Used parts: a different kind of deceased donation

How crematoriums are recovering precious metals from inside the dead
Worth thousands of dollars a year, money from recycling metal joints, other implants, goes to charity

"The recycling bin behind the cremation chamber is the first tip-off that Elgin Mills Crematorium, north of Toronto, is up to something different.

"The green bin is full of medical implants, including titanium hips and knees, stainless steel bone screws — even gold teeth.

"The pieces gathered here were, until recently, inside the bodies of deceased people. Cremating a body incinerates nearly all biological material, but artificial materials can be collected quite literally out of the ashes.

"But the Mount Pleasant Cemetery Group, which operates Elgin Mills Crematorium, has adopted a system not only to safely recover these materials but recycle them with a rather altruistic buyer — who compensates them based on what they pass on.
...
"There are typically about a dozen metals collected after a series of cremations. Titanium from hip and knee replacements, gold and silver from dental work and jewellery, plus cobalt, palladium, platinum and a series of lower value materials from various other devices. It is then placed in a bin similar to what many Canadians use to take their own recycling to the curb.

"Rather than being diverted to a mass grave in a cemetery, however, the metals are collected by OrthoMetals, a Dutch firm that specializes in post-cremation recycling.

The unbundling of hotel services--marketplaces for luggage storage

Airbnb is remarkable for the way it has become a major competitor to hotels, by deploying properties that were designed (and may be zoned) as private residences.  In doing so, it has separated the lodging services that hotels provide from some of the other services, like lounges, restaurants, bars, gyms, spas, and ... luggage storage.  So what are you to do if your plane arrives hours before your airbnb is ready, or if you have time to kill after checkout time?

There's an app for that: Lifehacker has the rundown.
How to Temporarily Store Your Luggage When You're Staying at an Airbnb

There's Stasher, for "Luggage storage in trusted shops & hotels
Book on-demand at a low daily rate"

And Bounce: "Bounce: Bag Storage Everywhere--On-demand storage & delivery".

Luggage Hero: "Store your luggage in a local shop"

and in Europe, Nannybag.

De-biasing academic hiring?

This is the season when new Ph.D.'s in Economics are hired as assistant professors. More senior professors are hired throughout the year. A constant source of concern is how to promote a diverse professoriate.  But because academics are very different from one another, we have to get to know potential candidates reasonably well before we hire them. Just for example, they have papers that have to be read, and they typically give a seminar before the whole faculty once they get far enough in the process.

So...along with learning about what they have studied and written about, we also learn their race and gender, and where they studied and with whom, and what the senior scholars in their field think about them, and a host of other things that could influence our collective decision when it comes time to vote who to hire.

Here are two stories, from Britain and Finland, about efforts to design the faculty hiring process to remove "extraneous" considerations.  I am very skeptical that we can learn all that we need to know about candidates without learning extraneous things, so I would be astonished if these proposals gain traction.

Both articles, linked below from Inside Higher Ed,  appeared in Times Higher Education.

From Britain:

Trying to ‘De-Bias’ Faculty Recruiting
Can a shift in the way candidates are evaluated eliminate bias based on gender, race and background?
By John Morgan for Times Higher Education  January 31, 2019

"CVs and interviews are being removed from university hiring processes under a new approach to “de-bias” academic recruitment being pioneered in Britain.

"The Recruiting for Difference approach, billed as an attempt to address biases around gender, ethnicity and university background, is led by the recruitment firm Diversity by Design, co-founded by the writer and broadcaster Simon Fanshawe, former chair of council at the University of Sussex.

"Fanshawe, a founder of the LGBT equality charity Stonewall, said the aim was to “de-bias” to the greatest extent possible, explaining that, under this approach, “what you don’t use in the short-listing process at all is CVs.” He argued that stripping out CVs allowed universities to see the true qualities of the people they were considering for jobs.

"The application process allows applicants to state which journals they have published in and the roles they played in these papers. But candidates’ names do not figure in the short-listing process -- thus their gender and ethnicity are not revealed -- and at no stage of the hiring process is it disclosed at which universities candidates have worked or studied."
****************

From Finland:
U of Helsinki Tries Anonymized Academic Hiring--Pilot project seeks to eliminate bias.
By Rachael Pells for Times Higher Education  December 20, 2018

"Finland’s leading university is trying the use of anonymized applications for academic roles as part of a nationwide push toward greater equality in hiring practices.

"The University of Helsinki confirmed that it was conducting two pilot programs focused on academic recruitment, in which applications were stripped of candidates’ names, dates of birth, ethnicities and genders.

"Universities are increasingly experimenting with name-blind student recruitment, and advocates of its use in the hiring process argue that it could help to limit the impact of unconscious biases that penalize women and minorities.

"However, there are questions over whether it could catch on in academic departments, in which recruitment decisions are closely tied to a researcher’s publication record and scholarly reputation."

Marijuana debate in New Hampshire

The NY Times has the story:

Legalize Pot? Amid Opioid Crisis, Some New Hampshire Leaders Say No Way

"MANCHESTER, N.H. — The push to legalize recreational marijuana is sweeping the Northeast: Massachusetts, Vermont and Maine have done it, and the governors of Rhode Island, Connecticut, New York, and New Jersey say they want their states to do it, too.

"But in New Hampshire, Gov. Chris Sununu and some other state leaders are opposed. The problem, they say, is not just about pot. It’s about opioids — drugs that have ripped across this state, devastating thousands of residents and leaving New Hampshire in recent years with one of the highest per capita death rates from opioid-related overdoses. After so many deaths, so much misery and so much state money spent fighting opioids, the opponents say, how could anyone even think about easing access to some other drug?

"There is little consensus about a relationship between marijuana use and opioid addiction, and the debate in New Hampshire, where a key vote on the issue is expected this week, is tapping into a national discussion about whether marijuana is a gateway drug or something else entirely."

Market design in Management Science (the journal)

The journal Management Science is open to market design papers in at least two of its departments. Gabriel Weintraub alerts me to the following announcement:

Revenue Management and Market Analytics Department in Management Science

It begins:

Dear MD colleagues:

We wrote the blog below about this new department in Management Science. Part of the mission of the department is related to “market analytics”, which has a significant market design component. We have been receiving several strong market design papers from economists and from other disciplines but would like to see more, so we are sharing this here. 

We look forward to receiving your work!

Best,

Gabriel Weintraub

Associate Professor

Stanford GSB

Official and unoffical Iranian kidney marketplaces--online prices

The Journal of Urology has published an in-press short paper about an informal website that seems to operate alongside the official Iranian monetary market for kidneys. (Thanks to Jim Brooks for the pointer.)

 Donor Willingness to Accept for Selling a Kidney for Transplantation: Evidence from Iran  by Mehdi Feizi and Tannaz Moeindarbari

"The Iranian model of kidney donation, established in 1988, is a state-funded system of living  renal  transplant  where  the  government  pays  for  all  transplant-related  expenses.  The Iranian Kidney Foundation, IKF hereafter, is in charge to match recipients and compensated donors. On the supply side, each donor registers at the local IKF after conducting preliminary medical  tests.  On  the  demand  side,  any  ESRD  patient  could  enter  the  kidney  waiting  list according to his/her blood type. A renal patient is matched to a donor, basically with the same blood type, based on the first come, first served.

"Both sides could also find each other outside the IKF, say in an online kidney matching website. However, since the transplant is exclusively possible through an official letter from the IKF,  they  have to register there."
***********
The article goes on to analyze prices asked and offered for kidney donation at the online kidney website that they refer to, http://www.koliee.ir/ .  It's in Farsi, but when I ask Google to translate it, their home page looks pretty interesting.  (It seems to offer the opportunity to search for kidneys by price as well as blood type.)

It contains some cautionary sentences:

"If you want to reach your goal without problems on this website, refuse to pay any money before the operation. Also, carry out kidney donation only through the Association for the Protection of Nephrology in your city."

It would be interesting to understand how websites like this interact with the official kidney market.

They also have a list of "our other websites" (again, in translation). The first one deals with surrogacy:

 Rental uterus

 My card

 Kidney donation

 The purse

 Amateur crafts

 Toggle Finder

 Mbti test

 Hello

 Buy and Sell a Loan

 Gnocard

Congratulations to the 2019 Sloan Fellows

The full list, across all disciplines is here:

2019 Sloan Research Fellows

 Here are the 2019 economists:

Economics

Nikhil Agarwal, Massachusetts Institute of Technology

Denis Chetverikov, University of California, Los Angeles

Rebecca Diamond, Stanford University

Will Dobbie, Princeton University

Michal Kolesár, Princeton University

Melanie Morten, Stanford University

Philipp Strack, University of California, Berkeley

Gabriel Zucman, University of California, Berkeley

And the computer scientists:

Computer Science

Yang Cai, McGill University

Alvin Cheung, University of Washington

Reetuparna Das, University of Michigan

Rong Ge, Duke University

Bernhard Haeupler, Carnegie Mellon University

Moritz Hardt, University of California, Berkeley

Haitham Hassanieh, University of Illinois, Urbana-Champaign

Gillat Kol, Princeton University

Jason D. Lee, University of Southern California

Sergey Levine, University of California, Berkeley

Wyatt Lloyd, Princeton University

Shayan Oveis Gharan, University of Washington

Emily Whiting, Boston University

Christopher Wilson, Northeastern University

Keith Winstein, Stanford University

Mary Wootters, Stanford University

Payments for kidney disease in the U.S.

Medpage Today has the story:

Kidney Disease Payment System Draws Medicare Scrutiny
'We do not think the state of kidney disease care is acceptable'

"Medicare needs to change the way it pays for kidney disease treatment in order to get better results, Adam Boehler, director of the Center for Medicare & Medicaid Innovation, said here.

"We do not think the state of kidney care is acceptable," Boehler said Wednesday at the annual meeting of the Healthcare Information and Management Systems Society. "Right now, we're at a place where 10% of patients in Medicare [with kidney disease] are seen at home, while you have Hong Kong, with a 70% rate. That's not OK. The level of transplants is not OK."

"What happens is that end-stage renal disease (ESRD) is siphoned out and [effort is] focused there, instead of viewing the whole spectrum, instead of thinking about chronic kidney disease before ranging from diagnosing it in the first place, to integration of later-stage chronic kidney disease, to ESRD," he said. "Because what you really want is the prevention of ESRD from developing," he said. "If it develops, you want [it] to be transplant wherever possible; if not, [treatment at] home wherever possible, and it should be a last resort that people go to a dialysis center."

...

"Boehler said he wasn't trying to demonize dialysis centers. "It's our fault; we set the incentives," he said, referring to Medicare. "You need to change those incentives. If we want people to do what's best for patients, if we want them to lower costs and improve quality for patients, they need to make money for doing that -- we'll look specialty by specialty to set it up like that."

"Medicare spends about $120 billion a year on kidney care, Boehler noted. "The first thing you may think about in ESRD is dialysis centers ... but that is not the majority of spend. The majority of spend is in other places -- hospitals, complications arising from them, et cetera. That doesn't mean we have to cut the spend there; it means you have to change around the way people make money." Right now, he said, for the dialysis centers, "if somebody gets a transplant, that's a lost customer."

Carbon tax and dividend--now supported by 3300 economists from Aaron to Zykaj

The Financial Times reports on the growing number of U.S. economists who support a carbon tax, with the money to be returned to citizens as equal lump sum rebates.

Surge in US economists’ support for carbon tax to tackle emissions

"The carbon tax proposal, organised by the Climate Leadership Council, is a bipartisan effort that has united senior economists from both parties, and now garnered 3,300 signatures from professional economists and academics across the US."
*************

Here's the statement, and a list of all the signers from Henry Aaron to Blerina Zykaj; it's a long list...

ECONOMISTS’ STATEMENT ON CARBON DIVIDENDS
The Largest Public Statement of Economists in History
*************

Earlier post:

Thursday, January 17, 2019

Carbon tax with revenue returned through equal lump-sum rebates: open letter

Refugees and asylum seekers, in three charts

From the Federal Reserve Bank of St. Louis,

Where Do Most Refugees Come From, and Where Do They Go?
 By Subhayu Bandyopadhyay, and Asha Bharadwaj,

More on the immigration "emergency": U.S. undocumented population continues to fall

The latest  Journal on Migration and Human Security has an article whose title conveys a lot of information.  For example, most undocumented residents didn't cross the border illegally.

US Undocumented Population Continued to Fall from 2016 to 2017 and Visa Overstays Significantly Exceeded Illegal Crossings for the Seventh Consecutive Year  by Robert Warren

EXECUTIVE SUMMARY

This article presents estimates of the US undocumented population for 2017 derived by the Center for Migration Studies of New York (CMS). It focuses on the steep decline in the undocumented population from Mexico since 2010. While the president has focused the nation’s attention on the border wall, half a million[1] US undocumented residents from Mexico left[2] the undocumented population in 2016 alone, more than three times the number that arrived that year, leading to an overall decrease of nearly 400,000 undocumented residents from Mexico from 2016 to 2017. From 2010 to 2017, the undocumented population from Mexico fell by a remarkable 1.3 million.

For the past 10 years, the primary mode of entry for the undocumented population has been to overstay temporary visas. This article provides estimates of the number of noncitizens who overstayed temporary visas and those who entered without inspection (EWIs) in 2016 by the top five countries of origin.

Summary of Findings

• The US undocumented population from Mexico fell by almost 400,000 in 2017.
• In 2017, for the first time, the population from Mexico constituted less than one half of the total undocumented population.
• Since 2010, the undocumented population from Mexico has declined by 1.3 million.
• In California, the undocumented population from Mexico has declined by 26 percent since 2010, falling from 2.0 to 1.5 million; it also dropped by 50 percent in Alabama, and by one third in Georgia, New York, and New Mexico.
• The undocumented population from Venezuela grew rapidly after 2013, increasing from 60,000 to 145,000 in just four years.
• Visa overstays have significantly exceeded illegal border crossings during each of the last seven years.
• Mexico was the leading country for overstays in 2017, with about twice as many as India or China.

The estimates presented here were derived by CMS based on information collected in the Census Bureau’s annual American Community Survey (ACS). 

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

See earlier, same author:

Thursday, January 10, 2019

Repugnance watch: Illegal migration crisis? It's hard to see in the numbers

Commercial surrogacy to be legalized in New York?

Some stories on the current proposals and the controversy involved.

From the NY Post:

Cuomo proposes law to end ban on surrogate moms

"Gov. Cuomo is proposing a new law that will lift the ban on surrogacy contracts — enabling New Yorkers for the first time to pay a woman to have a baby for them through in-vitro fertilization.

The ban has been in place since 1992.

“New York’s antiquated laws frankly are discriminatory against all couples struggling with fertility, same sex or otherwise” Cuomo said in a statement to The Post."

***********

From the National Catholic Register:

Cuomo Proposal Would Lift New York’s Ban on Surrogacy Contracts --Under current law, surrogacy contracts in the state are punishable by a fine of up to $10,000 or by a felony charge.

"Just days after expanding legal abortion up to the point of birth, New York Gov. Andrew Cuomo is proposing a law that would lift the ban on surrogacy contracts in the state of New York.

If passed, the law would allow New Yorkers to pay a woman to carry to term a child conceived through in vitro fertilization. It would not allow a surrogate mother to use her own eggs (and therefore be related biologically to the child).
...
"Cuomo’s proposal, called the Child-Parent Security Act, is included in the governor’s executive budget plan for the state and is something his administration has been considering since at least 2015, according to the Post.  
When Cuomo first floated the idea, Jennifer Lahl of The Center for Bioethics and Culture Network, slammed surrogacy for treating women “like breeding animals.”
“We try to get a mother and a baby to bond,” Lahl told the Post in 2015. “We’re against ripping the baby from the mother the moment he leaves the womb. It’s not good for the child.”
Surrogacy laws vary widely throughout the United States. Besides New York, only three other states explicitly ban all surrogacy contracts: Nebraska, Michigan, and Arizona. Many other states have restrictions on surrogacy agreements and treat the surrogacy process similarly to adoption, requiring court appearances, home studies and a window for the birth mother to change her mind after the baby is born.
Surrogate mothers are typically paid between $30,000 and $50,000 for carrying a child to term, depending upon the state and the contract.  
...
"Kathleen Gallagher, the New York Catholic Conference director of pro-life activities, told the Post that she found the New York proposal “appalling.”
“This is the buying and selling of children and the exploitation of women. There are going to be poor women exploited by wealthy couples,” she said.
The Catholic Church denounced the practice of surrogacy in the 1987 document Donum Vitae, in which the Vatican stated that surrogacy “represents an objective failure to meet the obligations of maternal love,” calling it a “detriment” to the family and the dignity of the human person by divorcing the “physical, psychological and moral elements which constitute those families.”

Matching story for Valentine's day--BBC

Valentine's Day sparks a demand not just for love, but also for stories about marriage as a matching market.  This year I was among those interviewed by the BBC.  Below are two links:  you can listen to the interviews, or read a summary.

First, the interviews: They go for 18 minutes, and are easy listening.  I'm interviewed third, beginning just before minute 10 and going to about minute 14.   (I didn't see a way to embed it) :

Rational Partner Choice: "Should your head trump your heart when seeking lifelong love? We ask an economist, a romantic novelist and a hyper-rationalist businessman this Valentine's Day challenge."

(There actually are 4 interviews, the fourth is with the wife of the businessman, Ed Conard: they've been happily married for 20 years.)
************

The written summary has me as the middle of three views on the subject (the headline below reflects the first of the views they considered, with marriage modeled as an optimal stopping problem).

Forget love: This is how to find your perfect partner  By Justin Rowlatt

Here's what they say about their conversation with me:

"Mr Conard's approach to choosing a wife is a well-established method for buying things like a new place to live but, says Nobel Prize winning economist Alvin Roth, spouses aren't like houses: marriage is a market without prices.
...
"He agrees that it is important to meet quite a few possible partners before you take the plunge - "don't marry the first person you meet", he warns.

"You've also got to have realistic expectations: "the first thing a matrimonial agency has to do is persuade clients they aren't a 10."

"But, he says, you can do too much calibrating and evaluating. Choosing a partner is a two-way thing: it is only when you are serious about marriage that potential partners will take you seriously.

"Part of being well matched is the history you share and this starts when you first meet", Prof Roth says, "so investing in that history improves the quality of that match."
***************
And here are my Valentine's Day blog posts to date.

Market design through machine learning: David Parkes

If I were in Boston I'd go to hear David Parkes speak today about

Optimal Economic Design through Deep Learning

Abstract: Designing an auction that maximizes expected revenue is a major open problem in economics. Despite significant effort, only the single-item case is fully understood. We ask whether the tools of deep learning can be used to make progress. We show that multi-layer neural networks can learn essentially optimal auction designs for the few problems that have been solved analytically, and can be used to design auctions for poorly understood problems, including settings with multiple items and budget constraints. I will also overview applications to other problems of optimal economic design, and discuss the broader implications of this work. Joint work with Paul Duetting (London School of Economics), Zhe Feng (Harvard University), Noah Golowich (Harvard University), Harikrishna Narasimhan (Harvard -> Google), and Sai Srivatsa (Harvard University). Working paper: https://arxiv.org/abs/1706.03459

The new market for (and marketing of) nicotine--Robert Jackler (followed by the CDC)

My colleague Rob Jackler has been investigating the marketing of nicotine delivered through (non-burning) e-cigarettes, which deliver nicotine without combustion products, by "vaping." Apparently nicotine is highly addictive, and the marketing is taking aim at very young people, including  "stealth" delivery systems designed to camouflage the act of vaping.

Here's a Stanford Medicine interview, published yesterday:
Robert Jackler says Juul spurs 'nicotine arms race'


Here's a figure from the paper "Nicotine arms race: JUUL and the high-nicotine product market, " by Robert K Jackler, Divya Ramamurthi, in the Journal Tobacco Control.

 And here's a figure from the article
"JUUL and other stealth vaporisers: hiding the habit from parents and teachers," by Divya Ramamurthi, Cindy Chau, Robert K Jackler, in Tobacco Control

*****
In related news, also published yesterday, here's a press release from the Center for Disease Control (CDC):
4.9 million middle and high school students used tobacco products in 2018

"About 4.9 million middle and high school students were current users (used in the past 30 days) of some type of tobacco product in 2018, up from 3.6 million in 2017. This increase—driven by a surge in e-cigarette use—erased past progress in reducing youth tobacco product use, according to a new Vital Signs report published by the Centers for Disease Control and Prevention (CDC).
...
"More than 1 in 4 (27.1%) high school students and about 1 in 14 (7.2%) middle school students currently used a tobacco product in 2018. For the fifth year in a row, e-cigarettes (20.8%) were the most commonly used tobacco product among high schoolers...
...
"This Vital Signs report is based on data from the 2011–2018 National Youth Tobacco Surveys analyzed by CDC, the Food and Drug Administration (FDA), and the National Cancer Institute (NCI)."

Here's a figure from the Vital Signs report:

Computational and Experimental Economics Conference in Barcelona

Here's the call for papers, by Feb 28:
Computational and Experimental Economics

The workshop will run for 2 days and will take place on June 10-11, 2019 in Barcelona. In this two days’ workshop we want to bring together researchers working in two quite separate fields, computational economics and experimental economics, which yet have seen a steady increase of fruitful interaction in the recent years ( see e.g. The Handbook of Computational Economics, Heterogenous Agents, Edited by Cars Hommes, Blake LeBaron, Volume 4, 2018, Elsevier.).

Topics include the understanding of the emergent dynamic properties of economic models, some of which are too complex to solve analytically. However, human behavior can often be captured by relatively simple heuristics. While computational economics departs from simulations to derive their models, experimental economics uses human behavior and then often simulation techniques to develop descriptive models of such behavior. Such models include Agent Based Modeling (ABM), models of learning based on genetic algorithm, Reinforcement models, and other learning or cognitive models.

Keynote Speakers

• Yan Chen (University of Michigan)
• Herbert Dawid (University of Bielefeld)

Workshop organizers

• Jasmina Arifovic (Simon Fraser University)
• Domenico Delli Gatti (Università Cattolica del Sacro Cuore)
• John Ledyard (Caltech)
• Rosemarie Nagel (ICREA-UPF and Barcelona GSE)

Digital Economy and Inclusive Growth--report from the Luohan Academy

Here's an initial report from the Luohan Academy:

 Digital Technology and Inclusive Growth--Executive Summary

From the mission statement:
"Social scientists in general, including economists, must therefore collaborate to help societies adapt smoothly and fairly to the digital revolution. Two important objectives of the academic community are first, to understand business models and market structures that enable growth and progress, and second, to identify the impact of digitization on individual and social welfare. So far the rapidly increasing scale of digitization has not been followed by a corresponding increase in theoretically grounded empirical research on the rationales,  consequences, and policies of digitization. A well-organized research community could greatly facilitate and speed up such research efforts."

And, as the report makes clear, China is a good place to study ecommerce:

Stanford GSB celebrates Mohammad Akbarpour

Mohammad Akbarpour: Humanizing Math for the Greater Good
"The Stanford GSB economist discusses his groundbreaking research into kidney exchanges, wealth inequality, and “anything that wakes me up at night.”
...
"In 2012, ...He and four of his close friends, who had all attended high school, college, or graduate school together, were feeling unsatisfied with their influence beyond Stanford’s manicured campus. Then Salman Khan, the founder of Khan Academy, presented at Stanford GSB.

"After watching Khan’s talk, Akbarpour and his friends built KelaseDars, also known as KhanacademyFarsi, to which Akbarpour has now contributed more than 280 videos on subjects ranging from high school Newtonian physics to college-level game theory. The website as a whole has delivered more than 5 million free lessons to Farsi speakers who would otherwise not have access to a high-quality education. Many of them live in Afghanistan and Iran.
...
"It was hectic and hard, “but it was a beautiful experience with a magnificent team,” Akbarpour says. “KelaseDars is the most meaningful thing I’ve done with my life.”

And here:

Kidney matching podcast: Jeremiah Johnson interviews me and Josh Morrison

On the Neoliberal Podcast (49 minutes):
Kidney Matching featuring Dr Alvin Roth & Josh Morrison

Josh Morrison, who donated one of his kidneys as a non-directed donor, is a founder of Waitlist Zero.
*******

The audio connection seemed to change my voice a bit: here's an unusual comment, forwarded to me by a twitter-literate colleague:

Replying to @ne0liberal @JoshMorrison @waitlistzero

Dr Roth has the velvetiest voice I’ve ever heard

(if you find voices entertaining, you can compare it to the audio in yesterday's post, where I thought I sounded more like myself.)

Kidney exchange chains and altruistic kidney donation on PBS newshour

PBS economics correspondent Paul Solman interviews non-directed kidney donors, and kidney exchange patients, and me, in yesterday's PBS newshour.

Here's a link to video of the 10 minute segment on kidneys, including a transcript.
How an economist’s idea to create kidney transplant chains has saved lives

and here's the video itself:

The show talks about how a single altruistic donor can initiate a long chain of kidney transplants that helps many people.

The kidney exchange organization that started non-simultaneous non-directed donor chains is the Alliance for Paired Donation, run by Mike Rees, and I think that they still organize the longest chains, i.e. the ones with the highest average number of transplants.  

The very first long chain was reported in this article in the New England Journal of Medicine:

Rees, Michael A., Jonathan E. Kopke, Ronald P. Pelletier, Dorry L. Segev, Matthew E. Rutter, Alfredo J. Fabrega, Jeffrey Rogers, Oleh G. Pankewycz, Janet Hiller, Alvin E. Roth, Tuomas Sandholm, Utku Ünver, and Robert A. Montgomery, “A Non-Simultaneous Extended Altruistic Donor Chain,” New England Journal of Medicine, 360;11, March 12, 2009

Here's the full hour-long newshour: kidneys are from about minute 34:46 to minute 44:38 on the video below.

Michel Balinski (1933-2019)

Michel Balinski, perhaps best known for his work on the design of voting systems*, has passed away.
Here's the announcement:

"INFORMS is saddened to share the passing of Michel Balinski, a long-time INFORMS member and a major figure in operations research, mathematics, economics, and political science. Balinski is best known for bringing O.R. methodology to bear on the electoral process, for which he is recognized as the inventor of several fair voting and representation systems. We invite you to share remembrances, photos, and other thoughts on this post, and to learn more about Michel Balinski's incredible career and contributions to the field. His full biography is available under INFORMS History of O.R. and Excellence on INFORMS.org."

*See e.g.
Fair Representation: Meeting the Ideal of One Man, One Vote  
By Michel L. Balinski, H. Peyton Young

Philly and Feds at odds over reducing opioid overdoses

Here's the story from NPR:

U.S. Prosecutors Sue To Stop Nation's First Supervised Injection Site For Opioids

"After months of threats, federal prosecutors in Philadelphia launched a legal challenge on Wednesday against the nonprofit Safehouse, which is hoping to open what could be the nation's first site where people with opioid addiction can use drugs under medical supervision.

"The civil lawsuit, which is jointly being pursued by Pennsylvania-based prosecutors and the Department of Justice in Washington, is the first time the federal government has intervened in the hotly debated issue of supervised injection sites. The lawsuit could become an important legal test case as about a dozen cities across the country consider similar proposals.
...
"The provision of the law in question is widely known as the crack house statute. It makes it illegal to maintain a space for the purpose of making, storing, distributing or using an illegal drug. Safehouse would not make or provide opioids to users. But it would allow people to bring in their own drugs, to use while being monitored by medical staff."

Transplant statistics (through 2016) from the 2018 USRDS annual data report

The United States Renal Data System. 2018 USRDS annual data report  has come out. It seems to cover data through 2016.  Here are the bullet points on transplantation.

Chapter 6: Transplantation

• In 2016, 20,161 kidney transplants were performed in the United States (19,301 were kidney-alone; Figure 6.6).
• Fewer than a third (28%) of kidneys transplanted in 2016 were from living donors (Figure 6.6).
• From 2015 to 2016, the cumulative number of recipients with a functioning kidney transplant increased by 3.4%, from 208,032 to a total of 215,061 (Figure 6.7).
• On December 31, 2016, the kidney transplant waiting list had 81,418 candidates on dialysis, 51,238 (62.9%) of whom were active. Eighty-five percent of all candidates were awaiting their first transplant (Figure 6.1).
• Among Candidates newly wait-listed for either a first or repeat kidney-alone transplant (living or deceased-donor) during 2011, the median waiting time to transplant was 4.0 years (Figure 6.4). This waiting time varied greatly by region of the country, from a low of 1.4 years in Nebraska to a high of 5.1 years in Georgia (Reference Table E.2.2).
• Unadjusted rates of kidney transplantation among dialysis patients had been declining since at least 2006 for candidates for both living and deceased donors. These appear to have stabilized as of 2013, at about 2.5 per 100 dialysis patient-years for recipients from deceased donors and about 1.0 per 100 dialysis patient-years for recipients from living donors (Figure 6.8).
• The number of deceased kidney donors, aged 1-74 years, with at least one kidney retrieved increased by 62.7%, from 5,981 in 2001 to 9,732 in 2016 (Figure 6.19.a).
• The rate of kidney donation from deceased Blacks/African Americans nearly doubled from 2002 to 2016, from 4.5 to 7.9 donations per 1,000 deaths (Figure 6.21.b). This rate overtook that of Whites in 2009. Asians consistently had the highest rate of deceased kidney donation during this time, at about 9 per 1,000 deaths.
• Since 1999, Whites have had the highest rate of living kidney donation, although this has been in decline along with all other races except Asians, who as of 2016 showed rates of living donation essentially equivalent to Whites (Figure 6.16.b).
• Eighteen percent of kidneys recovered from deceased donors were discarded in 2016; this rate has increased slightly since 2010.
• The number of kidney paired donation transplants has risen sharply since 2005, with 642 performed in 2016, which represented 11% of living-donor transplants that year. The rate plateaued during 2012-2014 but increased again in 2016 (Figure 6.18).*
• Since 1999, the probabilities of graft survival have improved among recipients of both living and deceased-donor kidney transplants, over both the short-term (one-year survival) and long-term (five and ten-year survival) (Figure 6.25).
• In 2015, the probabilities of one-year graft survival were 93% for deceased and 98% for living-donor kidney transplant recipients (Figure 6.25).
• In 2015, the probabilities of patient survival within one-year post-transplant were 96% and 99% of deceased- and living-donor kidney transplant recipients (Figure 2.6).
• The one-year graft-survival and patient-survival advantages experienced by living-donor transplant recipients persisted at five and ten years post-transplant (Figures 6.25 and 6.26).

*

Repugnance in Spain: surrogacy and prostitution

I've relatively recently started to pay attention to repugnance in Spain, here are some useful older links.

From El Pais:
Spain struggles with surrogate pregnancy issue
Practice is illegal here but debate rages over whether surrogacy is a right or a form of exploitation


From la Asociación por la Gestación Subrogada en España
Sobre la Gestación Subrogada

GT "In our country the surrogate pregnancy is illegal: Article 10 of Law 14/2006, of May 26, on Techniques of Assisted Human Reproduction establishes that the contract by which gestation is agreed, with or without price, in charge of a woman who renounces maternal filiation in favor of the contracting party or third party is null and void. 

"However, the Instruction of October 5, 2010 of the General Directorate of Registries and Notaries has left without effective content the prohibition of surrogate pregnancy by contemplating the registration in the Civil Registry of children of this technique provided that the procedure has been carried out in a country where this technique is regulated, that one of the parents is Spanish and that there is a court order that guarantees, among other aspects, the rights of the pregnant woman. The name of this woman will not appear in the annotation made in our records.

"This creates an important discrimination between those Spaniards who can afford treatment outside our borders and those who can not."


From Bright Magazine;
Decriminalizing Sex Work in Spain Made It Safer For Women — and Traffickers
Thirty years ago, most sex workers were Spanish. Today almost 90 percent are immigrants, most under the control of organized crime networks.

Kidney exchange in Israel using Itai Ashlagi's software

My colleague Itai Ashlagi has been inventing, building, distributing and updating state of the art kidney exchange software ever since he came to Harvard, some years ago. Since then he's been at MIT, and now Stanford, but this recent article from the Jewish Telegraphic Agency about how his software is propagating in Israel still thinks he's at Harvard:

New program finds donors for complicated kidney transplant patients

"JERUSALEM (JTA) — Kidney transplant patients who have had a hard time finding a match will have another opportunity through a new unit at an Israeli hospital.

"Kidney transplant patients who suffer from high levels of antibodies due to previous transplants or blood donations can go for many years without finding a suitable donor. A new and advanced software program can be used to cross-check through advanced information systems from hospitals in Israel and around the world.

"The program, developed by Professor Itai Ashlagi of Harvard University, was donated to the Matnat Chaim organization and will be operated out of Beilinson Hospital’s Department of Transplantation in Petach Tikvah, in central Israel."

Kim Krawiec on repugnance, and global kidney exchange

Kim Krawiec talks about podcasts, and then about repugnance with some of her old podcast pals at Oral Argument.  They talk about global kidney exchange (the short title they propose to her is "more kidneys, more better," around minute 5:30 when the substantive discussion starts).

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


Kim blogs about this herself over at the Faculty Lounge:
Repugnance, Global Kidney Exchange, and Drinking Our Own Spit: An Oral Argument Reunion

Medically assisted death

The Guardian and the BBC bring us up to date on death with dignity in the Netherlands.

Here are some excerpts from the Guardian's long read:

Death on demand: has euthanasia gone too far?
Countries around the world are making it easier to choose the time and manner of your death. But doctors in the world’s euthanasia capital are starting to worry about the consequences
By Christopher de Bellaigue

"Keizer is one of around 60 physicians on the books of the Levenseindekliniek, or End of Life Clinic, which matches doctors willing to perform euthanasia with patients seeking an end to their lives, and which was responsible for the euthanasia of some 750 people in 2017. For Keizer, who was a philosopher before studying medicine, the advent of widespread access to euthanasia represents a new era. “For the first time in history,” he told me, “we have developed a space where people move towards death while we are touching them and they are in our midst. That’s completely different from killing yourself when your wife’s out shopping and the kids are at school and you hang yourself in the library – which is the most horrible way of doing it, because the wound never heals.
...
"Euthanasia has been legal in the Netherlands for long enough to show what can happen after the practice beds in.
...
"In 2002, the parliament in the Hague legalised euthanasia for patients experiencing “unbearable suffering with no prospect of improvement”. Since then, euthanasia and its close relation, assisted dying, in which one person facilitates the suicide of another, have been embraced by Belgium and Canada, while public opinion in many countries where it isn’t on the national statute, such as Britain, the US and New Zealand, has swung heavily in favour.

"The momentum of euthanasia appears unstoppable; after Colombia, in 2015, and the Australian state of Victoria, in 2017, Spain may be the next big jurisdiction to legalise physician-assisted death, while one in six Americans (the majority of them in California) live in states where it is legal. In Switzerland, which has the world’s oldest assisted dying laws, foreigners are also able to obtain euthanasia.
...
"Euthanasia is counted as a basic health service, covered by the monthly premium that every citizen pays to his or her insurance company. But doctors are within their rights not to carry it out. Unique among medical procedures, a successful euthanasia isn’t something you can assess with your patient after the event. A small minority of doctors refuse to perform it for this reason, and others because of religious qualms. Some simply cannot get their heads around the idea that they must kill people they came into medicine in order to save.
...
"At any meeting organised by the NVVE [Dutch Voluntary Euthanasia Society], you will look in vain for poor people, pious Christians or members of the Netherlands’ sizeable Muslim minority. Borne along by the ultra-rational spirit of Dutch libertarianism (the spirit that made the Netherlands a pioneer in reforming laws on drugs, sex and pornography), the Dutch euthanasia scene also exudes a strong whiff of upper-middle class entitlement.

"Over coffee I was introduced to Steven Pleiter, the director of the Levenseindekliniek. We went outside and basked in the early October sun as he described the “shift in mindset” he is trying to achieve. Choosing his words with care, Pleiter said he hoped that in future doctors will feel more confident accommodating demands for “the most complex varieties of euthanasia, like psychiatric illnesses and dementia” – not through a change in the law, he added, but through a kind of “acceptance … that grows and grows over the years”. When I asked him if he understood the scruples of those doctors who refuse to perform euthanasia because they entered their profession in order to save lives, he replied: “If the situation is unbearable and there is no prospect of improvement, and euthanasia is an option, it would be almost unethical [of a doctor] not to help that person.”
...
"Even those who have grave worries about the slippery slope concede that consensual euthanasia for terminal illness can be a beautiful thing, and that the principle of death at a time of one’s choosing can fit into a framework of care. The question for any country contemplating euthanasia legislation is whether the practice must inevitably expand – in which case, as Agnes van der Heide recognises, death will eventually “get a different meaning, be appreciated differently”. In the Netherlands many people would argue that – for all the current wobbles – that process is now irreversible."
*******

And here's a link and a figure from the BBC story, which concentrates on the difficult case of dementia--difficult because even the clearest directive from a patient with early stage dementia who wants to end his or her life as the disease progresses can often not be confirmed by the patient once dementia is fully established.

Wanting to die at 'five to midnight' - before dementia takes over

Colleges harvest signals of interest in more ways

Congested markets--those in which there are more potential transactions than can be easily processed--promote signaling, and the search for signals, about which transactions to pursue.  College admissions is a famously congested market, particularly since it became easy for students to submit many applications. So all but the most elite colleges have long searched for signals of "demonstrated interest."  The WSJ has an update on how technology is changing that search.

The Data Colleges Collect on Applicants
To determine ‘demonstrated interest,’ some schools are tracking how quickly prospective students open email and whether they click links  By Douglas Belkin

"Enrollment officers at schools including Seton Hall University, Quinnipiac College and Dickinson College know down to the second when prospective students opened an email from the school, how long they spent reading it and whether they clicked through to any links. Boston University knows if prospective students RSVP’d online to an event—and then didn’t show.
...
"At Seton Hall University, in South Orange, N.J., students receive a score between 1 and 100 that reflects their demonstrated interest, said Alyssa McCloud, vice president of enrollment management. The score includes about 80 variables including how long they spent on the school’s website, whether they opened emails and at what point in high school they started looking on the website (the earlier the better).
...
"In 2017, 37% of 493 schools surveyed by the National Association of College Admission Counseling said they consider demonstrated interest to be of moderate importance—on par with teacher recommendations, class rank and extracurricular activities. It carried less weight than grades, class rigor or board scores.
...
"Colleges also have low-tech means to help determine demonstrated interest. Last year, one third of students who applied to American University either visited its Washington, D.C., campus or attended an information session about the school, said Andrea Felder, assistant vice provost for undergraduate admissions. Two thirds of those admitted took part in either the campus tour or offsite information session.
...
"Mary Hinton, a senior at Dickinson College, benefited from demonstrated interested without knowing it. After she toured Dickinson in high school, she sent a thank-you note to her tour guide, at her mother’s suggestion.

Now a tour-guide herself, Ms. Hinton has learned those notes are forwarded from tour guides to admissions officers. Her advice to prospective students about thank-you notes: “Write them. It just takes a minute and it can make a difference.”