More on the UAE-Israel kidney exchange

If you're just tuning in, you can follow the story of the kidney exchange between the UAE and Israel here. The pairs who exchanged kidneys were an Israeli Arab husband and wife, a Jewish Israeli mother and daughter, and a mother and daughter who wish to be identified only as Arab residents of the United Arab Emirates.  (I joined their family at their home for a meal when I was in Abu Dhabi, but won't say more about them.)

It isn't a surprise that the donor in each pair couldn't donate to the intended recipient, because in each pair the recipient was a highly sensitized mother ( i.e. for whom it was hard to find a compatible kidney, because she had many antibodies against human proteins). During childbirth, mothers can develop such antibodies to the father's proteins that the children inherited. So the father and the daughters were incompatible donors, since the mother had antibodies against the paternal proteins (human leukocyte antigens) in their kidneys. Together with the fact that the mothers were quite hard to match, and that Israel and the UAE are both small, each with populations of around ten million, they had to look across national borders.

Cross border kidney exchange requires some diplomacy, particularly when the countries involved are getting together for the first time (and don't necessarily have a long history of cooperation). The key medical diplomats were Dr. Tamar Ashkenazi* the director of Israel Transplant and Dr Ali Abdulkareem Al Obaidli, Chairman of the UAE National Transplant Committee.  (Other key collaborators in the complicated logistics were Itai Ashlagi at Stanford and Atul Agnihotri and Mike Rees of the Alliance for Paired Kidney Donation.)  

So this was the plan:

And here's a picture of the Abu Dhabi kidney packed for shipping (masked in the picture are Sue and Mike Rees, who have a lot of experience with packing and shipping kidneys, another nurse whose name I don't know, and Dr. Muhammad Badar Zaman the UAE transplant surgeon who transplanted the  kidney that was on the way.

The little box taped to the top of the shipping container allows the kidney to be tracked in transit, via an app that gives you a picture of where it is at it travels:

And here's the swap of the two kidneys in shipping containers in the airport in Abu Dhabi (Tamar Ashkenazi and Dr. Ali are in the center, Atul and Mike are at the two ends...). Dr Ashkenazi was on both legs of the flight above--she flew in with the Israeli kidney and flew out with the UAE kidney.

On my last night in Abu Dhabi I had dinner with a lot of the docs. Across from me in the picture below are the two surgeons most actively involved in this exchange on the UAE side, transplant surgeon Dr. Zaman and the nephrectomy surgeon Dr. Hamid Reza Toussi.  Next to me is the nephrologist Dr. Mohamed Yahya Seiari.

Below is that whole dinner party. If you've been following these posts up til now, you've met all of them except the gentleman second from the left, Dr. Gehad ElGhazali, who is the head of the HLA lab, which is responsible for the data that allows the matching algorithm to predict which kidneys are compatible, and is responsible for the final 'crossmatch' tests that verify compatibility. Like all the other docs I encountered, he has a multi-international background. This reflects the UAE's very international population, which is why it seems a natural global hub for kidney exchange.

I only met the Israel participants in the exchange later, by Zoom: Shani Markowitz is the donor from the Jewish pair, and Walaa Azaiza is the recipient from the Israeli Arab pair.

The Israeli transplant surgeons are Dr Tony Karam at Rambam Hospital and Dr. Eitan Mor at Sheba Medical Center.

^^^^^^^^^^^^^^^^^^^

*As it happens, I've twice had the privilege of  being Dr. Ashkenazi's coauthor (concerning deceased organ donation):

1. Stoler, Avraham,  Judd B. Kessler, Tamar Ashkenazi, Alvin E. Roth, Jacob Lavee, “Incentivizing Authorization for Deceased Organ Donation with Organ Allocation Priority: the First Five Years,” American Journal of Transplantation, Volume 16, Issue 9, September 2016,  2639–2645. http://onlinelibrary.wiley.com/doi/10.1111/ajt.13802/full 

2. Stoler, Avraham, Judd B. Kessler, Tamar Ashkenazi, Alvin E. Roth, Jacob Lavee, “Incentivizing Organ Donor Registrations with Organ Allocation Priority,”, Health Economics, April 2016 online http://onlinelibrary.wiley.com/doi/10.1002/hec.3328/full ; doi: 10.1002/hec.3328. In print: Volume: 26   Issue: 4   Pages: 500-510   APR 2017

Technology and Equality in the Digital Era--Luohan Academy

 Last week I participated in a Luhohan Academy discussion called 

Boosting Shared Prosperity: Technology and Equality in the Digital Era

Speakers : David Autor, Erik Berglof, Long Chen, Hanming Fang, Ginger Jin, Alvin Roth, Tom Sargent, Michael Schwarz, Michael Spence, Steve Tadelis, Robert Townsend,

I discussed the presentations by David Autor and Rob Townsend.

Here's the video (on YouTube):

Here's a Symposium summary.

UAE as a natural hub for international/global kidney exchange

 There are excellent hospitals in the United Arab Emirates that can perform kidney transplants, and they are prepared to do kidney exchange, both domestically and internationally.  My post today is about why the UAE would be a natural international center for kidney exchange. 

International hubs for kidney exchange are needed because hard-to-match patient-donor pairs may need to find compatible exchanges outside the borders of their own countries. This is particularly true for citizens of countries with relatively small populations of potential compatible donors, and of countries that don't yet have widespread kidney exchange. But even a big country like the U.S., in which kidney exchange is a standard mode of transplantation, can sometimes be too small to find compatible kidneys for the hardest to match  patients. (The U.S. itself is a natural hub for global kidney exchange, about which I've written elsewhere. But so far, bureaucratic obstacles have prevented us from integrating kidney exchange even with Canada...)

The UAE itself is already quite international, as only about 10% of its approximately 10 million residents are Emirati citizens; the rest, largely foreign workers and their families, are citizens of other countries. The biggest of the Emirates, Abu Dhabi, provides medical care for its residents that includes dialysis and transplantation for kidney failure, which is prevalent there (perhaps due in part to the very hot weather and the perils of frequent dehydration in outdoor work). Most of those patients are on dialysis, although the national health insurance will pay for transplants for those who have willing donors either in the Emirates or in their home country. The UAE is wealthy, and many of the home countries are not, so my understanding is that the UAE is prepared to assume the costs of bringing family members to the UAE and providing the necessary medical care. This is cost effective as well as good for the patient, because in the UAE as elsewhere, transplantation is much cheaper than dialysis, as well as being the best treatment. So taking a UAE resident off dialysis via transplant saves a life and pays for itself.

Of course, sometimes the UAE resident's family member who is willing to donate a kidney isn't compatible with the UAE resident. So kidney exchange makes a lot of sense in this case. But with a resident population of only 10 million, there are severe limits on how much kidney exchange can do for hard-to-match patients. So international, global kidney exchange makes sense, in which patient-donor pairs from other countries could also be transplanted in the UAE through kidney exchange with UAE residents (or, eventually, with other international pairs).

It helps a lot that the UAE is also an air transit hub, with two international airlines. Emirates has a hub in the Emirate of Dubai, and Etihad has a hub in Abu Dhabi. So a big portion of the world's population is within a few hours of direct air travel to the UAE.  (When I went to the UAE this summer in connection with the UAE-Israel kidney exchange, I took a direct flight from San Francisco to Dubai, but that takes sixteen hours...)

My main goal in the UAE was to meet with various mostly government bodies engaged in an effort, in collaboration with the Alliance for Paired Kidney Donation, to make domestic and international kidney exchange a regular part of medical care there. To that end, we met with the Ministries of Health in Dubai and in Abu Dhabi, with the national health insurance, with the Red Crescent (which is able to get involved in care of patients and donors after they return home), and others.

The key player in organizing this collaboration, and in transplantation generally in the UAE is  Dr Ali Abdulkareem Al Obaidli, transplant nephrologist and Chairman of the UAE National Transplant Committee. Two other key figures from the APKD are Mike Rees and Atul Agnihotri. Many of our meetings ended in photos, and I'm with those three in all pictures below. 

I expect to write some more about this. In the meantime, here are related posts.

Thursday, September 30, 2021

Kidney Exchange between Israel and the UAE (in USA Today, yesterday)

Friday, October 1, 2021

Stanford celebrates Itai Ashlagi and the UAE-Israel kidney exchange

And this older one:

Friday, August 7, 2020

Global kidney exchange between Abu Dhabi and Kerala (India)

Here's a slide from a talk I'll be giving shortly at the annual conference of the Indian Society of Transplantation (ISOT) that provides some more information about this UAE-India exchange

Stanford celebrates Itai Ashlagi and the UAE-Israel kidney exchange

Here's a Stanford story celebrating Itai Ashlagi's role in this summer's UAE-Israel kidney exchange. (His matching software is embedded in the software suite of the Alliance for Paired Kidney Exchange (AKPD) which is a partner with a remarkable Abu Dhabi effort to further kidney exchange.)

Stanford engineers develop algorithm to aid kidney transplant exchanges. A historic and complex kidney exchange between Israel and Abu Dhabi put a spotlight on the Stanford algorithm that made it all possible. BY ANDREW MYERS.  AUGUST 12, 2021

"A historic kidney transplant exchange recently took place in the Middle East, but it might never have transpired without an algorithm developed at Stanford by Itai Ashlagi, a Stanford associate professor of management science and engineering, and his graduate student Sukolsak Sakshuwong. In all, three ailing recipients received life-sustaining transplants while three healthy donors gave kidneys.

...

"“One of the nice things in the software we developed is the user interface. We collect all the relevant patient data, but then we let the user play with the various thresholds that determine successful matches to see what works for them,” Ashlagi said as he explained the team’s game-like approach to matching. The software acts as a platform and allows different organizations to easily collaborate and create more possibilities for exchanges. “Just a few days ago, I was looking for matches and found an unexpected exchange between pairs from Israel and other European countries. Hopefully, this will lead to new collaborations.”

“Itai’s software was used on both sides of that historic exchange between Abu Dhabi and Israel,” said Alvin Roth, Nobel Laureate and Ashlagi’s mentor and frequent collaborator, who was in Abu Dhabi in connection with the exchange.

"Roth says Ashlagi exemplifies the concept of scientist-engineer and is now a driving force in contemporary kidney exchange through both his deep understanding of the immunological issues of matching kidneys to patients and his intimate appreciation of the needs of transplant centers.

“He’s turned those practical theoretical insights into widely deployed digital tools with the power to change lives,” Roth added. “Having the chance to collaborate with him has been among the best experiences of my intellectual career.”

Kidney Exchange between Israel and the UAE (in USA Today, yesterday)

 I spent a week in the UAE this summer, in connection with a three-pair kidney exchange between the UAE and Israel.  (The UAE is a natural hub for kidney exchange, something I'll say more about in subsequent posts.) Because there were some sensitivities about how it would be publicized, I've  refrained from blogging about it until now, but yesterday's front page story in USA Today met with just about everyone's approval, and so over the next few days I'll post some observations. Today I'll start with the USA Today story, which is gated, but can also be found ungated on Yahoo, here:

How three Jewish and Arab families swapped kidneys, saved their mothers and made history by Marco della Cava, USA TODAY, Wed, September 29, 2021 AM

"At a time when the world seems rife with division and discord, what happened on July 28 reminds how mutual survival often depends on shared humanity triumphing over historical differences.

"In this case, with the assistance of organ transplant experts in the United States, Israel and the United Arab Emirates, three pairs of kidney donors and recipients in Israel and the UAE saved each other in a series of choreographed, pay-it-forward surgeries known as a cyclic exchange.

...

"Just consider the logistics involved in the UAE-Israel exchange. A UAE daughter who was not a match for her mother volunteered to give her kidney to a stranger. An Israeli Arab woman was a match for that kidney, so her husband agreed to donate his kidney to save an Israeli Jewish mother – whose daughter in turn gave her kidney to the sick mother in UAE.

"“The reason we are excited about this is simply because the bigger the pool, the more likely you are to find matches,” says Dr. Michael Rees, a surgeon and founder of the Alliance for Paired Kidney Donation, a Toledo, Ohio-based nonprofit instrumental in making this politically groundbreaking kidney transplant chain a reality.

...

"Those communications, however, remain politically sensitive. When asked for comment, officials in the UAE focused less on the partnership with Israel and more on a general need for international cooperation.

"We are pleased that our innovative partnership with the Alliance for Paired Kidney Donation has allowed us to help our patients,” says Dr. Ali Al Obaidli, chairman of the UAE National Transplant Committee. He added that a collaborative spirit between countries can be used to “close the gap” for those in need of kidneys.

"The UAE donor daughter and recipient mother asked not to be identified by name or religion. Conversations with those involved in the cyclic exchange say kidneys donated outside the UAE generate negative reactions among some Emirati.

...

"This unique transplant chain began when the 60-something mother in the UAE found out in fall 2020 that she had kidney failure and would soon need to start dialysis or find a new kidney.

"Because her family members were not matches, Rees and his Alliance for Paired Kidney Donation team got to work finding a match, which also involved seeing where her daughter’s donor kidney might go.

"The first step was to plug all the relevant medical details into an algorithm ...

"Also crucial to the process was Roth's Israeli colleague Itai Ashlagi, who had developed software that could instantly mine his native country’s kidney database. While Israel had started to develop transplant relationships with Austria and the Czech Republic, he was excited about this new involvement with the UAE.

“Better to exchange kidneys than bombs,” says Roth, adding that using computers to search the world for medical solutions radically increases the chances of patients getting help. “International boundaries are artificial markers. Kidney disease doesn’t care about that.”

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

Here's the picture on the USA TODAY front page: Tamar Ashkenazi flew from Israel to UAE with an Israeli kidney, and flew back with the UAE kidney...

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

Here's a USA Today 1-minute video collage of pictures and video accompanying the story:

Daughters from the UAE and Israel put differences aside to save lives in kidney exchange. Three pairs of kidney donors and recipients in Israel and the UAE saved each other in a series of pay-it-forward surgeries known as a cyclic exchange. by Harrison Hill, USA TODAY

I'll have more to say soon, and will link back and forth between posts to make the whole story accessible.

Marcella Alsan and Jesse Shapiro are 2021 MacArthur Fellows

Two economists, Marcella Alsan at Harvard and Jesse Shapiro at Brown have been recognized for their innovative and influential work. (These are very good choices, imho...)

 The 2021 MacArthur Fellows

"In order for the medical care system to be trusted, it has to become more trustworthy."  Marcella Alsan, Physician-Economist | Class of 2021

 

"I think a fundamental premise of social science is that by better understanding our social world, we can figure out ways to make things work better." Jesse Shapiro, Applied Microeconomist | Class of 2021

Liver transplantation in the Middle East

 Here's a chapter on transplantation in a book about liver cancer.  The countries in the Middle East that can do liver transplants can also transplant kidneys, with living donors being the majority of donors across the region.

Liver Transplantation in the Middle East by Sezai Yilmaz,  In: Carr B.I. (eds) Liver Cancer in the Middle East. Springer, Cham. https://doi.org/10.1007/978-3-030-78737-0_12

It contains some interesting summaries by country.  Here is the summary of the transplant situation in the UAE (about which I expect to be able to say more soon).

"6 LT in the United Arab Emirates

"The United Arab Emirates (UAE) is an Arabian Gulf country located at the southeast end of the Arabian Peninsula with a population of about 9.3 million. It has made great strides in healthcare over the past several years and has among the highest life expectancy in the region. However, one of the key lacking areas of medical care in the country was the availability of solid organ transplantation. Collaborative efforts began a few years ago aiming to establish thoracic and abdominal solid organ transplantation from deceased donors in addition to continued development of the existing program on kidney transplantation from living donors. The UAE played an important role in efforts leading up to the declaration of Istanbul on organ trafficking and transplant tourism in 2008, the groundwork for which was laid in a steering committee meeting organized by the Transplantation Society and the International Society of Nephrology in Dubai in December 2007. This landmark declaration helped establish a framework of ethical principles to guide the practice of transplantation worldwide. The legal definition of brain death in the UAE was confirmed in May 2017, paving the way for deceased donor organ transplantation [42].

"The Cleveland Clinic Foundation was instrumental in the accelerated path to establishment of a multi-organ transplant center at Cleveland Clinic Abu Dhabi. Cleveland Clinic Abu Dhabi, which began clinical operations in early 2015, was established as a partnership between Mubadala Healthcare, Abu Dhabi, and Cleveland Clinic Foundation in Cleveland, Ohio. A meticulous and thoughtful collaborative approach, which began with identifying key operational needs, resulted in the establishment of transplant services within 2.5 years with the establishment of Cleveland Clinic Abu Dhabi. The first multi-organ procurement and transplant from a brain-dead donor in the UAE occurred at Al Qassimi Hospital in Sharjah on July 15, 2017 [42]. Also noteworthy was a regional organ sharing agreement with SCOT that enabled the utilization of deceased donor grafts for potential recipients in Saudi Arabia while awaiting full operational readiness for thoracic and LT at Cleveland Clinic Abu Dhabi. The overall organ donation rate remains low in terms of the number of organs recovered (3.66) and transplanted (3.57) per donor.

"Shortage of deceased donors remains one of the primary challenges facing the transplant community in the UAE. This mandated establishment of LDLT to complement ongoing efforts to improve DDLT. An extensive collaborative effort, with Cleveland Clinic’s main campus in Cleveland, Ohio, resulted in the first successful LDLT in the UAE on July 29, 2018. Since that time, an additional 13 LDLTs were performed (overall: four right lobe and ten left lobe grafts) over the past year and a half [42]."

Beware survivorship bias in advice on science careers

 Here's a 'career column' from Nature, with advice that I think academic advisors should keep in mind, especially in view of the growing number of attractive non-academic options for some kinds of Ph.D.s

Beware survivorship bias in advice on science careers. For objective careers advice, talk to those who left science as well as those who stayed.  by Dave Hemprich-Bennett , Dani Rabaiotti & Emma Kennedy

"A major flaw in much scientific and academic career advice is survivorship bias. This is a common logical error, involving drawing conclusions based on those who have ‘survived’ a process — and are thus more visible than those who did not. In the case of science careers advice, the bias arises because those who manage to stick to their chosen career path are there to advise the next generation of researchers on how to stay in their field.

...

"

Doctors and guns

 Americans are divided about  guns, and so are American doctors. While the American Medical Association regards guns as a public health crisis (https://www.ama-assn.org/press-center/press-releases/ama-calls-gun-violence-public-health-crisis), a recent survey of the American College of Surgeons reveals that many surgeons are gun owners who store loaded guns unlocked at home.

Firearm Storage Practices of US Members of the American College of Surgeons  by Brendan T.CampbellMD, MPH, FACS, Deborah A.KuhlsMD, FACS, Cynthia L.TalleyMD, FACS, Eileen M.BulgerMD, FACS, Ronald M.StewartMD, FACS, Journal of the American College of Surgeons, Volume 233, Issue 3, September 2021, Pages 331-336  ttps://doi.org/10.1016/j.jamcollsurg.2021.05.024

Background: As a part of its firearm injury prevention action plan, the American College of Surgeons (ACS) surveyed the entire US ACS membership regarding individual members' knowledge, experience, attitudes, degree of support for ACS Committee on Trauma (COT) firearm programs, and degree of support for a range of firearm injury prevention policies. This survey included questions regarding members' prevalence of firearm ownership, type of firearm(s) owned, type of firearm(s) in the home, personal reasons for firearm ownership, and methods of firearm/ammunition storage.

...

Conclusions: A significant percentage of ACS members keep firearms in their home, and nearly one-third store firearms in an unlocked and loaded fashion. Safe storage is a basic tenet of responsible firearm ownership. These data present opportunities for engaging surgeons in efforts to improve safe firearm storage.

HT: Irene Wapnir

Stanford celebrates Irene Lo

 Stanford's School of Engineering celebrates Irene Lo, in an interview and video:

"Engineer Irene Lo studies markets, but not traditional marketplaces based in cash.

Instead, she studies markets for goods/resources that place a high value on social goods like diversity, fairness and equity.

Thus, Lo came to help San Francisco create an algorithm to assign kids more fairly to public schools across geographic, social, racial and economic boundaries. As it turns out, math is just the first step. The most challenging part was getting families to trust in the system, begetting a multi-year community engagement effort.

Lo is now turning her attention to other markets with social impact, like her work on the system that places medical students in residency programs across the country or one trying to make the palm oil supply chain fairer for farmers.

Listen in as Irene Lo explains the changing face of markets to host Russ Altman in this episode of Stanford Engineering’s The Future of Everythingpodcast. Listen and subscribe here."

Muriel Niederle wins the 2021 Oskar Morgenstern Medal

 Oskar Morgenstern medal for Muriel Niederle, September 24, 2021

Muriel Niederle from Stanford University is this year's winner of the Oskar Morgenstern Medal. (© Manuel Amador)

"The Stanford professor receives the fifth Oskar Morgenstern medal

"The Faculty of Economics will award the Oskar Morgenstern Medal for the fifth time on October 7, 2021. This year's winner is Muriel Niederle, Levin Professor at Standford University and a leading expert in experimental economics and gender differences in competitive behavior in the labor market.

"Muriel Niederle is a Levin Professor in the School of Humanities in the Economics Department at Stanford University, California, and a leading global expert in experimental economics and market design. With her research on gender differences in competitive situations, Niederle made a significant contribution to the discussion about application behavior on the labor market. For her extensive research, Muriel Niederle, who studied at the University of Vienna and did her doctorate at Harvard, was awarded the Oskar Morgenstern Medal for outstanding research achievements in economics.

"Niederle's experiments on gender differences in competitive behavior are known internationally beyond the scientific community: Why women negotiate differently and what effects this behavior shows on the labor market, for example in salary negotiations, reported on, among others, by the Wall Street Journal, Forbes Magazine and The Atlantic. As one of the leading experts on gender equality and funding issues, Niederle is a sought-after speaker at international meetings and conferences. Her most cited works to date deal with norms of gender competition, such as "Do Women Shy away from Competition? Do Men Compete too Much?" (2007) in cooperation with Lise Vesterlund and "Performance in competitive environments: Gender differences" (2003) in cooperation with Uri Gneezy and Aldo Rustichini.

"The research focus on market design is dedicated to the question of how problems in non-self-regulating markets can be solved. Muriel Niederle carries out extensive studies and experiments in this area, for example on "Signaling in Matching Markets", a technique that is intended to bring companies and suitable applicants together more quickly.

"Muriel Niederle currently teaches at Stanford University in the fields of Experimental and Behavioral Economics and Gender.

"About the Oskar Morgenstern medal

"The Faculty of Economics is committed to conducting research at the highest level and promoting the reputation of top international research: The Oskar Morgenstern Medal, named after Oskar Morgenstern, co-founder of game theory and until 1938 professor at the University of Vienna, was awarded the title in 2013 Honoring the great Austrian economist and launched to celebrate the 250th anniversary of the faculty. The previous winners are Roger B. Myerson (2013), Robert F. Engle (2015), Ernst Fehr (2017) and Sir Christopher A. Pissarides (2019). The medal is endowed with 10,000 euros and is awarded by the faculty every two years.

"Martin Kocher, Federal Minister of Labor, will present the award with Dean Gerhard Sorger at the award ceremony.

"Awarding of the Oskar-Morgenstern-Medal and subsequent Celebratory Speech.  Date: Thursday, October 7, 2021, 10:00 am - 11:30 am  Location: Skylounge (12th floor), Oskar-Morgenstern-Platz 1, 1090 Vienna

"The event is due to of the Covid-19 measures take place on a small scale and by prior arrangement. Interested parties can be there via live stream: oskar-morgenstern-medaille.univie.ac.at/

******

And here's Muriel's webpage: Muriel Niederle

The Transplantation Society reaffirms the value of organ donation and transplantation, even for the poor

 You wouldn't think it would be news that TTS, The Transplantation Society, felt that transplantation is valuable for patients who need it, and would "stand against any form of barriers in access, ... particularly that related to gender, race, religion and income."  

But I think their statement yesterday to that effect, below, may be a reversal of the position adopted by some previous presidents of TTS, who, in arguing against black markets run by criminals, also argued that citizens of poor countries should be denied access to kidney exchange, i.e. that kidney exchange is repugnant when offered to poorer patients.

Here is the new statement (and I include links to some history  below it.)

 A Reaffirmation of Organ Donation (The Tribune Pulse, September 23, 2021)*

"Recent events call for a reaffirmation of essential values held by the worldwide community of transplant providers.

"Indeed, in this period when inequities in access to healthcare are stretched and emphasised, we feel compelled to highlight the universal value of organ donation and the immense success achieved by transplantation. Donation implies generosity and solidarity, and should take place daily, routinely and peacefully around the globe regardless of age, gender, race, education or income of donors. This Gift of Life is gratefully accepted by recipients in dire need of an organ to continue to live regardless of their age and gender, among others. International Medical Societies representing Transplantation Professionals across the globe support and nurture diversity and inclusion among their members, fostering education, and stand against any form of barriers in access, knowledge, transition and required training around the "Gift of Life", particularly that related to gender, race, religion and income. We embrace a call of action to support equitable access to transplantation for all patients with end-stage organ diseases, and the value of gender and race equality in access to education and career development in the diverse fields of transplant healthcare professions."

That sounds like a statement we can all support.

But those of you who have been following how Global Kidney Exchange can remove financial barriers to transplantation know that it has met with considerable opposition to allowing citizens of middle and low income countries access kidney exchange. 

Here's the original article on GKE:

Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation
by M. A. Rees, T. B. Dunn, C. S. Kuhr, C. L. Marsh, J. Rogers, S. E. Rees, A. Cicero, L. J. Reece, A. E. Roth, O. Ekwenna, D. E. Fumo, K. D. Krawiec, J. E. Kopke, S. Jain, M. Tan, S. R. Paloyo
American Journal of Transplantation, Volume 17, Issue 3 March 2017, Pages 782–790

And here is a letter from two former TTS presidents saying that GKE is essentially organ trafficking…

Opposition to Irresponsible Global Kidney Exchange

Francis L. Delmonico and Nancy L. Ascher

For a history lesson, see e.g.

Tuesday, September 12, 2017

Global kidney exchange and repugnance in the AJT: comments and replies

Monday, December 18, 2017

More on the endorsement of Global Kidney Exchange by the ASTS

Monday, December 25, 2017

Three stories of kidney donations (and one of a grinch that wants to limit them)

Monday, January 29, 2018

Italy recommends Global Kidney Exchange to the World Health Organization

Tuesday, November 20, 2018

Global kidney exchange celebrated together with the Declaration of Istanbul, in the AJT

Thursday, October 31, 2019

Global Kidney Exchange in the Lancet, by Minerva, Savulescu and Singer

Thursday, January 2, 2020

Global kidney exchange: continued controversies, perhaps moving towards resolution

* It looks like the statement of reaffirmation of organ donation may have originated with the International Liver Transplant Society, which has a Sept. 20th version, endorsed by many sister societies, here: https://ilts.org/news/reaffirmation-of-organ-donation/ 

Police assignments by seniority in Chicago

 Here's a recent NBER working paper reporting a study of the assignment of police officers in Chicago, where some officers can choose to transfer to newly vacant positions, with priority determined by seniority. The resulting allocation reveals that more senior officers move to assignments with lower levels of violent crime.

Police Officer Assignment and Neighborhood Crime  by Bocar Ba, Patrick Bayer, Nayoung Rim, Roman Rivera & Modibo Sidibé  WORKING PAPER 29243, DOI 10.3386/w29243,  September 2021

Abstract: We develop an empirical model of the mechanism used to assign police officers to Chicago districts and examine the efficiency and equity of alternative allocations. We document that the current bidding process, which grants priority based on seniority, results in the assignment of more experienced officers to less violent and high-income neighborhoods. Our empirical model combines estimates of heterogeneous officer preferences underlying the bidding process with causal estimates of the effects of officer experience on neighborhood crime. Equalizing officer seniority across districts would reduce violent crime rate by 4.6 percent and significantly decrease inequality in crime, discretionary arrests, and officer use of force across neighborhoods. Moreover, this assignment can be achieved in a revenue-neutral way while resulting in small welfare gains for police officers, implying that it is more equitable and efficient.

Congratulations to 51 new Econometric Society Fellows of 2021

 This year there are 51 new Fellows of the Econometric Society:

Congratulations to our 2021 Fellows  

Jaap Abbring, Tilburg University

Chunrong Ai, Chinese University of Hong Kong, Shenzhen

Ufuk Akcigit, University of Chicago

Simon Board, University of California, Los Angeles

Antonio Cabrales, Universidad Carlos III, Madrid

Arnaud Costinot, Massachusetts Institute of Technology

Peter Cramton, University of Cologne and University of Maryland (Emeritus)

Stefano Dellavigna, University of California, Berkeley

Prosper Dovonon, Concordia University, Montreal

Christian Dustmann, University College London

Graham Elliot, University of California, San Diego

Marcella Eslava, Universidad de los Andes

Armin Falk, University of Bonn

Oded Galor, Brown University

Yuriy Gorodnichenko, University of California, Berkeley

Veronica Guerrieri, University of Chicago

Luigi Guiso, Einaudi Institute for Economics and Finance

Bard Harstad, University of Oslo

Erik Hurst, University of Chicago

Patrick Kline, University of California, Berkeley

Fuhito Kojima, University of Tokyo

Botond Koszegi, Central European University

Rim Lahmandi-Ayed, University of Carthage

John Leahy, University of Michigan

Sydney Ludvigson, New York University

Ulrike Malmendier, University of California, Berkeley

Ramon Marimon, European University Institute

Alexandre Mas, Princeton University

Atif Mian, Princeton University

Magne Mogstad, University of Chicago

Benjamin Moll, London School of Economics

Sendhil Mullainathan, University of Chicago

Victor Murinde, SOAS University of London

Emi Nakamura, University of California, Berkeley

Volker Nocke, University of Mannheim

Nathan Nunn, Harvard University

Rohini Pande, Yale University

Bruce Preston, University of Melbourne

James Robinson, University of Chicago

Christina Romer, University of California, Berkeley

Antoinette Schoar, Massachusetts Institute of Technology

Matthew Shum, California Institute of Technology

Rohini Somanathan, Delhi School of Economics and University of Gothenberg

Stefanie Stantcheva, Harvard University

Wing Suen, University of Hong Kong

Balazs Szentes, London School of Economics

Silvana Tenreyro, London School of Economics

Aleh Tsyvinski, Yale University

Nicolas Vieille, HEC, Paris

Ebonya Washington, Yale University

Ekaterina Zhuravskaya, Paris School of Economics

 The Society is grateful for the work of its 2021 Fellows Nominating Committee consisting of Dirk Bergemann (Chair), Xiaohong Chen, Itzhak Gilboa, Kate Ho, Dilip Mookherjee, Monika Piazzesi, and Hélène Rey. 

Publication Date: Wednesday, September 22, 2021

Repugnance watch: Gender-affirming medical care for transgender adolescents becomes a crime in Arkansas

 Here's a recent article in repugnance to certain kinds of medical care involving transgender children as they approach puberty:

Increasing Criminalization of Gender-Affirming Care for Transgender Youths—A Politically Motivated Crisis by Benjamin C. Park, BS1; Rishub K. Das, BA1; Brian C. Drolet, MD, JAMA Pediatr. Published online September 13, 2021. doi:10.1001/jamapediatrics.2021.2969

"On April 6, 2021, Arkansas passed Act 626, to be known as the “Arkansas Save Adolescents From Experimentation (SAFE) Act,”1 thus becoming the first state to outlaw gender-affirming care (GAC) for transgender youth. Many other states are considering similar bills, some of which include provisions that impose criminal penalties on health care professionals.

"Although Act 626 is among the more severe examples of antitransgender legislation, the United States has a history of similar legislation. Since 2015, coordinated attacks against lesbian, gay, bisexual, transgender, and queer (LGBTQ) rights have escalated in an unprecedented fashion. The targets of these attacks have shifted from marriage equality, bathroom access, and sports participation to the most recent attacks on transgender youths and their bodies. Act 626 is a part of recent nationwide efforts to limit access to GAC for transgender youths. This year represents a critical time for transgender young people, with new bills targeting their access to health care in at least 21 states.

"Approximately 1.4 million adults (0.6% of adults in the United States) and 150 000 youths (0.7% of youths aged 13-17 years in the US) identify as transgender.2 A large body of research dedicated to transgender health indicates that GAC, including prescribing or using puberty blockers such as gonadotropin-releasing hormone agonists, (GnRHa), hormone therapy (eg, testosterone or estrogen therapy), and gender-affirming surgery, is medically necessary for patients experiencing gender dysphoria.3 The discordant effects of societal gender roles and gendered activities on transgender youths are exacerbated during puberty, when masculinizing and feminizing anatomical changes take place. Transgender youths may find that pubertal changes worsen the dissonance between their anatomy and their gender identity, contributing to gender dysphoria and increasing the risk for negative health outcomes."

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

You can find the bill here (the first link gives you the text of the bill in pdf):

HB1570 - TO CREATE THE ARKANSAS SAVE ADOLESCENTS FROM EXPERIMENTATION (SAFE) ACT.

The act is long and explains itself as protective of children from medical procedures it regards as unproven. This looks like the action paragraph directed at physicians:

"20-9-1502. Prohibition of gender transition procedures for minors.

"(a) A physician or other healthcare professional shall not provide gender transition procedures to any individual under eighteen (18) years of age.

"(b) A physician, or other healthcare professional shall not refer any 17 individual under eighteen (18) years of age to any healthcare professional for gender transition procedures."

Modern peer review: how it evolved since the 1950's in Sociology

 Peer review is a big part of the design of modern academic publishing in scholarly journals. It wasn't always that way, and the current peer review system is pretty modern. Here's an account of its development in the discipline of Sociology, since the 1950's (which is similar to what we see in Economics, except that it appears Sociology relies substantially more on double-blind reviews).

Merriman, B. Peer Review as an Evolving Response to Organizational Constraint: Evidence from Sociology Journals, 1952–2018. The American Sociologist 52, 341–366 (2021). https://doi.org/10.1007/s12108-020-09473-x

"Abstract: Double-blind peer review is a central feature of the editorial model of most journals in sociology and neighboring social scientific fields, yet there is little history of how and when its main features developed. Drawing from nearly 70 years of annual reports of the editors of American Sociological Association journals, this article describes the historical emergence of major elements of editorial peer review. These reports and associated descriptive statistics are used to show that blind review, ad hoc review, the formal requirement of exclusive submission, routine use of the revise and resubmit decision, and common use of desk rejection developed separately over a period of decades. The article then argues that the ongoing evolution of the review model has not been driven by intellectual considerations. Rather, the evolution of peer review is best understood as the product of continuous efforts to steward editors’ scarce attention while preserving an open submission policy that favors authors’ interests."

From the introduction:

"In the main, editors are faculty members who operate a journal concurrently with ordinary work responsibilities; some receive modest, fixed remuneration, but editors have no strong financial interest in the journals they edit, and commonly serve for fixed or periodically renewed terms. (For most current journals, the economic interest rests primarily with one of a handful of large commercial publishers.) Journals do not restrict submissions by status criteria such as institutional affiliation or academic rank, and submission ordinarily carries little or no money cost, even at journals where authors assume a large part of the eventual expense of publication. Authors are expected to submit a given work exclusively to a single journal. After initial screening, submissions to a typical journal undergo double-blind review, in which the identities of authors and reviewers are not known to one another. Most evaluations of submitted manuscripts are produced by scholars who are not part of the appointed editorial staff of the journal. Work that is published has ordinarily undergone at least one formal round of revision and resubmission in response to the substance of external evaluations.

...

"At ASA journals, blind review, external review, exclusive submission, the formal revise and resubmit decision, and a developmental (rather than advisory) model of assessment developed in succession over a period of more than 30 years. In the twenty-first Century, persistent difficulties in obtaining timely reviews prompted a rapid, order of magnitude increase in frequency of rejections without review, commonly called desk rejections. Blind review was the only feature of the present model adopted at an ASA journal with an explicitly stated, unambiguously intellectual aim. This article argues that the other features of the current peer review model emerged as improvised efforts to balance two competing organizational imperatives: editors must steward scarce time and attention, but have also sought to render reasonably timely decisions without a priori exclusion of large numbers of prospective authors or capricious rejection of submissions. This pattern in journal operations in many ways reflects larger structural changes in sociology: rapid expansion of the field in the mid-to-late twentieth Century was succeeded by increasing competition in the academic labor market and heightened publishing expectations for tenure and promotion."

A snippet from the body of the paper:

"Ad hoc review, in which manuscripts are referred to scholars not formally affiliated with the journal organization, did not become an integral feature of the ordinary reviewing process until the early 1970s. Before then, virtually all evaluations were produced by members of journal editorial boards. Exclusive submission to a single journal also did not become a rule until the 1970s, and there is suggestive evidence that simultaneous submission to multiple journals may have been somewhat common until that time.

"At first, reviewing was plainly intended to aid to the work of the editor; the occasional value of reviews to authors was taken as an incidental benefit. The evolution of a developmental model of review oriented toward the author was gradual, as was the emergence of the revise and resubmit decision as a nearly unavoidable intermediate step on the path to publication."

...

And in conclusion:

"A primary constraint on editorial innovation is, of course, the professional and status structure of academic disciplines. An extensive body of research on disciplines, and on higher educational institutions more generally, has shown a powerful isomorphic tendency: such structures tend to converge on a given form of practice even if all the actors are wholly aware of its inadequacies. Further, change in such practices will, under most circumstances, be slow: individual academic advancement involves regularly submitting oneself to the judgment of the more experienced members of a discipline according to the standards those more experienced scholars impose. Those who may have the freshest view of an intellectual field, and perhaps a greater impulse to explore new lines of work, also face the strongest pressures to invest their time and effort conservatively in the oldest means of publicizing their work.

"Efforts to change publishing norms therefore stand a much greater chance of success if they are adopted first, or early, by actors who occupy central places in a field, or if they are given the strong, credible endorsement of such actors (Starbuck 2016: 178). Conversations about academic publishing models, especially their relative unresponsiveness to changing circumstances in the twenty-first Century, often possess a degree of fatalism. But the development of editorial peer review itself is an important reminder of how rapidly a good idea may spread."

HT: Retraction Watch

Keeping the market for new economists thick: AEA guidelines on timing of interviews

 Below are some guidelines suggested by the American Economic Association for the conduct of this year's job market for new Ph.D.s

AEA Guidance on Timeline for 2021-22 Economics Job Cycle

"The AEA Executive Committee, in conjunction with its ad hoc Committee on the Job Market, recognizes that it is to the benefit of the profession if the job market for economists is thick, with many employers and job candidates participating in the same stages at the same time.  Moreover, the AEA's goals of fairness, inclusion, and diversity are fostered by having a timeline that remains widely accepted, even as public health conditions necessitate a virtual ASSA meeting again this year. With these goals in mind, and in light of inquiries from both students and departments about how to proceed, the Association asks that departments and other employers consider the following timeline for initial interviews and “flyouts” in the upcoming job cycle.

Interview invitations
The AEA suggests that employers wait to extend interview invitations until at least Thursday, December 2, 2021.

Rationale: the AEA will deliver signals from job candidates to employers on December 1. We suggest that employers review those signals and incorporate them into their decision-making before extending interview invitations. Job candidates from under-represented groups may lack informal networks and thus, may especially rely on the signals to convey their interest. Waiting to review the signals before issuing invitations promotes a fairer, more equitable process.

We also ask that all employers indicate on EconTrack when they have extended interview invitations; this allows candidates to learn about the status of searches without visiting websites posting crowd-sourced information and potentially inappropriate other content.

Interviews
The AEA suggests that employers conduct initial interviews starting on Monday, January 3, 2022, and that all interviews take place virtually; i.e. either by phone or online (e.g. by Zoom). We suggest that interviews not take place during the AEA meeting itself (January 7-9, 2022).

Rationale: In the past, interviews were conducted in person at the AEA/ASSA meetings. This promoted thickness of the market, because most candidates and employers were present at the in-person meetings, but had the disadvantage of precluding both job candidates and interviewers from fully participating in AEA/ASSA sessions. Given that the 2022 AEA/ASSA meetings will be entirely virtual, we suggest that interviews NOT take place on the meeting dates to allow job candidates and interviewers to participate in the conference.

We recommend that employers wait until January 3 to interview candidates because job candidates may have teaching or TA responsibilities in December, and to ensure that candidates have accurate expectations of the timing of the stages of the market. An unraveling of the market works against the Association’s goal of having a thick market at each stage and also against candidates having uniform expectations of the market’s timing. All interviews should be conducted by phone or online to prevent risk of exposure to COVID, and to promote equity among the candidates.

Flyouts and offers
Flyouts and offers generally happen at times appropriate for the employer, and the AEA sees no reason to suggest otherwise.  We ask that all employers indicate on EconTrack when they have extended flyout invitations and closed their searches.

Job market institutions and mechanisms
Please keep in mind the various job market institutions and mechanisms created by the AEA to improve the job market:

• The JOE Network includes a database of job openings for economists.

  • Employers may sign up here: https://www.aeaweb.org/joe/employer.

  • Job candidates may search the database here: https://www.aeaweb.org/joe/listings.

  • The JOE Network has an electronic clearinghouse for job candidates to submit job applications. Job candidates may register here: https://www.aeaweb.org/joe/candidate.

• The AEA ad hoc Committee on the Job Market releases data and guidance on the job market here: https://www.aeaweb.org/joe/communications.

• EconTrack: a board on which employers can indicate when they have extended interview and flyout invitations, and closed their search: https://www.aeaweb.org/econtrack.

• EconSpark: a moderated forum in which one can discuss topics of interest to the profession, including the job market: https://www.aeaweb.org/forum/categories.

Thank you for your attention to this initiative."

Stanford welcomes students back to campus

Starting tomorrow, we'll have classes in person, indoors, masked.

Surrogacy law under review in New Zealand

 From the U. of Canterbury:

Who are my parents? Why New Zealand’s ‘creaky’ surrogacy laws are overdue for major reform by Debra Wilson, Annick Masselot,  and Martha Ceballos 

"several separate pieces of legislation cover the two types of surrogacy: gestational, where the child is not genetically related to the surrogate parent; and traditional, where the child is genetically related.

The resulting legal confusion is now the subject of a Law Commission review, which proposes significant reform based on the guiding principle that “the best interests of the child should be paramount”.

Right now, that cannot be said of the way surrogate children and their parents are treated under law that even judges have described as “creaky” and “inadequate”.

 ...

Surrogacy is regulated through the Human Assisted Reproductive Technology Act, which prohibits commercial surrogacy and requires gestational surrogacy to be approved by an ethics committee.

But that act is silent on the legal parentage of the child, leaving this to be determined by the Status of Children Act. Effectively, the woman who gives birth and her partner (if the partner consents to the assisted reproduction) are the child’s legal parents.

This means the intended parents have no legal rights to the child – even if they are the genetic parents – until they adopt the child under the Adoption Act.

But legal parentage is important. Legal parents transfer citizenship to their children and act on their behalf, such as giving consent to medical treatment or travel."