Tuesday, December 23, 2008

Incentives for organ donors, continued

Two eminent transplant docs, Drs. Frank Delmonico and William Harmon, have sent me an open letter expressing their concerns about proposed legislation described in a recent WSJ editorial (which I blogged about here). Dr. Delmonico, a transplant surgeon, is a man of many parts, including being past president of UNOS, and a founder of the New England Program for Kidney Exchange, and one of the most active speakers on the "against" side of the debate about compensating organ donors. Dr. Harmon, a transplant nephrologist, is the Chief of the division of Nephrology and a Professor of Pediatrics at Children's Hospital in Boston. Here is their letter:

The recent Wall Street Journal (WSJ) editorial “Wait Listed to Death” portrays an unrealistic picture of organ transplantation in the United States and proposes a change in our national policy that the rest of the world considers unethical and repugnant. The WSJ is recommending a market for organs which is the basis of legislation now proposed by Senator Specter of Pennsylvania.

Senator Specter’s legislation would lift NOTA’s restrictions on the payment of “valuable consideration” for organs from any “actions” by any level of government (from federal to tribal) that aim to increase the number of organs for transplantation. These “actions” could include authorizations for organizations—whether for-profit or nonprofit—to run incentive programs, different from one state to another, with no federal regulatory oversight.

Thus, the Specter legislation introduces a radical change after more than 50 years of transplantation that has always considered donated organs to be a gift. Benefits such cash equivalents would be permitted that could include stocks, bonds, housing, motor vehicles, tuition, funeral costs, tax incentives, etc. These “benefits” are no different than cash in soliciting individuals to be organ donors.

We commend Senator Specter’s concern about the imbalance of organ donors and candidates awaiting transplantation; but the WSJ editorial exaggerates that imbalance by citing statistics that are not true: a large proportion of those who die “while waiting” are not really active candidates and would not be helped by a system of financial incentives for organ donation. Moreover, approximately 40% of those that are dying on the list are in need of hearts, livers and lungs that will not be affected by markets for living unrelated donors. An eBay offer for lung donors, as the WSJ misrepresents, is not the issue; but a market for kidneys is an international concern.

These markets have been tested in many parts of the world. The single consistent result of those experiments has been the abuse of human rights. For that reason, the international transplant community was recently convened in Istanbul to combat organ trafficking and transplant tourism. The result was the Declaration of Istanbul that condemns transplant commercialism, because it targets the indigent and impoverished and inevitably leads to inequity and social injustice.

The Istanbul Declaration is now having success by regulatory authorities closing rogue transplant centers and prosecuting unethical doctors.

Importantly, in the United States, volunteer efforts such as the “Collaborative for Organ Donation” initiated by Secretary Thompson, have resulted in a major increase in deceased organ donors by appropriately educating both professionals and donor families. The expansion of these voluntary efforts has not yet reached its maximum potential.

Legislation can also support live donors by programs that do not currently exist. Federal protections for live donors to have job security, assured donor leave, and health and life insurance for donation-related events, would provide donor care and remove obstacles for those who wish to be organ donors.

Legislation must also consider provisions for organ failure prevention. The National Kidney Disease Education Program is an initiative of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), and the Department of Health & Human Services (DHHS) that can perform blood pressure screening and an inexpensive urine analysis to detect patients with hypertension and kidney dysfunction and treat them before the necessity of dialysis or transplantation.

Please join us in supporting legislation that will be a model testimony for the rest of the world. Otherwise, the legacy of transplantation is at risk if the United States endorses market programs that permit payments for organs; it will immediately and irreversibly open the door to a resumption of human rights abuses in many parts of the world.




NB: here is the 2008 Istanbul Declaration to which the letter refers.

Sunday, December 21, 2008

The market for economics: what should economists study?

The Boston Globe has a story in today's Ideas section about whether academic economists will and should redirect their energies to focus more on events like the current crisis (and less on the "luxury goods" of more academic or more microeconomic topics): Paradigm lost--Economists missed the brewing crisis. Now many are asking: How can we do better?

It's always good for individual economists to think about how they want to direct their efforts. A big crisis like the current one will surely cause some people to redirect their work to the new (and old) questions that it raises, and the new opportunities it presents for studying them.

But I am reminded, at times like these, that science is an incremental business with its own internal agenda. We don't always make the most progress by studying the most important problems directly. We often choose problems to study by some combination of their importance and their tractability. That is, sometimes we choose subjects to study because the tools (or the data) have gotten to the point where we can make progress on them, not because they have grown in importance.

I recall reading similar articles during previous crises. One that sticks with me was by an author who had looked at a recent issue of the American Economic Review, and complained that none of the articles were relevant to the stagflation we were then experiencing. Economists ignored important questions, he complained, and concentrated on small beer. I remember casually thinking of writing a reply along the lines of "I just looked at a recent issue of the Journal of the American Medical Association and noticed that all the articles are about relatively small scale problems, none of them directly addresses how to cure the major problem of medicine, which is Death."

My advice to young economic researchers is to keep your eye on the important questions you would like economics to be able to solve, but don't feel you have to take the steepest path up the mountain, feel free to look for ways to make the ascent step by step.

Saturday, December 20, 2008

Marriage market: dowries

The previous post got me thinking about dowries and their role in marriage markets: the paper I like best is "Why Dowries?" American Economic Review 93, no. 4 (September 2003): 1385-98, by Maristella Botticini and Aloysius Siow.

They argue that dowries make the most sense in agrarian societies in which daughters move to their husband's family upon marriage, while sons stay and invest in the family business. Thus parents who wish to support both sons and daughters give dowries to daughters and bequests (inheritances) to sons (instead of bequests to both, which would give sons less incentive to invest in running the family business...). As societies become less agrarian, and sons become less likely to remain in the family business, it becomes more efficient to treat sons and daughters more similarly and e.g. invest more in human capital by sending them both to college, etc...

Friday, December 19, 2008

Marriage market: Middle East

Head of Palestinian clan offers Iraqi shoe-throwing journalist a bride

"The head of a large West Bank family wants to reward the Iraqi journalist who lobbed his shoes at President George W. Bush by sending him a bride. 75-year-old Ahmad Salim Judeh says if journalist Muntadhar al-Zeidi is interested the family is willing to take one of its eligible daughters to Iraq along with her dowry. ... Al-Zeidi has become something of a folk hero since throwing his shoes at President Bush at a Sunday press conference."

Repugnant gambles

Justin Wolfers has a blog post at Freakonomics in which he observes that the Australian Federal Treasurer regards bets about the recession repugnant if placed on a book making site, although fine if placed in options markets. (This even though the bettors on the bookmaking site apparently are of the opinion that Australia will avoid a recession...)

Wednesday, December 17, 2008

Competition among airports

London's Heathrow, Gatwick, and Stansted airports are presently run by BAA Ltd, which also runs the Edinburgh and Glasgow airports in Scotland. The Telegraph reports on the decision of the British Competition Comission to dismantle this monopoly by requiring BAA to sell two of the three London airports and one of the Scottish ones: Delays could be cut by BAA sell-off of Gatwick, Stansted and Edinburgh airports

The Competition Commission reports, together with BAA's replies and other comments are here.

Incentives for Organ Donors

Apologies for this unusually long post: to make sense of this you have to look at bits of Federal legislation. The one sentence summary is that Senator Arlen Specter is preparing to propose an amendment to the National Organ Transplant Act to allow States to offer some (limited) incentives for organ donation...

The Wall Street Journal has an editorial today on incentives for organ donors: Wait-Listed to Death: Improving incentives for organ donations.
It is written in support of an amendment to the National Organ Transplant Act of 1984 being proposed by Senator Arlen Specter, part of which famously stated:

"TITLE 111-PROHIBITION OF ORGAN PURCHASES
SEC. 301. (a) It shall be unlawful for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation if the transfer affects interstate commerce."

The WSJ editorial observes that under current interpretation of the Act,
"Kidney transplant recipient Sally Satel has noted that burial and cremation expenses can be provided when a body is donated to science -- as long as it isn't used to save the life of a current patient."

Because the phrase "valuable consideration" could include much more than cash payments, the NOTA has already been amended to make clear that it does not preclude kidney exchange. The Charlie W. Norwood Living Organ Donation Act [Public Law 110-144] signed into law in December, 2007, amends the sentence of the NOTA quoted above by saying
"Section 301 of the National Organ Transplant Act (42 U.S.C.274e) is amended—(1) in subsection (a), by adding at the end the following:‘‘The preceding sentence does not apply with respect to human organ paired donation.’’"
(Note: the phrase "paired donation" is used in official circles to avoid the use of the word "exchange" in kidney exchange, to further separate it from any involvement with "valuable consideration.)

The amendment to be proposed by Senator Specter includes a further amendment of that sentence. (I don't think the proposed bill is on the web yet, this is a quote from a preliminary version that crossed my desk.)
"Section 301 of the National Organ Transplant Act4 (42 U.S.C. 274e) is amended—5 (1) in subsection (a), by striking the last sentence and inserting ‘‘The preceding sentence does not apply with respect to human organ paired donation or a government incentive to increase the supply of donated human organs.’’" (emphasis added). The proposed amendment also increases penalties for non-governmental buying and selling of organs for use in transplantation.

The WSJ notes that the amendment is motivated in part by the fact that
"After Pennsylvania passed a pilot program in 1994 to pay burial expenses for organ donors, state employees refused to implement the law for fear of federal prosecution."

However the italicized portion of the amended sentence is arousing some opposition because it seems to open the door to other sorts of government incentives, of a kind recently opposed by Pope Benedict and by the National Kidney Foundation.

Debate over the proposed bill looks likely to be a public forum in which issues of repugnant transactions will play a visible role.

Partly in anticipation of this (and after I posted the above), Sally Satel informs me that I've been working from an early draft of the proposed amendment. The new draft includes a summary stating
"A BILL
To prohibit human organ trafficking, to prohibit the misuse of immigration and government identification documents in furtherance of organ trafficking, to prohibit attempted organ trafficking, to mandate restitution for victims of organ trafficking, to create a civil remedy for victims of organ trafficking, and to clarify that laws that honor and reward organ donation are not preempted by Federal criminal law and acceptance of such government benefits is not criminal." (emphasis added)

The relevant parts of the bill (see para 3 below) now appear to rule out cash transfers even from government programs (although I'm not a lawyer...)"

"‘‘(2) GOVERNMENTS ENCOURAGING ORGAN DONATION.—This section and section 301 of the National Organ Transplant Act (42 U.S.C. 274e) shall
not—
‘‘(A) apply to actions taken by the Government of the United States or any State, territory, tribe, or local government of the United States to encourage organ donation; or
‘‘(B) prohibit acceptance of such a government benefit.
‘‘(3) CERTAIN STATE LAWS.—This section shall be construed to preempt any State law that authorizes the payment of cash to induce organ donation or otherwise authorizes the sale or purchase of a human organ for use in human transplantation.’’"

Academic marketplace: Recession at Yale

Yale's president, economist Richard Levin, has written a sensible letter to the Yale community about dealing with the sharp drop in Yale's endowment, in which he takes a long term view of faculty hiring:

"Second, we will continue to recruit faculty. Authorized searches in the Faculty of Arts and Sciences will proceed, and the deans in each of the professional schools will work with the Provost to strengthen their faculties. We do not want to lose the momentum of recent years, and we believe that it will be to Yale’s long-run advantage to continue to recruit outstanding and diverse faculty. This said, we will need to be judicious in authorizing new positions and filling vacancies, and departments will have to make a strong case for searches that are not yet authorized."

Tuesday, December 16, 2008

Bankruptcy

Contracts are shaped in part by the legal framework that determines what happens when contracts break down. The long time scholar of bankruptcy Michelle White has a timely new NBER working paper "Bankruptcy: Past Puzzles, Recent Reforms, and the Mortgage Crisis." (It is a revised version of her 2008 Presidential Address to the American Law and Economics Association.)

One arresting sentence:
"By the early 2000’s, more people were filing for bankruptcy each year than were graduating from college, getting divorced or being diagnosed with cancer."

Monday, December 15, 2008

Some transactions become repugnant again in Holland

Holland scrapping liberal policies on drugs and brothels to clean up image
"The Dutch are rethinking their famously liberal polices on legalised brothels, prostitution and soft drugs, such as magic mushrooms and cannabis, amid fears of growing crime and social decline.
New restrictions on marijuana selling cafés, a ban on the sale of magic mushrooms and plans to clean up Amsterdam's red light district have been announced across Holland."

But it looks like they are contemplating gradual change:

"Last week, Amsterdam announced that it planned to halve the number of its shop window brothels and cannabis cafés in an attempt to drive pimps, money launderers and criminals out of the city.
Now the Dutch government has announced new plans to strictly regulate the sex industry, massage parlours and brothels more by imposing a tough licensing system to drive out organised crime. "

Sunday, December 14, 2008

Surrogate motherhood, continued.

Last month I blogged about a NY Times Sunday magazine story written by a woman who hired a surrogate mother to bear her child, in connection with the stream of posts I've made about repugnant transactions, i.e. transactions that some people think other people shouldn't do. Today, the Magazine section has letters commenting on that article, some supportive of the author mom, some not. Some of those latter are full of a sense of repugnance: these two caught my eye.

"If prostitution is unethical, immoral and illegal, why is it O.K. for one woman to pay for the use of another woman’s body? If it’s unethical, immoral and illegal to buy and sell body parts for transplantation, why is it O.K. to rent a uterus? Our morality seems so malleable in the hands of those who feel entitled."

"I am filled with revulsion by Alex Kuczynski’s cover story. I find it unconscionable that in an era with so many children who cannot find homes there are rich, white, educated couples who can pay $25,000 so that another woman, living in far less well-off circumstances, can go through the physical ordeal and emotional pain of having and giving up her baby. ..."

Saturday, December 13, 2008

Illegal cartels and the prisoner's dilemma

Paraffin wax is a humble byproduct of oil refining, and the EU's competition commission recently fined a passel of big oil refiners for having maintained a paraffin cartel that illegally coordinated prices. Here's the story: Inside Europe’s High-Living Wax Cartel.

The cartel seems to date from the 1970's, so it was quite long lived. But when it collapsed, it collapsed quickly, because of the prisoner's-dilemma way the anti-cartel laws are written and enforced.

"In the paraffin case, as in others, some of the biggest offenders walked off with no, or relatively small, fines because they were first in the door with information implicating less-involved conspirators."
...
"By late February 2005, the cartel started to fracture. It gathered for what would be its last meeting in the brightly colored four-star Hotel Madison Residenz in Hamburg but was unable to come to an agreement on prices.
Three weeks after the Hamburg meeting, the cartel was shattered.
Shell, facing $360 million in fines for its participation in other cartels — involving synthetic rubber and bitumen, a thick form of petroleum — revealed the paraffin scheme to European Union authorities on March 17, 2005. Under European Union regulations, Shell won complete forgiveness for what would have been a nearly $130 million fine, as calculated by the commission. Other companies — some far less implicated — faced fines eventually totaling nearly $900 million."

Friday, December 12, 2008

School choice in Belgium

Estelle Cantillon, a leading market designer working in Belgium, writes in LeSoir about the current school choice situation, following the withdrawal on Wednesday of the current system of school-specific lotteries and waiting lists: Mixité : le tirage au sort n'est pas le problème, il pourrait même faire partie de la solution ('the lottery isn't the problem, it could be part of the solution'). She notes that this system was heavily gamed; because you couldn't be sure your child would be admitted to a given school, you had to apply to many schools, so the waiting list system was congested and the allocations were random.

She has organized a conference on the subject in Brussels in January, at which the new, strategy-proof designs in Boston and New York will be described. As she puts it in her column "Parents shouldn't have to break their heads" to try to get their kids into a school.

Thursday, December 11, 2008

Market for Senate seats

Auction theorist, designer, and entrepreneur Peter Cramton sends me the following email about the recent arrest of the Governor of Illinois on charges of seeking to sell the Senate seat vacated by the President-elect. Under the subject line "auctions vs. matching" he writes:

"Al,
As you know, I am a big fan of auctions, but below would appear to be an example of where using an auction (price-based matching) causes some discomfort among market participants and matching without prices may be preferred. :)
Peter"

He attaches this BBC story, asking When will the Illinois prison authorities finally grasp the nettle and open a governors' wing in Chicago's premier jail?

Wednesday, December 10, 2008

Should assisted suicide be a legal transaction? The debate continues.

The debate in England about whether the laws criminalizing assisted suicide should be changed has grown agonizing to follow, with a televised account of one man's suicide at the Swiss clinic that has been the subject of so much earlier discussion. The Times reports: Suicide on TV Condemned in Britain.
"Public opinion polls suggest that 80 percent of Britons believe the law should be changed to allow a doctor to end a patient's life in a case like Ewert's, but opposition from influential religious groups remains strong and the anti-suicide law remains in place."

The Other Times reports: Gordon Brown refuses to back law allowing assisted suicides
"Campaigners seeking to lift the ban on assisted suicide were dealt a blow yesterday when Gordon Brown repeated his opposition to a change in the law.
The Prime Minister said that he would never support legislation to permit assisted suicide that might put sick or elderly people under pressure to end their life. Privately, some politicians criticised him, claiming that he had breached a convention of government neutrality by expressing a view on an issue recognised as one of conscience rather than party policy.
His comments came as a television documentary last night showed the death of Craig Ewert, a motor neuron disease sufferer, the first time that footage of an assisted suicide including the moment of death had been broadcast in Britain.
"

In related stories, British prosecutors have decided not to prosecute the parents of the former rugby player for accompanying him to Switzerland: No charge for parents who took son, Daniel James, to suicide clinic

In the U.S., physician assisted suicide is legal only in Washington State and Oregon--here's a discussion in the New England Journal of Medicine: Physician-Assisted Death — From Oregon to Washington State

The debate about whether a patient with a terminal disease who wishes to hasten his death may legally do so, and may receive medical assistance, echoes in many ways similar debates about other repugnant transactions, i.e. transactions that some people don't want others to make. (My earlier posts on the debate over assisted suicide are here, here, here, here, and, tangentially, here.)

Tuesday, December 9, 2008

School choice in NYC

Last month I blogged about the New York City high school choice mechanism that Atila Abdulkadiroglu, Parag Pathak and I helped design. The NY Times reports on this year's version: even a well designed system doesn't remove the stress from choosing sensibly among hundreds of high school programs. Among the many ways the new system is an improvement on the old, pre 2003 system, is that families can state their preferences among schools without revealing them to the schools (so that schools can no longer adopt strategies like "only admit students who rank us first").

As the Times reports,
"Last week, more than 80,000 eighth graders submitted a ranked list of up to 12 of the city’s 400 high schools to their middle-school guidance counselors. Separately, students submit essays and other materials to individual schools, which do not know where they rank on the students’ lists. (Allison and her mother asked that their top choice not be revealed for fear it could hurt her chances elsewhere.)"

The new system also solves the congestion problem that plagued the old system; multiple applications by 80,000+ students overwhelmed the old system, but the present system uses a computerized, student proposing deferred acceptance algorithm.

HT to Parag Pathak

Academic marketplace: Recession at Harvard

Harvard's endowment has (like most assets) taken a huge hit in the market meltdown. However, it is likely that, when the storm is over, Harvard will remain the most richly endowed university in the world. Hence you might think the present recession would be an opportunity for Harvard to seek to build, e.g. in areas in which it is not yet the best university in the world (such as some of those that the engineering institute down the river excels at, for example). This would be challenging (because a vast but presently declining endowment faces very severe liquidity constraints), but Harvard is well positioned to borrow in the bond market.

It appears that this is not the plan, however. A story in today's Crimson (FAS Freezes All Faculty Salaries, Cuts Searches) leaks an email to department chairs that is to be discussed more fully at a faculty meeting today. The story suggests that
"[other measures and] a hold on the bulk of current searches for tenure-track and tenured faculty were among the cost-cutting measures announced in a letter circulated to department chairs in the Faculty of Arts and Sciences yesterday afternoon. ... The new policy marks a considerable departure from the stance outlined by FAS Dean Michael D. Smith at a Faculty meeting in November, when he told department leaders to go ahead with all current searches if applicant pools remained as strong as anticipated."

Applicant pools will of course be unusually strong in a year when many universities are cutting back their hiring. I can already see that more daring universities may have unusual opportunities. (Economics departments should be looking particularly to hire some of the best new market designers, experimenters, and theorists....)

Auctions of airport takeoff and landing slots--maybe not so soon after all

Auctions of slots at NYC airports delayed yet again: Court Order Delays Auction of Landing Slots at Airports

"A court order on Monday delayed a Bush administration plan to auction landing slots at the three major airports in the New York region, pushing the proposal into the Obama administration, where it may die.
The Court of Appeals for the District of Columbia granted a stay on Monday, in a case brought by the Port Authority of New York and New Jersey, pending arguments on whether the Federal Aviation Administration has the legal authority to auction the slots. The first auction was scheduled for Jan. 12, eight days before the Bush administration ends. "

Who would have thought that such a good idea would run into so much trouble...

HT to Scott Kominer

Sunday, December 7, 2008

Markets for durables when credit is tight

Two stories in the NY Times reflect changes in markets for durable goods and for real estate in the context of tight credit: layaway plans and rent with option to buy, respectively.

The Last Temptation of Plastic reports on the revival of layaway plans, which used to be popular before credit cards. In a layaway purchase, you make installment payments before taking possession of your purchase (e.g. a big furniture purchase); it's a form of enforced savings that locks in a price and helps supply self control and commitment (to save for the purchase) where it might be lacking.

Rent Now, Buy Later reports on the growing number of offerings in the NYC real estate market. These transactions allow potential purchasers to delay purchase until they have a bigger downpayment (and until they see which way the market is going), and they give sellers some rental income in the meantime.

These are both signs of tough times...

Auctions of airport takeoff and landing slots--maybe coming soon

U.S. to Auction Slots Soon at New York City Airports reports the Times.

"The auction is scheduled for next Friday, with results announced soon afterward; the changes are to take effect at La Guardia in March and at Kennedy and Newark in October.
If the auction is not overturned by the courts or Congress — and either seems possible — it could be the last significant transportation action of the Bush administration, which leaves on Jan. 20.
What is being auctioned is the right to land, or take off, within a half-hour period for 10 years. The reserve price — below which the slot will not be sold — is $10,000 for peak hours and $100 for off-peak, but the president of the auction company, Lawrence M. Ausubel of Power Auctions, said that those numbers were likely to be “well exceeded.”
Mr. Ausubel said he did not know of any prior auction of airport slots."

HT to Scott Kominer