particularly those from the Middle East, are frequently members of cultural, ethnic and religious minorities. In an age of rising American xenophobia and cultural protectionism, patients and families expose themselves to considerable risk coming to the United States. On a more practical level, recent travel bans have limited families from visiting sick or dying relatives who are already here.

...

"in American hospitals, patients and their families have access to advanced palliative and end-of-life care, which may not be the case in their home countries. For instance, opioids, which can be critical to alleviating suffering in the dying process, are not widely available in some countries.

Surrogacy, same sex marriage, and other Singapore repugnancies

Yesterday I blogged about a court ruling in Britain that, although commercial surrogacy is illegal in Britain, it is legal for a British subject to have a child by legal surrogacy in California.  Today we turn to Singapore, where a court had ruled that a child born by surrogacy to a gay couple could not be regarded as the biological father's child (even by adoption).  A higher court this week modified the decision.  It turns out that in Singapore surrogacy is not legal for unmarried couples, and there is no same sex marriage. In fact, homosexual sex remains a crime in Singapore...

NBC has the story:
Singapore court allows gay man to adopt son in landmark ruling
The ruling comes amid a renewed public push to review Singapore's colonial-era law under which gay sex carries a maximum penalty of two years in jail.

"Singapore's high court on Monday allowed a gay doctor to adopt his biological son, a landmark ruling in the socially conservative city-state that comes almost a year after his initial bid was rejected.

"The decision overturns a 2017 ruling in which a court said the man could not adopt the boy because he was born by a surrogate in the United States through in-vitro fertilization — a procedure not available to unmarried couples in Singapore.

"The ruling also comes amid a renewed public push to review Singapore's colonial-era law under which sex between consenting males carries a maximum penalty of two years in jail, after a repeal of a similar law in India this year.
...
"The man, in a relationship with a same-sex partner, paid $200,000 for a woman to carry his child through in-vitro fertilization in the United States after he had learned he was unlikely to be able to adopt a child in Singapore as a gay man."
*********

It appears that the judge's ruling acknowledged Singaporean law against same sex marriage and same sex relations generally, but felt that the welfare of the child (who otherwise would not have had a legal parent) needed to be given priority.

An English court awards a woman the costs of surrogacy in California (although commercial surrogacy is illegal in the UK)

Here's an unusual story about surrogacy, from the UK, with a legal opinion confirming that paying a surrogate is illegal in Britain, but that British citizens can legally pay a surrogate in California:

Woman left infertile after NHS failed to detect cancer for four years awarded £580k to cover surrogacy costs  by  Telegraph Reporters, 19 DECEMBER 2018

"A young woman left infertile because her cervical cancer was not spotted for more than four years has been awarded the costs of having surrogate children in America by the Court of Appeal.
...
"The High Court awarded XX a total of £580,000 in damages last year, including the costs of fertility treatment, cryopreserving her eggs and having children by surrogacy in the UK.

"However, XX's claim for the costs of four surrogacies in California, where commercial surrogacy is legal and binding, was dismissed as the court found that commercial surrogacy was still illegal in the UK and therefore contrary to public policy.

"But, giving judgment in London on Wednesday, senior judges allowed her appeal, meaning XX will now receive as much as an additional £560,000 to cover the cost of having children with commercial surrogates in the US.

"Her solicitors Irwin Mitchell say the ruling is the first time the costs of surrogacy in the USA have been awarded in a claim for clinical negligence.
...
"Finding that the ban on commercial surrogacy was "expressly limited to acts done in the UK", the judge said that "there seems to me to be an incoherence in depriving her of her claim at the outset when she personally proposes no wrongdoing, either under Californian law or under our own law".
***************
Update: here's an article from The Conversation that attempts to shed some light on the finer points of British surrogacy law.

"Under the Surrogacy Arrangements Act (1985), it is not illegal for a couple to pay a surrogate to carry a baby for them and it is not illegal for the mother to accept payment. However, it is illegal for any other person to take or offer money in relation to surrogate motherhood.

Commercial surrogacy agencies are therefore illegal, as are the activities of individual commercial surrogacy agents. And such commercial deals will not be upheld by the courts. By the terms of the Surrogacy Arrangements Act and section 36(1) of the Human Fertilisation and Embryology Act (1990), no surrogacy arrangement of any sort is enforceable in law."

Regulation of human and animal milk, in the U.S. and France

Here's an article full of interesting observations:

Mathilde Cohen, Regulating Milk: Women and Cows in France and the United States, 65 American Journal of Comparative Law, 469 (2017)


"Much like nineteenth-century milk reformers lobbied for a safe cow's milk supply in the cities, twenty-first-century public health officials are calling for the regulation of human milk.
...
"Milk is peculiar, however, in that, unlike other embodied forms of labor, it is also a food, cutting across species in two ways.15 Humans do not typically eat other humans' body parts or bodily fluids, yet human milk is their primal food.' 6 Humans do not typically turn to animals for sex cells, wombs, or sex, yet they commonly consume animal milk.
...
"The analogy between human and animal milk is sure to offend some. Much of human life and thinking, especially in Western cultures such as France and the United States, is concerned with distinguishing humans from other animals.
...
"I argue that some of the social and legal norms that have shaped the relationship
of the French and Americans to animal milk equally apply to human milk.
Why compare the United States to France? These are two of the biggest dairy consuming and producing countries in the world, 26which regulate animal milk production with little concern for animal welfare. Yet, the French and Americans entertain different cultural and regulatory approaches to human and animal milk, presenting us with a puzzling chiasm. The American sanitary regulation for animal milk is stricter than the French, resulting in a federal ban on raw milk.27 France, the birthplace of pasteurization, 28 is laxer, in part because raw milk is a necessary ingredient in its prized cheeses. With respect to human milk, the picture is reversed. The United States is the more permissive country, a land of no law, where American women can freely trade their milk. In France, human milk is so stringently governed that French women are prohibited from giving their milk to others, even for free, unless they turn to state-controlled milk banks."
...
p486. "In France, at the peak of the wet-nursing profession in the 1880s, close to 100,000 infants were placed in the care of wet nurses-about 10% of the children born in the country at the time."
...
p494. "Under French law the sale of human milk is illegal because milk is considered a bodily part similar to an organ.153 Article 16-1 of the French Civil Code states, "The human body, its elements and its products may not form the subject of a patrimonial right."54 Lactariums possess the exclusive right to process and distribute human milk.1 55 They are prohibited from paying donors for their milk 156-which, incidentally, has resulted in a state of near-constant shortage. Before the HIV/AIDS crisis, lactariums did compensate donors "for the time spent for the milk donation." 157 Since 1992, donors can no longer be indemnified. 158 The official explanation for this shift is that compensation would be contrary to the principle of gratuity of contracts pertaining to bodily parts."
...
p506. "The milk-sharing website, OnlyTheBreast.com, hosts wet-nursing classified ads. A recent example read:
'I am a Surrogate who is due to deliver any time in the next 2-3 weeks. I am an over producer and will not have a child to feed so I am looking for a local family who is in need and would like to provide their baby with liquid gold. I am looking to nurse a baby during work hours (M-F) and can provide pumped milk for over nights and weekends. Occasional weekend feeds can be .'
**************

See my other posts on breast milk.

Insuring your whiskey collection

A word to the financially prudent: don't forget to insure your whiskey collection.
Bloomberg has the story, about American International Group Inc.’s private client group.

What the Rise in Whisky Insurance Tells Us About the Super Rich
AIG’s head of global collections sees younger generations eschewing the collectibles of their forebears.

“Whisky collectors now number in the many hundreds, closing in on 1,000 individual collectors of all stripes and values,” says Fiamma of AIG customers highlighting whisky within their insured collection. “When auction houses are holding two or three whisky auctions a year, with some whisky going for a million or half a million dollars, clearly it warranted attention.”

Australia's parliament reports on organ trafficking

Australia's parliament has published a report on organ trafficking in Australia. They didn't find much trafficking there, but recommend that data be more vigorously collected. They report that only one case of (attempted) paid organ donation has come to the attention of the authorities, but that it was successfully prevented, and the intended recipient died. The report ends with a case study of an anatomical exhibit using human cadavers.

Compassion, Not Commerce:An Inquiry into Human Organ Trafficking and Organ Transplant Tourism

Human Rights Sub-Committee, House of Representatives, Joint Standing Committee on Foreign Affairs, Defence and Trade, November 2018, Canberra

(The above link is the the 178 page pdf version, and here's a link to the table of contents and each chapter separately).

"This report examines the global prevalence of human organ trafficking and the scope of Australian participation within this illicit trade.

...

"2.5...The commercial trade in human organs is near-universally prohibited. Despite these prohibitions and restrictions, the illicit commercial trade in human organs has been estimated by the research advisory organisation Global Financial Integrity to be worth between US$840 million and $1.7 billion globally each year.4 Up to 10 per cent of kidney transplants worldwide may now involve commercially traded organs.
...
"3.15 There has been only one reported case to date of alleged organ trafficking within Australian jurisdiction,
 Alleged case of organ trafficking in Australia
"In 2011, an Australian couple were alleged to have brought a woman from the Philippines to Australia, promising her monetary compensation and a working visa in exchange for a kidney donation.
The woman changed her mind upon arriving in Australia. Medical transplant integrity procedures – a pre-operative counselling session at a Sydney hospital –ensured that the situation was discovered before the removal of the organ.
The potential donor was identified as an alleged victim of organ trafficking, resulting in referral to the Australian Federal Police. Due to the death of the prospective recipient, and limitations of the legislation as then in force, the matter did not progress to prosecution."
...
"3.20 International studies have observed the tendency of patients born in a country where organ trafficking may occur, but living outside of that country, to be at a substantially higher risk of participation in transplant tourism.31 This would appear to be equally true in Australia, as Dr Campbell Fraser observed: "...less than five per cent of Australians who are waiting on organs are likely to even consider going overseas. ...most of the Australians who have purchased an organ overseas have ethnic family connections to the countries or regions where they buy their organs—Pakistani Australians tended to go to Pakistan, Egyptian Australians travel to Egypt, and so on."
...
"Mandatory reporting by medical practitioners
3.41 A large number of submissions and witnesses argued in favour of the establishment of a nationwide mandatory reporting scheme for commercial transplants. A Bill before the Parliament of New South Wales, Human Tissue Amendment (Trafficking in Human Organs) Bill 2016, introduced by Mr David Shoebridge MP, seeks to amend the Human Tissue Act 1983 (NSW). The amendment would, inter alia, require medical professionals to report to the NSW Secretary of Health any reasonable belief that a patient has received a commercial transplant or one sourced from a non-consenting donor.
...
"Case study on alleged human tissue trafficking 
‘Real Bodies’
6.1 The Real Bodies commercial anatomical exhibition, on display in Australia during the course of this inquiry, was brought to the attention of the  Sub-Committee by a number of witnesses and is illustrative of an apparent gap in the current legislation. The Real Bodies exhibition involves the commercial display of 20 plastinated human cadavers, and ‘over 200’ plastinated organs, embryos and foetuses.1
Allegations of the trafficking of organs and other human tissue
6.2Mr David Shoebridge MP of the New South Wales Parliament informed the Sub-Committee as to the nature of the exhibition:...
"[they] are real bodies ... they are displayed in quite grotesque circumstances—some of them literally sawn down the middle and presented as a human standing and divided in two so that you can look into the internal parts of them. There are pregnant women. There are multiple fetuses ... put on display for commercial gain ... it is a grossly exploitative process. The proprietors ... have been asked about the circumstances in which these bodies came into their possession, and they have been unable and unwilling to prove that any of the persons on display ever gave their consent."
**********

Here's an earlier post on repugnance to anatomical exhibits using cadavers:

Saturday, March 28, 2009, Markets for (viewing) bodies

Simons Institute program in Online and Matching-based market design, Fall 2019

Programs

Fall 2019

Online and Matching-Based Market Design

Aug. 21 – Oct. 4, 2019

Economists have developed a deep and rich theory for understanding the evolution and operation of markets, as well as a bounty of empirical methodologies and practical solutions pertaining to particular settings. Computer scientists have developed the powerful "algorithmic way of thinking," which has become a key enabler of the sciences in this century, just as mathematics was in the last. Sophisticated algorithms, such as the stable matching algorithm, maximum matching algorithms, and algorithms for budgeted auctions, have been applied to centralized labor markets, auctions, financial exchanges, the allocation of public goods, etc. However, in the past, this progress proceeded with limited direct interaction between economists and computer scientists.

In recent years, a vibrant IT ecosystem together with the en-masse relocation of our most important activities to online platforms has given birth to enormously influential and innovative online market structures, including online retail markets, ad auctions, short-term housing markets such as AirBnB, online labor markets such as Uber and Upwork, markets for virtual currencies such as Bitcoin and Ethereum, and markets for online dating such as OK Cupid and Match.com. These new applications require a truly interdisciplinary approach to market design. New algorithms include the specification of information available to consumers and feedback across time in dynamic mechanisms, in addition to the rules governing the aggregation of users’ responses. These new components suggest a new strategic environment, where fairness, transparency, and welfare are clear objectives.

As these markets occupy a rapidly increasing fraction of our economy, the time is ripe for bringing together market-design scholars from economics and computer science under the same roof for an extended period of time to address these challenges. This six-week long program has been designed to accomplish precisely that. 

Click here to subscribe to our announcements email list for this program.

Organizers: Vijay Vazirani (UC Irvine; chair), Itai Ashlagi (Stanford), Federico Echenique (Caltech), Nicole Immorlica(MSR, NE), Aranyak Mehta (Google, Mountain View), Leeat Yariv (Princeton and Caltech)

Workshops

Matching and Objectives

Sep. 5 – Sep. 6, 2019

Platform Markets

Sep. 17 – Sep. 18, 2019

Information Design and Data Science

Oct. 1 – Oct. 2, 2019

Those interested in participating in this program should send email to the organizers at this address.

Are uterus transplants repugnant? And to whom? And why? (in the Irish Times)

Here's an article in the Irish Times on uterus transplants , that makes clear the view that the views of those not directly involved should play a large  and perhaps decisive role in public discussions of transactions that some may find repugnant. The author indicates that among his concerns is that the parentage of the baby might be in doubt (i.e. that a child conceived from the eggs and sperm of his genetic parents and carried to birth by his pregnant genetic mother might have to be regarded as the child of the donor of the uterus...). I wonder if even the author thinks this is a serious reason to ban uterus transplants; rather, I get the sense that he is throwing his net widely in the hope that different objections might resonate with different parts of his audience. Maybe his goal is simply to be controversial. [Just to be clear, I am not disagreeing that child welfare is an important concern when evaluating issues related to reproduction and childbirth...but this concern strikes me as particularly far-fetched.]

Are uterus transplants ethically acceptable?
Several infertile women worldwide have given birth with wombs received from either living or dead donors   by George Winter

"In September 2014, the first live birth following UTx was reported from Sweden by Prof Mats Brännström and colleagues. The recipient had Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome – she was born without a viable womb – and the donor was a 61-year-old friend. Since then, there have been at least 12 successful births worldwide following UTx.

"Recently, it was revealed that the first baby had been born following a womb transplant from a deceased donor. Ten previous attempts had been made in different countries to deliver a live baby following a uterus or womb transplant from a deceased donor, but this – performed by surgeons in Brazil – was the first with a successful outcome.

...

"The UTx procedure begins with in-vitro fertilisation, using the recipient’s egg and her partner’s sperm; the subsequent embryo is frozen; a uterus – from a living or dead donor – is transplanted; the embryo is thawed and implanted; and following pregnancy and delivery by Caesarean section, a hysterectomy is performed, obviating the need for lifelong immunosuppressive therapy."

...

"The “Ethical Considerations” section of the Womb Transplant UK website implies that any societal misgivings on the acceptability of UTx will be ignored: “Ultimately, the decision to go forward will depend on the judgment of the researchers, the participating institution, and most importantly, the patient to whom the transplant will be offered.”

"Hardly an unbiased trio.

"What ethical dilemmas might arise?

"If a transplanted uterus were to jeopardise a recipient’s life, it could be removed; but what if it contains a viable foetus? And there is debate over living versus deceased donation, with Spanish and Japanese teams favouring the Swedish “live” model, and French, Belgian and UK researchers preferring deceased donors. Writing in the journal Bioethics, Dr Nicola Williams cites the view of the International Federation of Gynaecology and Obstetrics that “the retrieval of a uterus from a living donor necessitates a relatively major surgery with its own risk of complications [and] constitutes reason enough to deem the procedure ethically inappropriate”.

"Also, how much would a child be entitled to know about the donor from whose uterus he or she issued, and – irrespective of whether the donor had been dead or alive – would the infant be the child of the donor or the recipient?"

***********

George Winter, the author of the piece, apparently writes often on ethical issues in medicine (although the above is the first article I had read by him). See e.g.  his recent related articles on The ethical considerations of face transplants and 
The brave new world of wombless gestation--Artificial womb technology poses many ethical questions – we need to debate them
(that article is about experimental technology about lamb embryos brought to term "in a plastic “biobag” – literally, a womb with a view ..."  I was relieved to note that, in considering the implications for humans, the author didn't raise the question above about the parentage--or in this case perhaps the humanity--of the baby (so maybe he was just kidding.)

**********

And see my related post from yesterday:
Friday, December 14, 2018  Successful birth in Brazil to a woman who received a uterus transplanted from a deceased donor

Successful birth in Brazil to a woman who received a uterus transplanted from a deceased donor

The Lancet reports the first known case of a live birth to a woman born without a uterus who received a transplanted uterus from a deceased donor.

Livebirth after uterus transplantation from a deceased donor in a recipient with uterine infertility

December 04, 2018 DOI:https://doi.org/10.1016/S0140-6736(18)31766-5

Background

Uterus transplantation from live donors became a reality to treat infertility following a successful Swedish 2014 series, inspiring uterus transplantation centres and programmes worldwide. However, no case of livebirth via deceased donor uterus has, to our knowledge, been successfully achieved, raising doubts about its feasibility and viability, including whether the womb remains viable after prolonged ischaemia.

Methods

In September, 2016, a 32-year-old woman with congenital uterine absence (Mayer-Rokitansky-Küster-Hauser [MRKH] syndrome) underwent uterine transplantation in Hospital das Clínicas, University of São Paulo, Brazil, from a donor who died of subarachnoid haemorrhage. The donor was 45 years old and had three previous vaginal deliveries. The recipient had one in-vitro fertilisation cycle 4 months before transplant, which yielded eight cryopreserved blastocysts.

Findings

The recipient showed satisfactory postoperative recovery and was discharged after 8 days' observation in hospital. 

...

The female baby weighed 2550 g at birth, appropriate for gestational age, with Apgar scores of 9 at 1 min, 10 at 5 min, and 10 at 10 min, and along with the mother remains healthy and developing normally 7 months post partum. The uterus was removed in the same surgical procedure as the livebirth and immunosuppressive therapy was suspended.

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

In Brazil (where commercial surrogacy is apparently illegal, and legal surrogates must be family members of the intended mother), the urge to have one's own baby is nevertheless strong. 

See earlier post:

Wednesday, January 15, 2014

Womb transplants in Sweden (where surrogacy is illegal)

Kidney exchange looks imminent in Sweden

Dagens Medicin (Today's Medicine) has the story:

Nytt koncept ska ge fler en ny njure
Snart startar ett nytt utbytesprogram av njurar som sträcker sig över hela Sverige. 
(GT: New concept will give more a new kidney
Soon a new kidney replacement program will start all over Sweden.)

"The exchange program has shown good results in other countries, so expectations are high, says Per Lindnér, Senior Assistant and Operations Manager at Transplant Center at Sahlgrenska University Hospital in Gothenburg.

"He is one of the initiators of the first Swedish renal exchange program. It can easily be described as a database matching system that couples potential donors and recipients within renal donation.
...
"Today, all of the country's centers for kidney transplants participate, that is, Sahlgrenska University Hospital, Karolinska University Hospital, Academic Hospital and Skåne University Hospital.

- Even hospitals in Norway and Denmark want to connect. But the idea is to start nationally and expand over time, "says Per Lindnér.
...
"The idea of ​​a national exchange program was born three years ago when Per Lindnér visited a seminar with Tommy Andersson, professor of discreet mathematics at Lund University.

Tommy Andersson talked about the mathematical background of an American renal exchange program created by Alvin Roth, former winner of Sveriges Riksbank's award in economics, to Alfred Nobel's memory.

When Per Lindnér wanted to introduce the same concept in Sweden, Tommy Andersson contributed with his knowledge, which forms the basis for the program."

MD4SG Colloquium: (Market Design for Social Good): tomorrow (updated with a video)

I'll be speaking in the MD4SG Colloquium Series, online, tomorrow, Thursday, December 13th, 12-1:30 PM EST. 

Date: Thursday, December 13th, 12:00-1:30 PM EST
Link: https://www.youtube.com/watch?v=ku-ZRSB82SU. 

Market design is more complicated than mechanism design. And so is achieving good social outcomes.

Marketplaces are often small parts of large markets, and so potential marketplace participants may have large strategy sets, that include actions taken outside of the marketplace. And markets require social support, so the behavior of people who do not intend to participate in the market may nevertheless be important for market design. This talk will illustrate these points with some examples, drawing on experience from the design of school choice systems and kidney exchange clearinghouses.

*********

Update: here it is

The (private equity) market for dermatologists

Dermatology is a lucrative part of medicine, and private equity firms are buying medical practices, which has led to an unusual quarrel in the Journal of the American Academy of Dermatology, involving corporate interests.

The NY Times has the story:
Why Private Equity Is Furious Over a Paper in a Dermatology Journal

"Early this month, a respected medical journal published a research paper on its website that analyzed the effects of a business trend roiling the field of dermatology: the rapid entrance of private equity firms into the specialty by buying and running practices around the country.

"Eight days later, after an outcry from private equity executives and dermatologists associated with private equity firms, the editor of the publication removed the paper from the site.
...
"Dermatologists account for one percent of physicians in the United States, but 15 percent of recent private equity acquisitions of medical practices have involved dermatology practices. Other specialties that have attracted private equity investment include orthopedics, radiology, cardiology, urgent care, anesthesiology and ophthalmology.
...
"This week a lawyer for Advanced Dermatology and Cosmetic Surgery, which is backed by private equity and is the largest dermatology practice in the United States, called the general counsel at the University of Florida, where two of the authors are employed, demanding specific changes to the paper."

Self regulation of black markets on the dark web?

Here's an interesting story from the Guardian, about some dark-web black markets in the U.K. banning fentanyl, as too deadly and (hence) too likely to attract vigorous police attention:

Dark web dealers voluntarily ban deadly fentanyl
Suppliers, fearing police crackdown, decide opioid is too high-risk to trade

"Major dark web drug suppliers have started to voluntarily ban the synthetic opioid fentanyl because it is too dangerous, the National Crime Agency has said.

"They are “delisting” the high-strength painkiller, effectively classifying it alongside mass-casualty firearms and explosives as commodities that are considered too high-risk to trade.
...
"Vince O’Brien, one of the NCA’s leads on drugs, told the Observer that dark web marketplace operators appeared to have made a commercial decision, because selling a drug that could lead to fatalities was more likely to prompt attention from police.

"It is the first known instance of these types of operators moving to effectively ban a drug.
...
"O’Brien said that the NCA is working with US law enforcement agencies to prevent the UK from having a similar fentanyl epidemic, though the number of people dependent on opioids in the UK compared to America means it has a much smaller market."

Gabriel Weintraub's class on online marketplaces at Stanford GSB (winter quarter)

Gabriel Weintraub writes:

I am sharing this information in case some of you are interested on this new half-quarter PhD course I will be teaching this coming Winter:

OIT 648: Empirics of Online Markets
In this course we cover current research on the empirics of platforms and online marketplaces. We will study diverse topics relevant to the design of these markets such as search and matching, review and reputation systems, demand estimation, and pricing. We will do so in the context of different application domains such as rentals, sharing, e-commerce, labor markets, and advertising. The course will be eclectic in terms of approaches, using reduced-form and structural econometrics, machine learning, and experimentation. The course will mostly consist of recent papers presented by the instructor, guests, and students. Some background knowledge required to understand current work will be provided as needed.

The course will meet on the following Mondays between 3:30 and 6:20PM: 

- Mon. Feb 4

- Mon. Feb. 11

- Mon. Feb. 25
- Mon, Mar 4
- Mon. Mar 11
- Fri. Mar. 15

School choice, an overview by the Center for American Progress

The Center for American Progress, a DC think tank, reviews school choice:
Expanding Access to High-Quality Schools
Implementing School Choice Algorithms

From the introduction:

"According to a 2017 analysis by the Brookings Institution, the proportion of large school districts that offered school choice doubled from 2000 through 2016.1 As a result, of the more than 50.1 million students nationwide who attended public schools over the 2015-16 school year, more than 2.8 million students attended public charter schools, and more than 2.6 million students attended magnet schools. Additional students attended other types of public schools of choice, such as those with specialty or thematic programs.
...
"A centralized system can simplify enrollment for both families and schools. Students apply through a single application, ranking a list of schools that they would like to attend and receiving a single offer to one of their preferred schools. However, system design matters when it comes to centralized enrollment. Depending on how a district assigns an offer for each student, some families can unfairly manipulate the system to make it more likely that their child secures a seat at a more in-demand, usually better-performing school.

To reduce this risk of strategic manipulation in centralized enrollment systems, Atila Abdulkadiroglu, Parag Pathak, Alvin E. Roth and Tayfun Sönmez—economists with expertise in game theory and market design—proposed a solution. They designed two fair and efficient matching algorithms—or a set of rules and calculations—to ensure that, given the preferences of all other students and schools in the system, each student receives a single offer with his or her best possible school match. Specifically, the economists designed two matching algorithms suitable for centralized assignment: deferred acceptance (DA) and top trading cycles (TTC)."

Congratulations to Eva Tardos, winner of the 2019 IEEE John von Neumann Medal

Congratulations to Eva Tardos.  The Communications of the ACM has the news:
Tardos to Receive von Neumann Medal

"Tardos was cited "For contributions to the field of algorithms, including foundational new methods in optimization, approximation algorithms, and algorithmic game theory."
...
"She will receive the Medal next May at the IEEE Vision, Innovation, and Challenges Summit and Awards Ceremony in San Diego, CA."

Repugnance watch: pay toilets

Citylab reports:
Pay Toilets Are Illegal in Much of the U.S. They Shouldn't Be.
In the 1970s, many American cities and states banned pay toilets, but the vision of abundant free toilets for all never came to pass.
NOV 19, 2018, by Sophie House

"failures of sanitation are not confined to the developing world. In cities around the United States, groups from pregnant women to taxi drivers and people experiencing homelessness suffer from the lack of public restrooms. One solution common in European cities—the pay toilet, which charges a small fee for use—is largely absent from the American landscape, and in fact, is banned in many cities and states.
...
"In 1969, California Assemblywoman March Fong Eu smashed a porcelain toilet with an axe in front of the California state capitol, protesting the misogyny of restrooms that charged entrance fees for stalls but not urinals. She was not alone in her frustration. ...The grassroots organization CEPTIA—the Committee to End Pay Toilets in America—mobilized against pay toilets, putting out a quarterly newsletter (the Free Toilet Paper) and exchanging warring pamphlets with Nik-O-Lok, the leading pay-toilet manufacturer. The group won a citywide ordinance banning pay toilets in Chicago in 1973, followed by bans in Alaska, California, Florida, Illinois, Iowa, Michigan, Ohio, New Jersey, New York, Tennessee, and Wyoming.

In the decades since CEPTIA disbanded, however, pay-toilet bans have proven to be a Pyrrhic victory. The committee’s vision of free toilets for all never came to pass. Cities have persistently refused to construct public restrooms, and existing facilities have fallen into disrepair. Citing the difficulty of keeping bathrooms safe and clean, municipalities are often unwilling or unable to pay. ...

By contrast, in cities from Europe to India to Latin America, small entrance fees help to cover the costs of keeping facilities in good condition. Creating a similar revenue stream to defray operating costs would likely make pay toilets more attractive to U.S. municipalities. For example, fees could offset the costs of hiring restroom attendants—an excellent, but expensive, way to keep bathrooms safe. Pay toilets also redistribute the operating costs of restrooms. Free toilets are, of course, taxpayer-funded, while under pay-toilet schemes, tourists who use urban infrastructure also contribute to its functioning."

HT: Alex Tabarrok at MR

Would government compensation of kidney donors help or hurt the poor?

Here's an article in PLOS ONE that asks a question whose answer is often simply assumed by those who oppose compensation for kidney donors:

Would government compensation of living kidney donors exploit the poor? An empirical analysis
Philip J. Held  , Frank McCormick , Glenn M. Chertow, Thomas G. Peters, John P. Roberts
Published: November 28, 2018https://doi.org/10.1371/journal.pone.0205655

Abstract
"Government compensation of kidney donors would likely increase the supply of kidneys and prevent the premature deaths of tens of thousands of patients with kidney failure each year. The major argument against it is that it would exploit the poor who would be more likely to accept the offers of compensation. This overlooks the fact that many poor patients desperately need a kidney transplant and would greatly benefit from an increased supply of kidneys. The objective of this study is to empirically test the hypothesis that government compensation of kidney donors would exploit the poor. Exploitation is defined by economists and several noted ethicists as paying donors less than the fair market value of their kidney. Exploitation is expressed in monetary terms and compared with the economic benefit recipients receive from a transplant. Data are from the Scientific Registry of Transplant Recipients and the United States Renal Data System annual data reports. Educational attainment is used as a proxy for income. We estimate that if the government rewards living donors with a package of non-cash benefits worth $75,000 per kidney, donors would not be exploited. Much more important, this compensation would likely end the kidney shortage, enabling many more patients with kidney failure to obtain transplants and live longer and healthier lives. The value of kidney transplantation to a U.S. recipient is about $1,330,000, which is an order of magnitude greater than any purported exploitation of a living donor (zero to $75,000). Consequently, the aggregate net benefit to the poor alone from kidney transplantation would increase to about $12 billion per year from $1 billion per year currently. Most of the benefit would accrue to poor kidney recipients. But poor donors would receive the fair market value of their kidney, and hence would not be exploited. If the government wanted to ensure that donors also received a net benefit, it could easily do so by increasing the compensation above $75,000 per donor."

Feeding America: Podcast on HBS case study of Canice Prendergast and Feeding America

Here's an audio interview of Canice Prendergast and Scott Kominers (who wrote the HBS case study) about the work that Prendergast and colleagues did with a team from Feeding America, which manages a network of more than 200 food banks nationwide.

The podcast is here: Building a Nonprofit Marketplace to Feed America

Prendergast says at one point: "The dynamic of the group was wonderful. I think one of the amazing things about this committee was essentially the length of time we got to listen to each other. I think if it has turned out to be a success, the reason was largely because of the willingness not of the academics to listen to the practitioners, but actually the practitioners to listen to the academics. This was a long way removed from anything that they imagined they would do when we started."


You can read the whole transcript by clicking on "Read More" at the bottom of the page linked above.

Arrow Lecture at Columbia (video): Market design (with discussion by Parag Pathak and Joe Stiglitz)

Here's a video of the lecture I gave on Columbia on November 8, in honor and in memory of Ken Arrow. My title was "Market Design in Large Worlds: The Example of Kidney Exchange."
My discussants were Parag Pathak and Joe Stiglitz, and you can see them too.
I used slides (and so did Parag), but they don't seem to have made it fully onstage in the video.  But the audio is good, and you can see how good looking we all are...



The theme of my talk is that one big lesson of market design is that participants have big strategy sets, and this has implications for, among other things, how marketplaces need to be adaptively maintained.  One of Parag's examples in his discussion is how more NYC schools have begun to screen students since more effective choice was introduced, and how this may sometimes work against the goals that increased choice was intended to achieve (so that the NYCDOE is working to reduce screening by schools...).

Match-Up 2019 conference in Switzerland, May 2019. Call for papers

Bettina Klaus points me towards this call for papers, for the latest in a series of conferences on matching. (I had the good fortune to attend the first and the fourth of these, in 2008 and 2017.)

MATCH-UP 2019: the Fifth International Workshop on Matching Under Preferences

May 26th-29th 2019
Congressi Stefano Franscini,
Monte Verità, Ascona, Switzerland
http://www.optimalmatching.com/MATCHUP2019/ (please subscribe to our mailing list there)
contact e-mail (Bettina Klaus): frontiers.marketdesign@gmail.com

(each participant will pay a fee covering direct costs of meals, coffee breaks, and an excursion, based on actual costs, of about 400 CHF)

MATCH-UP 2019 is the fifth workshop in the series of interdisciplinary and international workshops on matching under preferences.  The first in the series took place in Reykjavik in 2008, the second took place in
Budapest in 2012, the third in Glasgow in 2015, and the fourth in Boston in 2017.

Background:

Matching problems with preferences occur in widespread applications such as the assignment of school-leavers to universities, junior doctors to
hospitals, students to campus housing, children to schools, kidney
transplant patients to donors and so on. The common thread is that
individuals have preference lists over the possible outcomes and the task
is to find a matching of the participants that is in some sense optimal
with respect to these preferences.

The remit of this workshop is to explore matching problems with
preferences from the perspective of algorithms and complexity, discrete
mathematics, combinatorial optimization, game theory, mechanism design and economics, and thus a key objective is to bring together the research communities of the related areas.

List of topics:

The matching problems under consideration include, but are not limited to:
* two-sided matchings involving agents on both sides (e.g. college
  admissions, resident allocation, job markets, school choice, etc.)
* two-sided matchings involving agents and items (e.g. house allocation,
  course allocation, project allocation, assigning papers to reviewers,
  school choice, etc.)
* one-sided matchings (roommates problem, kidney exchanges, etc.)
* matching with payments (assignment game, etc.)

Invited speakers:
* Péter Biró, Hungarian Academy of Sciences, Budapest, Hungary
* Flip Klijn, Institute for Economic Analysis (IAE-CSIC), Barcelona, Spain
* Bahar Rastegari, University of Southampton, UK
* Ildi Schlotter, Budapest University of Technology and Economics, Hungary

MATCH-UP 2019 Submissions, Easychair Paper Submission link: https://easychair.org/conferences/?conf=matchup2019

We call for original papers that have not previously been published in (or accepted to appear in) a conference proceedings or a journal. Papers can however be under review for a conference or journal elsewhere at the time of submission.
There is no page limit for submissions. The submission should contain within the first 12 pages a clear presentation of the merits of the paper, including a discussion of the paper's importance within the context of prior work and a description of the key technical and conceptual ideas used to achieve its main claims. Proofs that can enable the main mathematical claims of the paper to be verified must be provided. Material other than the first 12 pages will be read at the committee's discretion.
Only abstracts of accepted papers will appear in the workshop proceedings. This should allow the simultaneous or subsequent submission of contributed papers to other workshops, conferences or journals. If authors so choose, they may include a link to the full version of their paper (if published, e.g., on arXiv, REpeC, SSRN or on a personal web page) in the proceedings.

MATCH-UP 2019 Important dates:

• Paper submission deadline: 15 January 2019
• Notification: 22 February 2019
• Final version for proceedings: 15 March 2019
• Poster abstract submission deadline: 1 April 2019
• Workshop: Sunday 26 May (starting at 1400) to Wednesday 29 May (ending at 1830) with an excursion in the afternoon of Tuesday 28 May

MATCH-UP 2019 Organizing Committee:

• Péter Biró, Hungarian Academy of Sciences, Budapest, Hungary
• Tamás Fleiner,  Budapest University of Technology and Economics, Hungary (CS Program Chair)
• Bettina Klaus, University of Lausanne, Switzerland (Chair)
• David Manlove, University of Glasgow, UK
• Marek Pycia, University of Zürich, Switzerland (ECON Program Chair)

MATCH-UP Steering Committee:

• Péter Biró, Hungarian Academy of Sciences, Hungary
• Brian Dean, Clemson University, USA
• Bettina Klaus, University of Lausanne, Switzerland
• David Manlove, University of Glasgow, UK

Further information:

Web: http://www.optimalmatching.com/MATCHUP2019/

Why own your own (fashionable) clothes?

There's a rental market for fashionable women's clothes, Rent the Runway

The NY Times ran a feature story on it:
The Transformational Bliss of Borrowing Your Office Clothes
Rent the Runway’s Unlimited service saves working women something more valuable than money: their time.

"Though Rent the Runway was originally conceived as a solution for women who didn’t want to invest in party-wear they might use only once, Unlimited has become a strategic solution for professional women...