Organs for transplant: supply and demand

An interesting post at Freakonomics brings to attention a paper in the International Journal of Health Services by Herring, Woolhandler, and Himmelstein titled
INSURANCE STATUS OF U.S. ORGAN DONORS AND TRANSPLANT RECIPIENTS: THE UNINSURED GIVE, BUT RARELY RECEIVE

The subtitle tells much of the story, the paper finds that "16.9 percent of organ donors but only 0.8 percent of transplant recipients were uninsured"

The paper begins with the following story:
"In September of 2005, one of us (Herring), then a third-year medical student, cared for a previously healthy 25-year-old uninsured day laborer who arrived at the emergency department with rapidly advancing idiopathic dilated cardiomyopathy. The patient was ultimately deemed unsuitable for cardiac transplantation.
The decision on transplantation was driven, in part, by realistic concern about the patient’s inability to pay for long-term immunosuppressive therapy and to support himself during recovery. Absent such resources, the likelihood of a successful outcome is compromised (1–4). The clinicians caring for him faced a wrenching dilemma: deny the patient a transplant, or use a scarce organ for a patient with a reduced chance of success. He died of heart failure two weeks after his initial presentation. This tragedy inspired us to examine data on the participation of the uninsured in organ transplantation, both as recipients and as donors."

HT Scott Kominers

Matching students to high schools in NYC

The final version of our paper on the design of the NYC high school match is now available: Abdulkadiroglu, Atila , Parag A. Pathak, and Alvin E. Roth, "Strategy-proofness versus Efficiency in Matching with Indifferences: Redesigning the NYC High School Match,'' revised, November, 2008, American Economic Review, forthcoming.

This paper had a long evolution, partly because of the actual work it represents, and partly because of the lengthy and interesting process of figuring out and negotiating (among coauthors and with editors and referees) how to write a paper that properly represents the mix of theory, institutional detail, and empirical work that is integral to practical market design.

Incentives for kidneys

Kidney Disease Takes a Growing Toll reports the Times, as a result of diabetes and hypertension. The article touches on the debate about compensation for donors.

Writing of the National Kidney foundation the article says
"The organization has also been criticized by advocates who support financial compensation for organ donors, which the foundation firmly opposes as unethical and unlikely to increase the availability of organs. (In contrast, the American Association of Kidney Patients supports research into how financial incentives would affect organ donation.)"

Receivables exchange

The NY Times reports on a new online market in which companies can sell their receivables: An Online Market for Selling I.O.U.’s

"Businesses getting pinched by the credit squeeze can now tap a new source of cash — by selling the money owed to them by other companies.
A new online marketplace, the Receivables Exchange, was formally introduced on Monday after 18 months in development. It allows companies to sell their outstanding receivables at a discount to a panoply of financial institutions."

Truth in advertising: I'm on their advisory board.

Market for health care: adding choice in Britain

Choice is having an effect on Britain's National Health Service, the Telegraph reports:
NHS hospital units shunned by patients face closure
NHS hospitals units are facing closure as patients choose to be treated in more successful medical centres, new figures show.

"Patients are now able to choose where they are treated, with many snubbing the traditional visit to their local hospital and opting for units with the best treatment records, facilities and, crucially, cleanliness and infection control.
GPs can also choose where to send their patients. Crucially, hospitals no longer receive a guaranteed block grant and are paid according to the number of patients they treat. "

"The internal market reforms were the source of a bitter struggle within the Labour Government. Tony Blair and Alan Milburn, his Health Secretary, fought against union and backbench opposition to force through many of the changes to the way the NHS was run. "

Gay marriage: protests over election setbacks

I think of bans on who can marry whom as being pure cases of repugnant transactions, namely transactions that some people don't want other people to be able to participate in. In the case of gay marriage, we're seeing the beginning of the end of an ancient ban, but it may not come easily.

The NY Times reports that demonstrations have been held in protest over Proposition 8 in California: Across U.S., Big Rallies for Same-Sex Marriage

"In New York, some 4,000 people gathered at City Hall, where speakers repeatedly called same-sex marriage “the greatest civil rights battle of our generation.”"

"The big crowds notwithstanding, it has been a tough month for gay rights. Proposition 8 was just one of three measures on same-sex marriage passed on Nov. 4, with constitutional bans also being approved in Arizona and Florida. In Arkansas, voters passed a measure aimed at barring gay men and lesbians from adopting children. "

"The protests over Proposition 8 also come even as same-sex marriages began Wednesday in Connecticut, which joined Massachusetts as the only states allowing such ceremonies. By contrast, 30 states have constitutional bans on such unions. "

Organized crime in Japan

The market for crime is organized differently in Japan. The NY Times reports on a local lawsuit involving the headquarters of a yakuza headquarters: Neighborhood in Japan Sues in Bid to Oust Mafia

"The Dojinkai is one of the country’s 22 crime syndicates, employing some 85,000 members and recognized by the government.
Traditionally, the yakuza have run protection rackets, as well as gambling, sex and other businesses that the authorities believed were a necessary part of any society. By letting the yakuza operate relatively freely, the authorities were able to keep an extremely close watch on them."

British organ donation: opt in versus opt out

The Telegraph reports that A report into organ donation ordered by Gordon Brown will not recommend a system of presumed consent.

"The group ordered to look into the system as a possible solution to a shortage of donors is due to report at the start of next week. It will recommend that ministers work to increase the number of donors but is expected to favour a situation where donors still register to donate organs after their death.
The group is understood to have come under pressure from Muslim organisations to keep the opt-in system.
But senior government figures, including the Prime Minister and Liam Donaldson, the Chief Medical Officer, are understood to believe that presumed consent is the only way to solve the problem. "

The London Times also covers the story, with a different emphasis: Brown’s organ donor plan is rejected by scientists

"Mr Brown has argued previously that presumed consent, already used in Spain and other countries, could help to “close the aching gap between the potential benefits of transplant surgery in the UK and the limits imposed by our current system of consent”. ...
But the taskforce, an expert working group of healthcare professionals, lawyers and ethicists set up to look at ways to increase the number of organ donations, is understood to believe that an opt-out system would do little to boost the number of life-saving transplants. It is expected to say such a move would create practical problems for the NHS and risk a potential backlash among the public.
Last night a senior Whitehall source told The Times: “It’s fair to say this report is not helpful to the case for a change in the law to presumed consent.” "

Thaler and Sunstein will be disappointed too.

Update: Thaler emails me as follows
"Thaler and Sunstein will NOT be disappointed. We favor mandated choice for two reasons. First, presumed consent raises hackles. Second, it leads to more overrides by family since the donor's intentions may be only implicit.
Illinois has adopted this with zero fanfare. When you renew your license they just ask you "donor or not donor". Perfect."

Repugnant transactions in Inauguration tickets

eBay to Ban Resale of Inaugural Tickets

"eBay Inc. is banning the sale of coveted free tickets to the swearing-in of President-elect Barack Obama after a U.S. senator said she was crafting a bill to make such online sales a federal crime.
Representatives of the online auction site met with the Joint Congressional Committee on Inaugural Ceremonies this week and came to a mutual decision on the prohibition, said Nichola Sharpe, a spokeswoman for eBay.
“The tickets are free. We felt that it is an official event,” Sharpe said in an interview today. “We think it’s in the best interest of all concerned.”
Sen. Dianne Feinstein (D-Calif.), chairman of the committee, announced Monday that she was contacting sites, like eBay and Craigslist, to ask them to stop selling the tickets to the Jan. 20 event. She also said she was drafting legislation to criminalize the sales. "

Market for lawyers

A NY Times article reports that the recession is causing some law firms to contract: Law Firms Feel Strain of Layoffs and Cutbacks .

It contains two insights into the market that struck me:

"Lawyer departures, whether voluntary or through layoffs, pose special risks to firms. Layoffs scare off law school recruits, who crave security and wealth. "

“Clients often don’t want to invest in discretionary litigation in a downturn,” Mr. Younger said. Responding to government investigations has been keeping lawyers busy but does not generate continuing work for armies of associates, like a big lawsuit does, he said. “There are tons of government investigations going on now.”

Treasury abandons plans for reverse auction to purchase troubled assets

The Treasury announced today what had already become clear, which is that it has abandoned the initial plan to purchase troubled assets, in favor of buying equity in troubled companies: Remarks by Secretary Henry M. Paulson, Jr. on Financial Rescue Package and Economic Update

"As credit markets froze in mid-September, the Administration asked Congress for broad tools and flexibility to rescue the financial system. We asked for $700 billion to purchase troubled assets from financial institutions. At the time, we believed that would be the most effective means of getting credit flowing again.
During the two weeks that Congress considered the legislation, market conditions worsened considerably. It was clear to me by the time the bill was signed on October 3rd that we needed to act quickly and forcefully, and that purchasing troubled assets – our initial focus – would take time to implement and would not be sufficient given the severity of the problem. In consultation with the Federal Reserve, I determined that the most timely, effective step to improve credit market conditions was to strengthen bank balance sheets quickly through direct purchases of equity in banks. "

HT to Eric Budish (a market designer on the market)

Market for medical services: time of day

Timing is an important part of many markets: Beth Israel Medical Center in NYC is experimenting with a 24 hour a day clinic for non-emergency services, intended to serve parts of the market that have trouble making appointments during standard doctors' hours: When You Just Have to Get a Flu Shot... at 3 A.M.

Market for spam

The BBC, reporting on the work of Stefan Savage, director of UCSD's Collaborative Center for Internet Epidemiology and Defenses, says that the number of sales generated by spam are surprisingly small, so that spam networks might be vulnerable to measures that would increase their costs even slightly: Study shows how spammers cash in

Savage's study involved sending his own spam, he must have had an interesting conversation with UCSD's Institutional Review Board (i.e. human subjects committee...)

College admissions, international

Harvard's director of admissions visits China: Colleges scour China for top students

"There are no quotas, no limits on the number of Chinese students we might take," Fitzsimmons told a standing-room-only crowd of more than 300 students during a visit to Beijing No. 4 High School. "We know there are very good students from China not applying now. I hope to get them into the pool to compete."

Market for check cashing and payday loans

The NY Times has a nuanced article about the business and recent sale of a big check cashing chain: Check Cashers, Redeemed

"Selling to the poor is a tricky business. Poor people pay more for just about everything, from fresh groceries to banking; Prahalad, the economist, calls it the “poverty penalty.” They pay more for all kinds of reasons, but maybe most of all because mainstream firms decline to compete for their business. Nix has served customers that traditional financial institutions neglected, but he has also profited from that neglect. Whether he profited too much, charging poor communities what the market would bear — that’s a moral question as much as an economic one. And there’s no simple answer. "

Academic marketplace

Tough Times Strain Colleges Rich and Poor
"“Budget cuts mean that campuses won’t be able to fill faculty vacancies, that the student-faculty ratio rises, that students have lecturers instead of tenured professors,” said Mark G. Yudof, president of the California system. “Higher education is very labor intensive. We may be getting to the point where there will have to be some basic change in the model.” "

In the meantime, there's concern that the credit crisis will reduce the availability of student loans:
U.S. Buying More Loans to Students
"While students are still able to obtain federally backed loans, the credit crisis has hurt the lenders that provide them. Dozens have stopped offering the loans, blaming market conditions.
The initiative by the Education Department is intended to make it easier for these loan companies to obtain financing. In the 2009-10 academic year, the agency will purchase loans, as it has this year. The agency will also pledge to be the buyer of last resort for loans purchased by a private intermediary in an effort to foster investment in the student loan industry."

Pope Benedict speaks about organ transplantation

Pope condemns organ transplant abuses as ‘abominable’, the Catholic News Agency reports. (stale link is updated at bottom of post)

 The Pope spoke to a conference at the Pontifical Academy for Life. "Pope Benedict began his address to the conference entitled, “A Gift for Life. Considerations on Organ Donation.” by applauding the great advances of medical science in the realm of issue and organ transplants. Though these measures give hope to people who are suffering, he lamented the problem of a limited availability of organs, as evidenced “in the long waiting lists of many sick people whose only hopes of survival are linked to a minimal supply which in no way corresponds to effective need." Despite the fact that the supply of organs is limited, the Pontiff emphasized that people can only donate, “if the health and identity of the individual are never put at serious risk, and always for morally-valid and proportional reasons. Any logic of buying and selling of organs, or the adoption of discriminatory or utilitarian criteria ... is morally unacceptable,” he stressed. " "The Pope went on to address abuses in the transplant plant of organs and tissues such as organ trafficking, which often affect innocent people such as children. These abuses, he said, “must find the scientific and medical community united in a joint refusal. These are unacceptable practices which must be condemned as abominable.”

*********

Update of stale links (June 2022)

NOVEMBER 7, 2008  UPDATED 14 YEARS AGO

Pope slams human organ trade, warns on transplants

Animal organs for human transplants

The Times of London reports on hopes of
Pig organs ‘available to patients in a decade’

If the formidable immunilogical barriers to such xenotransplants can be overcome, it would be a welcome development that could overcome the present dire shortage of transplantable organs. I'd be happy to see kidney exchange replaced by even better alternatives.

Pig kidneys for transplantation would presumably be sold without becoming a repugnant transaction of the kind that selling human kidneys is widely seen to be. However the breeding of transgenic pigs involves some of the same perception of repugnance:

"Professor Winston said that “organs that might be transplantable” could be ready “within two to three years” and on the basis that research went smoothly they would be fully licensed and tested in as little as ten years. He expected the first “proof of principle” pigs to be bred next year.
Two months ago he hit out at the “red tape” blocking the project’s progress in Britain. Under UK and EU rules, his team has been banned from mating and producing offspring from the transgenic pigs. Research in developing transgenic pigs is now likely to move to the US where the regulatory system is more relaxed. "

Market for professors

A report from Boston College's Center for International Higher Education says that Saudi Arabia has the highest academic salaries, and China the lowest. (I suspect that this may not reflect the qualities of the universities that will emerge in those two very different places...)

Gay marriage: one step forward, 3 steps back

Election day was a good day for studying repugnant transactions, that is, transactions that some people want to engage in, but others don't want them to be able to:
Bans in 3 States on Gay Marriage

In Massachusetts, a referendum banned greyhound racing.

In other referenda relating to repugnant transactions, Colorado and South Dakota voters rejected bills banning most abortions, Arkansas voted to prohibit unmarried couples from adopting children, Massachusetts voters decriminalized possession (but not sale) of less than 1 ounce of marijuana, Michigan legalized marijuana for medical uses, voters in the State of Washington legalized physician-assisted suicide for terminally ill patients, and San Franciscans defeated a proposition that would have prevented police from enforcing laws against prostitution.