A stranger, a gift, and a marathon miracle: Ellyn Cohen needed a lung to live, then a woman she’d never met offered hers
"It was an unusual act of kindness. Last year, out of 1,661 lung transplants in the United States, only one came from a living donor. In 2008, the number of living lung donors was zero, according to the Organ Procurement and Transplantation Network, the government agency that coordinates national waitlists for organ transplants. And in 2004, the year Greene made her donation, she was one of just 28 living lung donors out of 1,172 transplants. That year, 492 people died while waiting for a lung.
As uncommon as living lung donors are, it is even less common for the organ to come from a stranger. And the way Greene found out about Cohen’s plight — from a mass e-mail forwarded by a friend — makes the story all the more incredible, said Sean Fitzpatrick, spokesman for the New England Organ Bank, the federally designated nonprofit organization that identifies deceased donors and recovers organs and tissues for transplants in the region."
...
"A few weeks after the surgery, Greene was playing tennis. The four lobes that remain in her two lungs are one less than a normal healthy person has. But her doctors have told her that her lungs work better than those of many healthy people. Two years ago, Greene started running. She decided to do the marathon to mark her half-century milestone. She got a charity number from her spouse, Angela Cenzalli, who works for the Special Olympics. But she will wear the shirt of the New England Organ Bank, to draw attention to the plight of the more than 1,800 people in the country awaiting lung transplants.
“If more people registered as donors we wouldn’t have to take parts out of living bodies,’’ Greene said. “I’m not asking people to donate their organs when they are alive.’’
She is not expecting to finish the race in less than five hours.
“I like to think that I’ll be fairly high up among the four-lobe people,’’ she smiled."
Monday, April 19, 2010
Sunday, April 18, 2010
Civet coffee
Here's a story from the NY Times that, if published on April 1, would have won a prize.
From Dung to Coffee Brew With No Aftertaste
"Costing hundreds of dollars a pound, these beans are found in the droppings of the civet, a nocturnal, furry, long-tailed catlike animal that prowls Southeast Asia’s coffee-growing lands for the tastiest, ripest coffee cherries. The civet eventually excretes the hard, indigestible innards of the fruit — essentially, incipient coffee beans — though only after they have been fermented in the animal’s stomach acids and enzymes to produce a brew described as smooth, chocolaty and devoid of any bitter aftertaste.
As connoisseurs in the United States, Europe and East Asia have discovered civet coffee in recent years, growing demand is fueling a gold rush in the Philippines and Indonesia, the countries with the largest civet populations. Harvesters are scouring forest floors in the Philippines, where civet coffee has emerged as a new business. In Indonesia, where the coffee has a long history, enterprising individuals are capturing civets and setting up minifarms, often in their backyards.
Neither the Indonesian government nor the Association of Indonesia Coffee Exporters breaks down civet coffee’s tiny share of Indonesia’s overall coffee production. The Association of Indonesian Coffee Luwak Farmers, created in 2009 to handle the rising demand for civet coffee, or kopi luwak, as it is called in Indonesian, said most civet producers were small-time businessmen who exported directly overseas.
Given the money at stake, fake and low-grade civet coffee beans are also flooding the market. "
...
"Competition is touching off fierce debates. What is real civet coffee, anyway? Does the civet’s choice of beans make the coffee? Or is it the beans’ journey through the animal’s digestive tract? Can the aroma, fragrance and taste of beans from the droppings of a caged civet ever be as tasty as those from its wild cousin? "
Update. Bettina Klaus writes from Lisbon (where she's stranded by the Icelandic ash cloud), "I found a link on further "Disgusting Delicacies" http://www.walletpop.com/specials/bw/disgusting-delicacies/. Goat poop oil also sounds nice. And the coffee can be mail ordered: http://www.animalcoffee.com/ "
From Dung to Coffee Brew With No Aftertaste
"Costing hundreds of dollars a pound, these beans are found in the droppings of the civet, a nocturnal, furry, long-tailed catlike animal that prowls Southeast Asia’s coffee-growing lands for the tastiest, ripest coffee cherries. The civet eventually excretes the hard, indigestible innards of the fruit — essentially, incipient coffee beans — though only after they have been fermented in the animal’s stomach acids and enzymes to produce a brew described as smooth, chocolaty and devoid of any bitter aftertaste.
As connoisseurs in the United States, Europe and East Asia have discovered civet coffee in recent years, growing demand is fueling a gold rush in the Philippines and Indonesia, the countries with the largest civet populations. Harvesters are scouring forest floors in the Philippines, where civet coffee has emerged as a new business. In Indonesia, where the coffee has a long history, enterprising individuals are capturing civets and setting up minifarms, often in their backyards.
Neither the Indonesian government nor the Association of Indonesia Coffee Exporters breaks down civet coffee’s tiny share of Indonesia’s overall coffee production. The Association of Indonesian Coffee Luwak Farmers, created in 2009 to handle the rising demand for civet coffee, or kopi luwak, as it is called in Indonesian, said most civet producers were small-time businessmen who exported directly overseas.
Given the money at stake, fake and low-grade civet coffee beans are also flooding the market. "
...
"Competition is touching off fierce debates. What is real civet coffee, anyway? Does the civet’s choice of beans make the coffee? Or is it the beans’ journey through the animal’s digestive tract? Can the aroma, fragrance and taste of beans from the droppings of a caged civet ever be as tasty as those from its wild cousin? "
Update. Bettina Klaus writes from Lisbon (where she's stranded by the Icelandic ash cloud), "I found a link on further "Disgusting Delicacies" http://www.walletpop.com/specials/bw/disgusting-delicacies/. Goat poop oil also sounds nice. And the coffee can be mail ordered: http://www.animalcoffee.com/ "
Live kidney donation via twitter and other social networking sites
For many years the transplant community was very uneasy about solicitation of live kidney donors, but that seems to be changing. Web sites like MatchingDonors.com have achieved much more widespread acceptance (and they have in turn started to integrate themselves with kidney exchange programs).
Arthur Matas, the Director of Renal Transplant at U. Minnesota, has a blog post on Kidney donation via Twitter. Here's a newspaper article that follows the story: Kidney Transplant A Success Among Cyber Friends.
Social network sites may be just the sort of thing needed to help people let their friends know that they need a kidney, without putting any particular friend on the spot with a direct request.
Arthur Matas, the Director of Renal Transplant at U. Minnesota, has a blog post on Kidney donation via Twitter. Here's a newspaper article that follows the story: Kidney Transplant A Success Among Cyber Friends.
Social network sites may be just the sort of thing needed to help people let their friends know that they need a kidney, without putting any particular friend on the spot with a direct request.
Saturday, April 17, 2010
Boston Globe on school choice
The problem with school choice is not enough seats at good schools. And in every city I've dealt with, there are two political parties when it comes to school choice: the "walk to school" party, who live near good schools, and the "school choice" party, who don't. Here's how it looks to the Globe, following a season in which a city councillor's child did not get a place in his local kindergarten.
City tries anew to end school-placement frustrations: Even those with clout chagrined by lottery
By James Vaznis, Globe Staff April 16, 2010
"Among young families in West Roxbury, it was one of the most closely watched lotteries: Would the 3-year-old son of their neighborhood city councilor win entry into a public school pre-kindergarten program, particularly a coveted placement just down the street from his home?
After all, a host of other children in the city’s well-connected political families have received their top choices in the school lottery in the past, leading to a slew of conspiracy theories that the computer-generated algorithm was subject to political tinkering.
As it turned out, luck was not on the side of City Councilor John Tobin and his wife, Kate. Their son was wait-listed recently at all four of their choices, an ironic outcome for a politician who long advocated for greater leeway in allowing students to attend neighborhood schools.
Being locked out is a crushing event experienced by hundreds of parents across the city each year, prompting some to flee to the suburbs. For Tobin, the disappointment has added a personal twist fueling his crusade for changes in the city’s school-placement system.
“I’m just like everyone else tremendously disappointed by this system,’’ he said yesterday in a phone interview. “Kids in a neighborhood should get the first chance at their neighborhood school’s seats, and those left open could be filled by other students. Schools should just be part of a neighborhood as community centers and libraries.’’
Tobin, who penned a recent column about his family’s lottery loss for the West Roxbury Transcript, is stepping up his push as the district embarks on a new effort that could lead to a radical overhaul in the way the city has been assigning students to school for decades.
The new effort has two parts. First, civil rights lawyers and others are helping the district with a federal grant to find ways to change the student-assignment system without disenfranchising the city’s poorest children. Meanwhile, Superintendent Carol R. Johnson is working to raise the quality of education in the city’s poorest neighborhoods, calling it the Circle of Promise.
Under the current system, established to replace a court-created desegregation plan, the city is divided into three sprawling-geographic regions, allowing parents to choose from dozens of schools in their zone. For instance, it allows a student from a housing development in Roxbury — which has a disproportionate share of low-performing schools — to attend a high-quality school in West Roxbury, a city neighborhood with a suburban character.
The system has created stiff competition for the city’s top-performing schools, often leading to heartache and bitterness when families don’t get their top choices, especially in kindergarten.
Adding confusion at decision time is mystery over the complex computerized program that randomly assigns students. The formula, among other factors, gives weight to applicants who have a sibling at a school and allows half of seats at a school to go to applicants who live a certain distance away from the school.
Some families, Tobin said, question the lottery system’s fairness. During last fall’s mayoral race, a challenger to Mayor Thomas M. Menino and then city councilors Sam Yoon and Michael Flaherty noted in a debate that the trio had family members at top-choice schools.
“People think there are shenanigans that go on with the lottery system,’’ Tobin said. “When something is done behind closed doors, it raises eyebrows.’’
Matthew Wilder, a school department spokesman, defended the lottery system, saying that Tobin’s story shows “how blind the system is.’’ Even one of the mayor’s grandchildren didn’t get in a pre-kindergarten program in recent years.
Wilder noted, however, that about 80 percent of children who applied this year in the first round for a seat in pre-kindergarten, an optional city program with limited capacity, got one.
“We don’t feel this is an assignment issue, but a space issue,’’ Wilder said. “We don’t have enough room for everyone who wants a seat for their 4-year-old. We are very lucky in Boston we offer full-day kindergarten for 4-year-olds. Not a lot of cities can say that.’’
Tobin said every year around this time he has conversations “with people calling me up in tears’’ because they did not get into any of their chosen schools — whether for kindergarten or some other grade — prompting them to consider leaving the city for the suburbs. Tobin, who grew up in Mattapan and West Roxbury, said many of his friends have departed for Walpole.
Theresa Strang, a stay-at-home mother in West Roxbury, whose daughter was wait-listed this year for pre-kindergarten, is organizing a group of mothers to push for changes to the system.
“Everyone is talking about moving,’’ she said. “I know a woman who put her house on the market. . . . Why don’t they invest in neighborhoods and make them better?’’
Past attempts by the city to change the system have collapsed amid a tug-of-war over school access. Last year intense community opposition doomed a plan to break the city into five zones.
Tobin said he is not optimistic about seeing a return to more neighborhood schools. In some respects, he said, the city is a victim of its own success as education at many elementary schools has improved with the addition of such programs as full-day pre-kindergarten.
Still, he said, there are not enough high-quality schools.
“We live on Joyce Kilmer Road, and we can see the Joyce Kilmer School,’’ which was the family’s top choice and is one of the highest-performing schools in the city, Tobin said. “Explain the logic of why my son can’t go to that school. I will go to my grave not understanding that one.’’
City tries anew to end school-placement frustrations: Even those with clout chagrined by lottery
By James Vaznis, Globe Staff April 16, 2010
"Among young families in West Roxbury, it was one of the most closely watched lotteries: Would the 3-year-old son of their neighborhood city councilor win entry into a public school pre-kindergarten program, particularly a coveted placement just down the street from his home?
After all, a host of other children in the city’s well-connected political families have received their top choices in the school lottery in the past, leading to a slew of conspiracy theories that the computer-generated algorithm was subject to political tinkering.
As it turned out, luck was not on the side of City Councilor John Tobin and his wife, Kate. Their son was wait-listed recently at all four of their choices, an ironic outcome for a politician who long advocated for greater leeway in allowing students to attend neighborhood schools.
Being locked out is a crushing event experienced by hundreds of parents across the city each year, prompting some to flee to the suburbs. For Tobin, the disappointment has added a personal twist fueling his crusade for changes in the city’s school-placement system.
“I’m just like everyone else tremendously disappointed by this system,’’ he said yesterday in a phone interview. “Kids in a neighborhood should get the first chance at their neighborhood school’s seats, and those left open could be filled by other students. Schools should just be part of a neighborhood as community centers and libraries.’’
Tobin, who penned a recent column about his family’s lottery loss for the West Roxbury Transcript, is stepping up his push as the district embarks on a new effort that could lead to a radical overhaul in the way the city has been assigning students to school for decades.
The new effort has two parts. First, civil rights lawyers and others are helping the district with a federal grant to find ways to change the student-assignment system without disenfranchising the city’s poorest children. Meanwhile, Superintendent Carol R. Johnson is working to raise the quality of education in the city’s poorest neighborhoods, calling it the Circle of Promise.
Under the current system, established to replace a court-created desegregation plan, the city is divided into three sprawling-geographic regions, allowing parents to choose from dozens of schools in their zone. For instance, it allows a student from a housing development in Roxbury — which has a disproportionate share of low-performing schools — to attend a high-quality school in West Roxbury, a city neighborhood with a suburban character.
The system has created stiff competition for the city’s top-performing schools, often leading to heartache and bitterness when families don’t get their top choices, especially in kindergarten.
Adding confusion at decision time is mystery over the complex computerized program that randomly assigns students. The formula, among other factors, gives weight to applicants who have a sibling at a school and allows half of seats at a school to go to applicants who live a certain distance away from the school.
Some families, Tobin said, question the lottery system’s fairness. During last fall’s mayoral race, a challenger to Mayor Thomas M. Menino and then city councilors Sam Yoon and Michael Flaherty noted in a debate that the trio had family members at top-choice schools.
“People think there are shenanigans that go on with the lottery system,’’ Tobin said. “When something is done behind closed doors, it raises eyebrows.’’
Matthew Wilder, a school department spokesman, defended the lottery system, saying that Tobin’s story shows “how blind the system is.’’ Even one of the mayor’s grandchildren didn’t get in a pre-kindergarten program in recent years.
Wilder noted, however, that about 80 percent of children who applied this year in the first round for a seat in pre-kindergarten, an optional city program with limited capacity, got one.
“We don’t feel this is an assignment issue, but a space issue,’’ Wilder said. “We don’t have enough room for everyone who wants a seat for their 4-year-old. We are very lucky in Boston we offer full-day kindergarten for 4-year-olds. Not a lot of cities can say that.’’
Tobin said every year around this time he has conversations “with people calling me up in tears’’ because they did not get into any of their chosen schools — whether for kindergarten or some other grade — prompting them to consider leaving the city for the suburbs. Tobin, who grew up in Mattapan and West Roxbury, said many of his friends have departed for Walpole.
Theresa Strang, a stay-at-home mother in West Roxbury, whose daughter was wait-listed this year for pre-kindergarten, is organizing a group of mothers to push for changes to the system.
“Everyone is talking about moving,’’ she said. “I know a woman who put her house on the market. . . . Why don’t they invest in neighborhoods and make them better?’’
Past attempts by the city to change the system have collapsed amid a tug-of-war over school access. Last year intense community opposition doomed a plan to break the city into five zones.
Tobin said he is not optimistic about seeing a return to more neighborhood schools. In some respects, he said, the city is a victim of its own success as education at many elementary schools has improved with the addition of such programs as full-day pre-kindergarten.
Still, he said, there are not enough high-quality schools.
“We live on Joyce Kilmer Road, and we can see the Joyce Kilmer School,’’ which was the family’s top choice and is one of the highest-performing schools in the city, Tobin said. “Explain the logic of why my son can’t go to that school. I will go to my grave not understanding that one.’’
Friday, April 16, 2010
Matching with preferences for colleagues
Marek Pycia at UCLA has a revised paper on matching when you care who your colleagues are:
Stability and Preference Alignment in Matching and Coalition Formation
Abstract: In any state of nature, agents have preference rankings over coalitions they belong to. Given a state of nature, agents’ preferences are pairwise aligned if any two agents in the intersection of any two coalitions prefer the same one of the two coalitions. Our main result says that under mild regularity conditions there exists a core stable coalition structure in every state of nature if, and only if, the preferences are pairwise-aligned in every state of nature. Pairwise alignment is satisfied by some standard models of payoff determination such as Nash bargaining that were not previously recognized as related to stability. As applications, we study complementarities and peer effects in many-to-one matching, the assortative structure of coalitions, and the impact of inequality among agents on coalition formation.
Stability and Preference Alignment in Matching and Coalition Formation
Abstract: In any state of nature, agents have preference rankings over coalitions they belong to. Given a state of nature, agents’ preferences are pairwise aligned if any two agents in the intersection of any two coalitions prefer the same one of the two coalitions. Our main result says that under mild regularity conditions there exists a core stable coalition structure in every state of nature if, and only if, the preferences are pairwise-aligned in every state of nature. Pairwise alignment is satisfied by some standard models of payoff determination such as Nash bargaining that were not previously recognized as related to stability. As applications, we study complementarities and peer effects in many-to-one matching, the assortative structure of coalitions, and the impact of inequality among agents on coalition formation.
Thursday, April 15, 2010
Waiting lists
A pessimistic story in the NY Times about college admissions waiting lists, which are long this year: For Students, a Waiting List Is Scant Hope
"The admission process is a complicated dance of supply and demand for colleges. And this spring, many institutions have accepted fewer applicants, and placed more on waiting lists, until it becomes clear over the next few weeks how many spots remain.
M.I.T., which had a 6 percent increase in applicants, increased its waiting list by more than half, to 722. Last year, it accepted fewer than 80 from that list. Yale, which had a slight dip in applications this year yet still admitted fewer than 8 percent of applicants, placed nearly 1,000 others on its waiting list, an increase of more than 150. Dartmouth increased its list by about 80, to 1,740."
...
"Like its competitors, Duke does not rank students on its waiting list. Instead, decisions about who will rise to the top are often a function of what the admissions office perceives as deficiencies in the next freshman class. There might be, for example, a surplus of aspiring engineers and not enough potential English majors, or too few students from Florida. Or there might be an unexpected shortage of oboe players.
While Mr. Guttentag encourages students on the waiting list to send him a one-page letter — or a video of 60 seconds or less — letting him know how strongly they wish to attend, and why, they can do little to improve their chances. "...
"Since waiting list offers went out in late March, Mr. Guttentag and his colleagues have been deliberating whether to end the suspense for at least several hundred who are on it — those who probably have little hope of coming off.
Another reason the list is so long this year, he said, is that he and his colleagues were so overwhelmed by the volume of applicants that they ran out of time.
“What we could have done, had we had another week,” he said, “was to look at everybody on the waiting list and say, ‘Do they all need to be on?’ ”
“Of all the priorities,” he added, “that was not in the top two or three.” "
"The admission process is a complicated dance of supply and demand for colleges. And this spring, many institutions have accepted fewer applicants, and placed more on waiting lists, until it becomes clear over the next few weeks how many spots remain.
M.I.T., which had a 6 percent increase in applicants, increased its waiting list by more than half, to 722. Last year, it accepted fewer than 80 from that list. Yale, which had a slight dip in applications this year yet still admitted fewer than 8 percent of applicants, placed nearly 1,000 others on its waiting list, an increase of more than 150. Dartmouth increased its list by about 80, to 1,740."
...
"Like its competitors, Duke does not rank students on its waiting list. Instead, decisions about who will rise to the top are often a function of what the admissions office perceives as deficiencies in the next freshman class. There might be, for example, a surplus of aspiring engineers and not enough potential English majors, or too few students from Florida. Or there might be an unexpected shortage of oboe players.
While Mr. Guttentag encourages students on the waiting list to send him a one-page letter — or a video of 60 seconds or less — letting him know how strongly they wish to attend, and why, they can do little to improve their chances. "...
"Since waiting list offers went out in late March, Mr. Guttentag and his colleagues have been deliberating whether to end the suspense for at least several hundred who are on it — those who probably have little hope of coming off.
Another reason the list is so long this year, he said, is that he and his colleagues were so overwhelmed by the volume of applicants that they ran out of time.
“What we could have done, had we had another week,” he said, “was to look at everybody on the waiting list and say, ‘Do they all need to be on?’ ”
“Of all the priorities,” he added, “that was not in the top two or three.” "
Wednesday, April 14, 2010
Egg donor compensation
Study hard. The Globe reports: Yes, top students reap rich rewards, even as egg donors
Would-be parents want high scorers
"The Harvard Crimson was one of three college newspapers that ran an identical classified ad seeking a woman who fit a narrow profile: younger than 29 with a GPA over 3.5 and an SAT score over 1,400. The lucky candidate stood to collect $35,000 if she donated her eggs for harvesting.
The ad was one of 105 college newspaper ads examined by a Georgia Institute of Technology researcher who issued a report yesterday that appeared to confirm the long-held suspicion that couples who are unable to have children of their own are willing to pay more for reproductive help from someone smart. The analysis showed that higher payments offered to egg donors correlated with higher SAT scores.
“Holding all else equal, an increase of 100 SAT points in the score of a typical incoming student increased the compensation offered to oocyte donors at that college or university by $2,350,’’ wrote researcher Aaron D. Levine.
The paper, published in the March-April issue of the Hastings Center Report, examined ads in 63 student newspapers in spring 2006 and was billed as the first national cross-sectional sample of ads for egg donors. "
...
"Concerned about eggs being treated as commodities, and worried that big financial rewards could entice women to ignore the risks of the rigorous procedures required for harvesting, the American Society for Reproductive Medicine discourages compensation based on donors’ personal characteristics. The society also discourages any payments over $10,000.
Levine’s paper points out, however, that no outside regulator enforces those guidelines and that they are often ignored.
Of the advertisements Levine examined, nearly one-quarter offered donors more than $10,000, and about one-quarter of the ads listed specific requirements, such as appearance or ethnicity, also in violation of guidelines that discourage greater payment for particular personal characteristics."
...
"The issue of the report containing Levine’s analysis also offers a counterperspective from John A. Robertson, who chaired the ethics committee of the American Society of Reproductive Medicine. He casts doubt on the notion that it is an ethical problem to pay more for eggs from a woman with a particular ethnic background or high IQ. “After all, we allow individuals to choose their mates and sperm donors on the basis of such characteristics,’ Robertson wrote. “Why not choose egg donors similarly?’’ "
See also The Value of Smart Eggs from The Faculty Lounge by Kim Krawiec.
"In his response accompanying the report, John Robertson (Texas, law) questions whether there are really any ethical problems raised by the study – after all, Levine finds compliance with the ASRM guidelines in at least half the advertisements in his sample. I would argue, however, that Levine’s study highlights a serious ethical issue, though it is not infertile couples or the agencies working on their behalf whose behavior is ethically troubling. It is ASRM’s paternalistic and misguided attempts to control oocyte donor compensation through the same type of professional guidelines that courts have rejected when employed by engineers, lawyers, dentists, and doctors that should raise an ethical red flag."
And here is the Hastings Center Report: Self-Regulation, Compensation, and the Ethical Recruitment of Oocyte Donors by Aaron D. Levine
Would-be parents want high scorers
"The Harvard Crimson was one of three college newspapers that ran an identical classified ad seeking a woman who fit a narrow profile: younger than 29 with a GPA over 3.5 and an SAT score over 1,400. The lucky candidate stood to collect $35,000 if she donated her eggs for harvesting.
The ad was one of 105 college newspaper ads examined by a Georgia Institute of Technology researcher who issued a report yesterday that appeared to confirm the long-held suspicion that couples who are unable to have children of their own are willing to pay more for reproductive help from someone smart. The analysis showed that higher payments offered to egg donors correlated with higher SAT scores.
“Holding all else equal, an increase of 100 SAT points in the score of a typical incoming student increased the compensation offered to oocyte donors at that college or university by $2,350,’’ wrote researcher Aaron D. Levine.
The paper, published in the March-April issue of the Hastings Center Report, examined ads in 63 student newspapers in spring 2006 and was billed as the first national cross-sectional sample of ads for egg donors. "
...
"Concerned about eggs being treated as commodities, and worried that big financial rewards could entice women to ignore the risks of the rigorous procedures required for harvesting, the American Society for Reproductive Medicine discourages compensation based on donors’ personal characteristics. The society also discourages any payments over $10,000.
Levine’s paper points out, however, that no outside regulator enforces those guidelines and that they are often ignored.
Of the advertisements Levine examined, nearly one-quarter offered donors more than $10,000, and about one-quarter of the ads listed specific requirements, such as appearance or ethnicity, also in violation of guidelines that discourage greater payment for particular personal characteristics."
...
"The issue of the report containing Levine’s analysis also offers a counterperspective from John A. Robertson, who chaired the ethics committee of the American Society of Reproductive Medicine. He casts doubt on the notion that it is an ethical problem to pay more for eggs from a woman with a particular ethnic background or high IQ. “After all, we allow individuals to choose their mates and sperm donors on the basis of such characteristics,’ Robertson wrote. “Why not choose egg donors similarly?’’ "
See also The Value of Smart Eggs from The Faculty Lounge by Kim Krawiec.
"In his response accompanying the report, John Robertson (Texas, law) questions whether there are really any ethical problems raised by the study – after all, Levine finds compliance with the ASRM guidelines in at least half the advertisements in his sample. I would argue, however, that Levine’s study highlights a serious ethical issue, though it is not infertile couples or the agencies working on their behalf whose behavior is ethically troubling. It is ASRM’s paternalistic and misguided attempts to control oocyte donor compensation through the same type of professional guidelines that courts have rejected when employed by engineers, lawyers, dentists, and doctors that should raise an ethical red flag."
And here is the Hastings Center Report: Self-Regulation, Compensation, and the Ethical Recruitment of Oocyte Donors by Aaron D. Levine
Tuesday, April 13, 2010
Biological markets: exchange of goods and services among non-human species
From the web pages of the French scientist Ronald Noe:
Biological Markets. "The label 'biological markets' was proposed by Noë & Hammerstein (1994; 1995) for all interactions between organisms in which one can recognise different classes of 'traders' that exchange commodities, such as goods (e.g. food, shelter, gametes) or services (e.g. warning calls, protection, pollination). "
"The characteristics of biological markets are found in mating systems ('mating markets'), mutualisms between members of different species and cooperation among conspecifics
"The term 'market' was chosen because it is assumed that shifts in supply and demand cause changes in the exchange value of the commodities traded. Important phenomena are: partner choice and outbidding.
"Formal properties of Biological Markets
Commodities are exchanged between individuals that differ in the degree of control over these commodities
Trading partners are chosen from a number of potential partners.
There is competition among the members of the chosen class to be the most attractive partner. This competition by 'outbidding' causes an increase in the value of the commodity offered.
Supply and demand determine the bartering value of commodities exchanged.
Commodities on offer can be advertised. As in commercial advertisements there is a potential for false information."
"Explicitly excluded is the use of physical force or threat to appropriate commodities or to eliminate the competition. The use of force is common, of course, as are theft and foul play in human markets, but one needs different paradigms to describe these phenomena.
"Examples of Biological Markets:
Obligate pollination mutualisms (to be added)
Ant protection mutualisms (to be added)
Mycorrhiza & rhizobia
Cleaner fish
Grooming in primates
Cooperative breeders
Delayed plumage maturation
Nest building in red bishops
links to further examples"
See also Market Models, on papers using game theory and comparative advantage to explore biological markets, which includes a bibliography of "Related theoretical approaches that also revolve around phenomena such as partner choice and competition by outbidding ..."
Biological Markets. "The label 'biological markets' was proposed by Noë & Hammerstein (1994; 1995) for all interactions between organisms in which one can recognise different classes of 'traders' that exchange commodities, such as goods (e.g. food, shelter, gametes) or services (e.g. warning calls, protection, pollination). "
"The characteristics of biological markets are found in mating systems ('mating markets'), mutualisms between members of different species and cooperation among conspecifics
"The term 'market' was chosen because it is assumed that shifts in supply and demand cause changes in the exchange value of the commodities traded. Important phenomena are: partner choice and outbidding.
"Formal properties of Biological Markets
Commodities are exchanged between individuals that differ in the degree of control over these commodities
Trading partners are chosen from a number of potential partners.
There is competition among the members of the chosen class to be the most attractive partner. This competition by 'outbidding' causes an increase in the value of the commodity offered.
Supply and demand determine the bartering value of commodities exchanged.
Commodities on offer can be advertised. As in commercial advertisements there is a potential for false information."
"Explicitly excluded is the use of physical force or threat to appropriate commodities or to eliminate the competition. The use of force is common, of course, as are theft and foul play in human markets, but one needs different paradigms to describe these phenomena.
"Examples of Biological Markets:
Obligate pollination mutualisms (to be added)
Ant protection mutualisms (to be added)
Mycorrhiza & rhizobia
Cleaner fish
Grooming in primates
Cooperative breeders
Delayed plumage maturation
Nest building in red bishops
links to further examples"
See also Market Models, on papers using game theory and comparative advantage to explore biological markets, which includes a bibliography of "Related theoretical approaches that also revolve around phenomena such as partner choice and competition by outbidding ..."
Monday, April 12, 2010
Unpaid workers: athletes and interns
Several blogs and news stories follow unpaid parts of the labor force, college athletes and student interns.
For Love of The Game (And The Money) from The Faculty Lounge by Kim Krawiec and Against the NCAA Cartel from The Volokh Conspiracy by Ilya Somin both consider the unpaid status of college athletes. The latter story explicitly mentions the high salaries of college coaches in basketball and football to indicate that these are profit making entertainment businesses despite the fact that the workers/players/students are unpaid.
There has also been a good deal of attention to the recent NY Times story headlined Growth of Unpaid Internships May Be Illegal, Officials Say
"With job openings scarce for young people, the number of unpaid internships has climbed in recent years, leading federal and state regulators to worry that more employers are illegally using such internships for free labor. "...
"Ms. Leppink said many employers failed to pay even though their internships did not comply with the six federal legal criteria that must be satisfied for internships to be unpaid. Among those criteria are that the internship should be similar to the training given in a vocational school or academic institution, that the intern does not displace regular paid workers and that the employer “derives no immediate advantage” from the intern’s activities — in other words, it’s largely a benevolent contribution to the intern.
No one keeps official count of how many paid and unpaid internships there are, but Lance Choy, director of the Career Development Center at Stanford University, sees definitive evidence that the number of unpaid internships is mushrooming — fueled by employers’ desire to hold down costs and students’ eagerness to gain experience for their résumés. Employers posted 643 unpaid internships on Stanford’s job board this academic year, more than triple the 174 posted two years ago.
In 2008, the National Association of Colleges and Employers found that 83 percent of graduating students had held internships, up from 9 percent in 1992. This means hundreds of thousands of students hold internships each year; some experts estimate that one-fourth to one-half are unpaid. "
Some regulatory guidance from California: California Labor Dept. Revises Guidelines on When Interns Must Be Paid
"Many wage and hour regulators maintain that interns must be paid if their work is of “immediate advantage” to the employer, but the California agency’s top lawyer advised that such an advantage can be offset — and the intern not be paid — if the employer provides close supervision and lays out money for training.
Over all, the guidance from the California Division of Labor Standards Enforcement was emphatic that for internships to be unpaid, they must be educational and predominantly for the benefit of the intern, not the employer. "
Some of these discussions have something in common with the discussions in the transplant community about compensation for donors.
For Love of The Game (And The Money) from The Faculty Lounge by Kim Krawiec and Against the NCAA Cartel from The Volokh Conspiracy by Ilya Somin both consider the unpaid status of college athletes. The latter story explicitly mentions the high salaries of college coaches in basketball and football to indicate that these are profit making entertainment businesses despite the fact that the workers/players/students are unpaid.
There has also been a good deal of attention to the recent NY Times story headlined Growth of Unpaid Internships May Be Illegal, Officials Say
"With job openings scarce for young people, the number of unpaid internships has climbed in recent years, leading federal and state regulators to worry that more employers are illegally using such internships for free labor. "...
"Ms. Leppink said many employers failed to pay even though their internships did not comply with the six federal legal criteria that must be satisfied for internships to be unpaid. Among those criteria are that the internship should be similar to the training given in a vocational school or academic institution, that the intern does not displace regular paid workers and that the employer “derives no immediate advantage” from the intern’s activities — in other words, it’s largely a benevolent contribution to the intern.
No one keeps official count of how many paid and unpaid internships there are, but Lance Choy, director of the Career Development Center at Stanford University, sees definitive evidence that the number of unpaid internships is mushrooming — fueled by employers’ desire to hold down costs and students’ eagerness to gain experience for their résumés. Employers posted 643 unpaid internships on Stanford’s job board this academic year, more than triple the 174 posted two years ago.
In 2008, the National Association of Colleges and Employers found that 83 percent of graduating students had held internships, up from 9 percent in 1992. This means hundreds of thousands of students hold internships each year; some experts estimate that one-fourth to one-half are unpaid. "
Some regulatory guidance from California: California Labor Dept. Revises Guidelines on When Interns Must Be Paid
"Many wage and hour regulators maintain that interns must be paid if their work is of “immediate advantage” to the employer, but the California agency’s top lawyer advised that such an advantage can be offset — and the intern not be paid — if the employer provides close supervision and lays out money for training.
Over all, the guidance from the California Division of Labor Standards Enforcement was emphatic that for internships to be unpaid, they must be educational and predominantly for the benefit of the intern, not the employer. "
Some of these discussions have something in common with the discussions in the transplant community about compensation for donors.
Sunday, April 11, 2010
Couples on the labor market
One of the longstanding puzzles in market design is why we have been as lucky as we have been in the design and operation of labor market clearinghouses that allow couples to state preferences over pairs of jobs. You can't get a stable matching without allowing couples to state their preferences this way, but when they do, the set of stable matching can be empty. But it almost never is, in practice.
Here's a first step towards understanding that:
Kojima, Fuhito, Parag A. Pathak, and Alvin E. Roth, " Matching with Couples: Stability and Incentives in Large Markets," working paper, April 8 2010.
Abstract: Complementarities pose problems in models of two-sided matching markets. This has been a longstanding issue in the design of centralized labor market clearinghouses that need to accommodate complementarities due to couples, as in the US market for medical doctors. These clearinghouses aim for a stable matching but a stable matching does not necessarily exist when
couples are present. This paper provides conditions under which a stable matching exists with high probability in large markets. Moreover, we present a mechanism that finds a stable matching with high probability and in which truth-telling by all participants is an approximate equilibrium. We relate these theoretical results to data from the labor market for clinical psychologists, in which stable matchings exist for all years of our data, despite the presence of couples.
Here's a first step towards understanding that:
Kojima, Fuhito, Parag A. Pathak, and Alvin E. Roth, " Matching with Couples: Stability and Incentives in Large Markets," working paper, April 8 2010.
Abstract: Complementarities pose problems in models of two-sided matching markets. This has been a longstanding issue in the design of centralized labor market clearinghouses that need to accommodate complementarities due to couples, as in the US market for medical doctors. These clearinghouses aim for a stable matching but a stable matching does not necessarily exist when
couples are present. This paper provides conditions under which a stable matching exists with high probability in large markets. Moreover, we present a mechanism that finds a stable matching with high probability and in which truth-telling by all participants is an approximate equilibrium. We relate these theoretical results to data from the labor market for clinical psychologists, in which stable matchings exist for all years of our data, despite the presence of couples.
Saturday, April 10, 2010
Networks in markets that unravel, and those that don't: Itay Fainmesser
Itay Fainmesser defended his dissertation yesterday.
One of the papers in his dissertation concerns job markets that have “unraveled” so that a large part of the market consists of early, exploding offers. He develops a network model, motivated by the observation that when many markets unravel (as when medical labor markets start to hire doctors well over a year before they begin employment), hiring also becomes more local (as hospitals start to hire students from local medical schools, etc.). Itay takes this as evidence that when hiring is very early, employers are forced to rely more on their local networks for information. He builds a network model that allows him to investigate which properties of local networks lead to unraveling, and which lead to later hiring. In this model, information about the quality of candidates eventually becomes widely available, but early information about candidate quality can only be reliably transmitted along links of a network. (When Markets Unravel: Social Networks, Information Transmission, and the 'Hiring Frenzy' older version here.)
Another of his papers tackles the question of cooperation in repeated games, where the possible interactions are constrained by a network, and he asks which buyer-seller network structures will support persistent cooperation (where sellers have an opportunity to cooperate by shipping a high quality good, or to defect by shipping a low quality good). It’s a hard problem, and (in a third paper) he and a coauthor invent models and tools to deal with it (in a large-network framework), that allow him to turn some difficult non-monotonic relationships among networks into well behaved statements about the value of links. (Community Structure and Market Outcomes: Towards a Theory of Repeated Games in Networks )
Itay will be an assistant professor of economics at Brown next year.
Welcome to the club, Itay.
One of the papers in his dissertation concerns job markets that have “unraveled” so that a large part of the market consists of early, exploding offers. He develops a network model, motivated by the observation that when many markets unravel (as when medical labor markets start to hire doctors well over a year before they begin employment), hiring also becomes more local (as hospitals start to hire students from local medical schools, etc.). Itay takes this as evidence that when hiring is very early, employers are forced to rely more on their local networks for information. He builds a network model that allows him to investigate which properties of local networks lead to unraveling, and which lead to later hiring. In this model, information about the quality of candidates eventually becomes widely available, but early information about candidate quality can only be reliably transmitted along links of a network. (When Markets Unravel: Social Networks, Information Transmission, and the 'Hiring Frenzy' older version here.)
Another of his papers tackles the question of cooperation in repeated games, where the possible interactions are constrained by a network, and he asks which buyer-seller network structures will support persistent cooperation (where sellers have an opportunity to cooperate by shipping a high quality good, or to defect by shipping a low quality good). It’s a hard problem, and (in a third paper) he and a coauthor invent models and tools to deal with it (in a large-network framework), that allow him to turn some difficult non-monotonic relationships among networks into well behaved statements about the value of links. (Community Structure and Market Outcomes: Towards a Theory of Repeated Games in Networks )
Itay will be an assistant professor of economics at Brown next year.
Welcome to the club, Itay.
Friday, April 9, 2010
Liver exchange
Living Donor Exchange Poses New Option for Liver Transplantation
"Two major transplant centers in Hong Kong and South Korea released results from their paired donor exchange programs for living donor liver transplantation (LDLT). A single paired exchange, performed by the Hong Kong team under emergency circumstances, was a success. The Korean team reported 16 donor exchanges conducted over a 6-year period were successful.
Full details of this novel approach to organ transplantation appear in the April issue of Liver Transplantation."
And here are the two papers and abstracts:
Paired Donor Interchange to Avoid ABOIncompatible Living Donor Liver Transplantation, by See Ching Chan, Chung Mau Lo, Boon Hun Yong, Wilson J. C. Tsui, Kelvin K. C. Ng, and Sheung Tat Fan, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
"We report an emergency paired donor interchange living donor liver transplant performed on January 13, 2009. The 4 operations (2 liver transplants) were performed simultaneously. The aim was to avoid 2 ABO-incompatible liver transplants. One recipient in acute liver failure underwent transplantation in a high-urgency situation. The abdomen of the other recipient had severe adhesions from previous spontaneous bacterial peritonitis that rendered the recipient operation almost impossible. The ethical and logistical issues are discussed. Approaches adopted in anticipation of potential adverse outcomes are explained in view of the higher donor and recipient mortality and morbidity rates in comparison with kidney transplantation."
Liver Transpl 16:478-481, 2010
Exchange Living Donor Liver Transplantation to Overcome ABO Incompatibility in Adult Patients, by Shin Hwang, Sung-Gyu Lee, Deok-Bog Moon, Gi-Won Song, Chul-Soo Ahn, Ki-Hun Kim, Tae-Yong Ha, Dong-Hwan Jung, Kwan-Woo Kim, Nam-Kyu Choi, Gil-Chun Park, Young-Dong Yu, Young-Il Choi, Pyoung-Jae Park, and Hea-Seon Ha, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
"ABO incompatibility is the most common cause of donor rejection during the initial screening of adult patients with end-stage liver disease for living donor liver transplantation (LDLT). A paired donor exchange program was initiated to cope with this problem without ABO-incompatible LDLT. We present our results from the first 6 years of this exchange adult LDLT program. Between July 2003 and June 2009, 1351 adult LDLT procedures, including 16 donor exchanges and 7 ABO-incompatible LDLT procedures, were performed at our institution. Initial donor-recipient ABO incompatibilities included 6 A to B incompatibilities, 6 B to A incompatibilities, 1 A to O incompatibility, 1 A+O (dual graft) to B incompatibility, 1 O to AB incompatibility, and 1 O to A incompatibility. Fourteen matches (87.5%) were ABO incompatible, but 2 (12.5%) were initially ABO-compatible. All ABO-incompatible donors were directly related to their recipients, but 2 compatible donors were each undirected and unrelated directed. After donor reassignment through paired exchange (n = 7) or domino pairing (n = 1), the donor-recipient ABO status changed to A to A in 6, B to B in 6, O to O in 1, A to AB in 1, A+O to A in 1, and O to B in 1, and this made all matches ABO identical (n = 13) or ABO-compatible (n = 3). Two pairs of LDLT operations were performed simultaneously on an elective basis in 12 and on an emergency basis in 4. All donors recovered uneventfully. Fifteen of the 16 recipients survived, but 1 died after 54 days. In conclusion, an exchange donor program for adult LDLT appears to be a feasible modality for overcoming donor-recipient ABO incompatibility."Liver Transpl 16:482-490, 2010. V
Thursday, April 8, 2010
Organ trafficking: a black market for kidneys
Israeli police arrest suspected black market brokers, after complaints were made by unpaid donor/sellers.
Reserve general suspected of organ trafficking: Six arrested in organ-trafficking scandal after donors complain they were not paid for their kidneys
"Police have uncovered a large organ-trafficking ring that made its members millions, a court cleared for publication Wednesday.
...
"According to the police, the ring members advertised online offering people waiting for years for a kidney transplant an alternate solution, for the price of $140,000.
Other online ads made offers of $10,000 for kidneys. To those who remained hesitant, the suspects allegedly offered up to $100,000. However the donors were never paid.
Police were given their first clue when a 50-year old woman from Nazareth issued a complaint saying she had donated a kidney due to financial difficulties, for which she expected to receive $100,000. She said she was called in to undergo a series of tests and then flown to Azerbaijan with another donor, where she was relieved of her kidney.
Upon returning to Israel, she said, she asked those who had sent her for the money but never received it. Police launched an investigation and meanwhile received another complaint, this time from an 18-year old boy. He said he was promised $80,000 and flown to the Philippines to donate his kidney.
Superintendant Aharon Galor told Ynet, "We ran an undercover investigation and were shocked by the proportions of this. Despite the few complaints we received, we learned that there are many people willing to sell a kidney for just $10,000. These are people who have severe financial difficulties, for whom such a sum is a dream come true." "
More details here: Israel police uncovers organ trafficking ring in north
""The ring is operating throughout Israel and not only in the north, and appeals to the public through local media and internet," a police official said. "The organ traffickers somehow receive details about potential transplant candidates and they offer them their services," he said.
"The investigators said that the traffickers usually demand around 120,000 dollars for a kidney transplant. While the donors, the majority of which are in serious financial troubles, are taken advantage of and receive around 10,000 dollars. Some of them get even smaller sums, and some do not receive any money at all.
"The donors sign a contract and fill out fraudulent affidavits claiming a family connection between the donor and the recipient - a requirement in the countries where the surgeries take place.
"Afterwards, the donors undergo medical examinations where they are categorized by blood types and other medical conditions, and are then flown to countries in Eastern Europe, the Philippines, and Ecuador.
"There, the donors undergo surgery to extract their kidney, and shortly afterwards return to Israel without any medical documentation, many times suffering from medical complications. "
Reserve general suspected of organ trafficking: Six arrested in organ-trafficking scandal after donors complain they were not paid for their kidneys
"Police have uncovered a large organ-trafficking ring that made its members millions, a court cleared for publication Wednesday.
...
"According to the police, the ring members advertised online offering people waiting for years for a kidney transplant an alternate solution, for the price of $140,000.
Other online ads made offers of $10,000 for kidneys. To those who remained hesitant, the suspects allegedly offered up to $100,000. However the donors were never paid.
Police were given their first clue when a 50-year old woman from Nazareth issued a complaint saying she had donated a kidney due to financial difficulties, for which she expected to receive $100,000. She said she was called in to undergo a series of tests and then flown to Azerbaijan with another donor, where she was relieved of her kidney.
Upon returning to Israel, she said, she asked those who had sent her for the money but never received it. Police launched an investigation and meanwhile received another complaint, this time from an 18-year old boy. He said he was promised $80,000 and flown to the Philippines to donate his kidney.
Superintendant Aharon Galor told Ynet, "We ran an undercover investigation and were shocked by the proportions of this. Despite the few complaints we received, we learned that there are many people willing to sell a kidney for just $10,000. These are people who have severe financial difficulties, for whom such a sum is a dream come true." "
More details here: Israel police uncovers organ trafficking ring in north
""The ring is operating throughout Israel and not only in the north, and appeals to the public through local media and internet," a police official said. "The organ traffickers somehow receive details about potential transplant candidates and they offer them their services," he said.
"The investigators said that the traffickers usually demand around 120,000 dollars for a kidney transplant. While the donors, the majority of which are in serious financial troubles, are taken advantage of and receive around 10,000 dollars. Some of them get even smaller sums, and some do not receive any money at all.
"The donors sign a contract and fill out fraudulent affidavits claiming a family connection between the donor and the recipient - a requirement in the countries where the surgeries take place.
"Afterwards, the donors undergo medical examinations where they are categorized by blood types and other medical conditions, and are then flown to countries in Eastern Europe, the Philippines, and Ecuador.
"There, the donors undergo surgery to extract their kidney, and shortly afterwards return to Israel without any medical documentation, many times suffering from medical complications. "
Wednesday, April 7, 2010
Update on economics job market scramble
Registration on the 2010 Economics Job Market Scramble for new Ph.D.s is now closed, and those who have registered will be able to view the site for another week.
67 employers registered 71 positions this year (with 24 of those employers choosing to remain invisible to viewers). There's no obvious difference between the visibles and the invisibles (e.g. the visibles include 14 universities with graduate programs, the invisibles include 11).
374 job candidates registered, in line with previous years (there were 361 and 395 in 2008 and 2009).
All this is from the revised version of our paper on the job market:
Peter Coles, John Cawley, Phillip B. Levine, Muriel Niederle, Alvin E. Roth, and John J. Siegfried , " The Job Market for New Economists: A Market Design Perspective," revised April 6, 2010, forthcoming in Journal of Economic Perspectives, Summer 2010.The current version of that paper can be found here .
Good luck to all those still on the market.
67 employers registered 71 positions this year (with 24 of those employers choosing to remain invisible to viewers). There's no obvious difference between the visibles and the invisibles (e.g. the visibles include 14 universities with graduate programs, the invisibles include 11).
374 job candidates registered, in line with previous years (there were 361 and 395 in 2008 and 2009).
All this is from the revised version of our paper on the job market:
Peter Coles, John Cawley, Phillip B. Levine, Muriel Niederle, Alvin E. Roth, and John J. Siegfried , " The Job Market for New Economists: A Market Design Perspective," revised April 6, 2010, forthcoming in Journal of Economic Perspectives, Summer 2010.The current version of that paper can be found here .
Good luck to all those still on the market.
Tuesday, April 6, 2010
The first kidney exchange in the U.S., and other accounts of early progress
The Student BMJ (a student run affiliate of the British Medical Journal) has an article interviewing the pioneering surgeons who conducted the first kidney exchange in the U.S., in 2000. (It's gated, but you can register for free.)
Anthony P Monaco and Paul E Morrissey: a pioneering paired kidney exchange
Transplant surgeons Anthony P Monaco and Paul E Morrissey performed the first paired kidney exchange in the United States
By: Prizzi Zarsadias
Published: 24 March 2010, Cite this as: Student BMJ 2010;18:c1562
The article is in interview form. Some highlights:
"When two patients found they were ABO incompatible with their live kidney donors it seemed that a long wait on the organ donor list awaited them. But by coincidence the donors were a match for each other’s recipient. Rather than lose this chance for both patients to receive a live kidney donation Anthony P Monaco and Paul E Morrissey saw an opportunity, and in 2000 they performed the first paired kidney donation in the United States. "
How did the first paired kidney donation come about?
Paul E Morrissey: We knew about paired donation from an experience in Korea. We had encountered articles about paired donation. Then these pairs simultaneously presented to us; it just clicked that we could exchange the donors. I wouldn’t attribute the idea to myself or Dr Monaco but to the entire team. We discussed it with 15 of our doctors and nurses, social workers, and various other people, and we agreed that it would be something that we would propose to the family.
How did the patients in the first exchange fare?
PEM: The surgeries were uneventful. One recipient had great kidney function. The second had recurrence of the original disease and a bad acute rejection shortly after the transplant and went back onto dialysis several weeks after the transplant. One outcome was not good. The other patient did fantastically. Any time that a living donation doesn’t work is sad. And in this circumstance, to have had a child make a donation for a parent and to have it work out for the person she donated to but not work out for the parent was sad and unfortunate.
What was the worst case scenario?
PEM: This would be close to it; the success rate for a live kidney donation is in the neighbourhood of 98% or so. This might happen once in every 50. It’s an extremely unusual circumstance for any living donation, and in this setting it adds to the unhappiness. There was a lot of hand holding for the recipient with the failed kidney but also for the donor. There was a lot of follow-up on a longitudinal basis. They are both alive and well today but who knows exactly what emotion they harbour, and I hope that the other patient is enjoying the outcome of her operation.
APM: The worst case scenario for any living transplant would be that the recipient or donor die because of surgery. We haven’t seen that, but that’s the risk in this scenario. We’ve had recipients who have died a week or two later, but that has not happened with swap transplants.
PEM: We inform the patients more of the adverse outcomes. It was, of course, at the forefront of our minds when we proceeded the second time.
During the first exchange did you envisage the technique’s success?
APM: We did not envision it, but we were not surprised that it has grown because it works well. There is a natural evolutionary process to extend it into other situations. We do swaps that involve not just ABO incompatibility; we also swap kidneys between pairs that are incompatible because of HLA antibodies. We are also currently working on a five-way swap.
PEM: The credit obviously goes to countless groups throughout the country that have pushed it forward. In particular the group in our organ procurement organisation, the New England Organ Bank, has really been a leader in taking this forward nationally but at the time that we did this, we didn’t have thoughts about expanding it beyond the reaches of our own programme. I think that they’ll continue to grow out of necessity.
The article begins with these biographical details:
Anthony P Monaco
Peter Medawar professor of transplantation surgery, Harvard University, emeritus director of the Beth Israel Deaconess Harvard Medical Center Transplant Program, and director of the Rhode Island Hospital Transplant Services
Biography—After graduating from Harvard Medical School in 1956 his career has spanned five decades. In that time he has published more than 470 papers and has held the post of editor of Transplantation for 32 years until 2001 and has been the special features editor for the same journal ever since. He is also a trustee of the New England Organ Bank.
Paul E Morrissey
Associate professor of surgery and transplant surgeon at Rhode Island Hospital and assistant medical director for the New England Organ Bank
Biography—Trained at the University of Massachusetts and held residencies and research fellowships at Yale and Harvard Medical Schools. He has been a transplant surgeon at Rhode Island Hospital since 1997 and has been surgical director of the Division of Organ Transplant since 2002. He has been awarded many honours, including the Thomas Murray award from the Rhode Island Organ Donor Awareness Coalition. "
As the article indicates, an earlier exchange had been carried out in S. Korea. Another country that has been active in kidney exchange is Holland, and a recent report of their experience is in the April 2010 issue of the American Journal of Transplantation: "Altruistic Donor Triggered Domino-Paired Kidney Donation for Unsuccessful Couples from the Kidney-Exchange Program" by Roodnat, J. I.; Zuidema, W.; van de Wetering, J.; de Klerk, M.; Erdman, R. A. M.; Massey, E. K.; Hilhorst, M. T.; IJzermans, J. N. M.; Weimar, W.
The New England Program for Kidney Exchange (the institutional descendent of that first U.S. exchange by Monaco and Morrissey) maintains a page listing Kidney Exchange:A Chronology of Scientific Contributions (scroll to the bottom of that page).
While I'm on the subject of important firsts, donating a kidney became much easier with the introduction of laproscopic kidney nephrectomies for donor kidneys (taking the kidney out via a small incision instead of a big one). Here's the article by Lloyd Ratner et al. reporting the first one:
Laparoscopic live donor nephrectomy.
Ratner LE, Ciseck LJ, Moore RG, Cigarroa FG, Kaufman HS, Kavoussi LR., Transplantation. 1995 Nov 15;60(9):1047-9.
"A laparoscopic live-donor nephrectomy was performed on a 40-year-old man. The kidney was removed intact via a 9-cm infraumbilical midline incision. Warm ischemia was limited to less than 5 min. Immediately upon revascularization, the allograft produced urine. By the second postoperative day, the recipient's serum creatinine had decreased to 0.7 mg/dl. The donor's postoperative course was uneventful. He experienced minimal discomfort and was discharged home on the first postoperative day. We conclude that laparoscopic donor nephrectomy is feasible. It can be performed without apparent deleterious effects to either the donor or the recipient. The limited discomfort and rapid convalescence enjoyed by our patient indicate that this technique may prove to be advantageous."
Anthony P Monaco and Paul E Morrissey: a pioneering paired kidney exchange
Transplant surgeons Anthony P Monaco and Paul E Morrissey performed the first paired kidney exchange in the United States
By: Prizzi Zarsadias
Published: 24 March 2010, Cite this as: Student BMJ 2010;18:c1562
The article is in interview form. Some highlights:
"When two patients found they were ABO incompatible with their live kidney donors it seemed that a long wait on the organ donor list awaited them. But by coincidence the donors were a match for each other’s recipient. Rather than lose this chance for both patients to receive a live kidney donation Anthony P Monaco and Paul E Morrissey saw an opportunity, and in 2000 they performed the first paired kidney donation in the United States. "
How did the first paired kidney donation come about?
Paul E Morrissey: We knew about paired donation from an experience in Korea. We had encountered articles about paired donation. Then these pairs simultaneously presented to us; it just clicked that we could exchange the donors. I wouldn’t attribute the idea to myself or Dr Monaco but to the entire team. We discussed it with 15 of our doctors and nurses, social workers, and various other people, and we agreed that it would be something that we would propose to the family.
How did the patients in the first exchange fare?
PEM: The surgeries were uneventful. One recipient had great kidney function. The second had recurrence of the original disease and a bad acute rejection shortly after the transplant and went back onto dialysis several weeks after the transplant. One outcome was not good. The other patient did fantastically. Any time that a living donation doesn’t work is sad. And in this circumstance, to have had a child make a donation for a parent and to have it work out for the person she donated to but not work out for the parent was sad and unfortunate.
What was the worst case scenario?
PEM: This would be close to it; the success rate for a live kidney donation is in the neighbourhood of 98% or so. This might happen once in every 50. It’s an extremely unusual circumstance for any living donation, and in this setting it adds to the unhappiness. There was a lot of hand holding for the recipient with the failed kidney but also for the donor. There was a lot of follow-up on a longitudinal basis. They are both alive and well today but who knows exactly what emotion they harbour, and I hope that the other patient is enjoying the outcome of her operation.
APM: The worst case scenario for any living transplant would be that the recipient or donor die because of surgery. We haven’t seen that, but that’s the risk in this scenario. We’ve had recipients who have died a week or two later, but that has not happened with swap transplants.
PEM: We inform the patients more of the adverse outcomes. It was, of course, at the forefront of our minds when we proceeded the second time.
During the first exchange did you envisage the technique’s success?
APM: We did not envision it, but we were not surprised that it has grown because it works well. There is a natural evolutionary process to extend it into other situations. We do swaps that involve not just ABO incompatibility; we also swap kidneys between pairs that are incompatible because of HLA antibodies. We are also currently working on a five-way swap.
PEM: The credit obviously goes to countless groups throughout the country that have pushed it forward. In particular the group in our organ procurement organisation, the New England Organ Bank, has really been a leader in taking this forward nationally but at the time that we did this, we didn’t have thoughts about expanding it beyond the reaches of our own programme. I think that they’ll continue to grow out of necessity.
The article begins with these biographical details:
Anthony P Monaco
Peter Medawar professor of transplantation surgery, Harvard University, emeritus director of the Beth Israel Deaconess Harvard Medical Center Transplant Program, and director of the Rhode Island Hospital Transplant Services
Biography—After graduating from Harvard Medical School in 1956 his career has spanned five decades. In that time he has published more than 470 papers and has held the post of editor of Transplantation for 32 years until 2001 and has been the special features editor for the same journal ever since. He is also a trustee of the New England Organ Bank.
Paul E Morrissey
Associate professor of surgery and transplant surgeon at Rhode Island Hospital and assistant medical director for the New England Organ Bank
Biography—Trained at the University of Massachusetts and held residencies and research fellowships at Yale and Harvard Medical Schools. He has been a transplant surgeon at Rhode Island Hospital since 1997 and has been surgical director of the Division of Organ Transplant since 2002. He has been awarded many honours, including the Thomas Murray award from the Rhode Island Organ Donor Awareness Coalition. "
As the article indicates, an earlier exchange had been carried out in S. Korea. Another country that has been active in kidney exchange is Holland, and a recent report of their experience is in the April 2010 issue of the American Journal of Transplantation: "Altruistic Donor Triggered Domino-Paired Kidney Donation for Unsuccessful Couples from the Kidney-Exchange Program" by Roodnat, J. I.; Zuidema, W.; van de Wetering, J.; de Klerk, M.; Erdman, R. A. M.; Massey, E. K.; Hilhorst, M. T.; IJzermans, J. N. M.; Weimar, W.
The New England Program for Kidney Exchange (the institutional descendent of that first U.S. exchange by Monaco and Morrissey) maintains a page listing Kidney Exchange:A Chronology of Scientific Contributions (scroll to the bottom of that page).
While I'm on the subject of important firsts, donating a kidney became much easier with the introduction of laproscopic kidney nephrectomies for donor kidneys (taking the kidney out via a small incision instead of a big one). Here's the article by Lloyd Ratner et al. reporting the first one:
Laparoscopic live donor nephrectomy.
Ratner LE, Ciseck LJ, Moore RG, Cigarroa FG, Kaufman HS, Kavoussi LR., Transplantation. 1995 Nov 15;60(9):1047-9.
"A laparoscopic live-donor nephrectomy was performed on a 40-year-old man. The kidney was removed intact via a 9-cm infraumbilical midline incision. Warm ischemia was limited to less than 5 min. Immediately upon revascularization, the allograft produced urine. By the second postoperative day, the recipient's serum creatinine had decreased to 0.7 mg/dl. The donor's postoperative course was uneventful. He experienced minimal discomfort and was discharged home on the first postoperative day. We conclude that laparoscopic donor nephrectomy is feasible. It can be performed without apparent deleterious effects to either the donor or the recipient. The limited discomfort and rapid convalescence enjoyed by our patient indicate that this technique may prove to be advantageous."
Monday, April 5, 2010
Sniping in auctions with substitutes
On an auction site like eBay, many copies of the same good may be on offer for different auctions. A new sniping site, goSnipe, allows bidders to specify a group of auctions on which to submit last minute bids, one at a time, but to stop when the desired purchase is made.
Here's some research on bid sniping, and the underlying game theory.
Here's some research on bid sniping, and the underlying game theory.
Sunday, April 4, 2010
Repugnant transactions in New Zealand: Easter Sunday sales
The NZ Herald reports on Illegal Trading.
"The number of shops found to be trading illegally over the Easter weekend appears to be similar to last year, the Department of Labour says. The Department will consider the prosecution of 38 retailers after 19 were caught trading on Good Friday and another 19 on Easter Sunday.
"The issue of Easter trading hours remained a contentious issue this year, with business owners calling for more clarity on the laws. Auckland business advocate Cameron Brewer, who was lobbying this year for changes to the law, said "confusion reigned high" as some towns were banned from trading while others were not. Licensed premises, cafes, gardening and hardware stores were also a problem, he said. "Cafes can open if they have ready-to-eat food, but what is ready-to-eat food? More and more hardware stores, most of which have big gardening departments, are opening and facing $1000 fines, even though gardening shops can legally open on Easter Sunday. "This weekend there has been more confusion and frustration than ever before around Easter trading laws. It can't go on any longer."
"The number of shops found to be trading illegally over the Easter weekend appears to be similar to last year, the Department of Labour says. The Department will consider the prosecution of 38 retailers after 19 were caught trading on Good Friday and another 19 on Easter Sunday.
"The issue of Easter trading hours remained a contentious issue this year, with business owners calling for more clarity on the laws. Auckland business advocate Cameron Brewer, who was lobbying this year for changes to the law, said "confusion reigned high" as some towns were banned from trading while others were not. Licensed premises, cafes, gardening and hardware stores were also a problem, he said. "Cafes can open if they have ready-to-eat food, but what is ready-to-eat food? More and more hardware stores, most of which have big gardening departments, are opening and facing $1000 fines, even though gardening shops can legally open on Easter Sunday. "This weekend there has been more confusion and frustration than ever before around Easter trading laws. It can't go on any longer."
Work hours of surgical residents
The culture is changing to comply with the law, but it's hard.
For doctors, a matter of time: MGH residents cut back to 80-hour weeks, but with mixed feelings
"The hospital had a wake-up call last year, when a national accrediting agency put the program on probation for violating patient-protection rules that limit trainees’ work hours. Some junior surgeons, called residents, had been staying too late because they didn’t want to sign over their very sick patients to other doctors, out of a combination of duty to patients, work ethic, and unspoken peer pressure.
"Now, say senior surgeons and residents alike, the program is in complete compliance with the rules that require trainees to average no more than 80 hours of work a week and have 10 hours off between shifts."
The story makes the case that residents sometimes need and want to work long hours.
A related story about sleeplessness makes the case that it would be good both for patients and young docs if they got enough sleep: At Midnight, All the Doctors…
For doctors, a matter of time: MGH residents cut back to 80-hour weeks, but with mixed feelings
"The hospital had a wake-up call last year, when a national accrediting agency put the program on probation for violating patient-protection rules that limit trainees’ work hours. Some junior surgeons, called residents, had been staying too late because they didn’t want to sign over their very sick patients to other doctors, out of a combination of duty to patients, work ethic, and unspoken peer pressure.
"Now, say senior surgeons and residents alike, the program is in complete compliance with the rules that require trainees to average no more than 80 hours of work a week and have 10 hours off between shifts."
The story makes the case that residents sometimes need and want to work long hours.
A related story about sleeplessness makes the case that it would be good both for patients and young docs if they got enough sleep: At Midnight, All the Doctors…
Saturday, April 3, 2010
Presumed consent and deceased donor organ donation
Kim Krawiec writes: "Duke sociologist (and Crooked Timber blogger) Kieran Healy visited my Taboo Trades and Forbidden Markets seminar this week to discuss his book, Last Best Gifts (University of Chicago Press, 2006) -- a study of the social organization of exchange in human blood and organs – as well as his research on presumed consent laws (See, Do Presumed Consent Laws Raise Organ Procurement Rates? DePaul Law Review, 55:1017–1043 (2006)) (PDF). Healy has also written several other articles about gift and market exchange in human blood and organs and, in addition, studies the moral order of market society (See, for example, Marion Fourcade and Kieran Healy, Moral Views of Market Society. Annual Review of Sociology 33:285–311 (2007) (PDF.))"
...
[The article on presumed consent] "is a comparative study of rates of cadaveric organ procurement in seventeen OECD countries between 1990 and 2002. Those in the United States (and other countries, including the UK) concerned with insufficient cadaveric donor rates frequently advocate a switch to a presumed-consent legal regime (as opposed to the US informed consent regime), as a quick fix to the problem of under-supply. This seems logical enough – in other contexts we have reason to believe that alterations to the default rule, and particularly from an opt-in to an opt-out regime, may meaningfully impact behavior. This is especially plausible when the law functions as some sort of signaling device about societal norms or when, as in the case of organ donation, choosing involves scenarios – death – that one prefers not to contemplate, perhaps causing inertia.
But in the case of cadaveric organ donation an additional argument is typically put forward in favor of presumed consent: the removal of next of kin from the decision-making process. Though the Revised Uniform Anatomical Gift Act specifies that family consent or concurrence is not required, the reluctance of procurement organizations in the U.S. to proceed with organ retrieval against next-of-kin wishes has been generally recognized.
Yet Healey finds that presumed consent laws do not make a material difference to the procurement rate. Importantly, presumed consent laws typically do not remove the next of kin from the procurement process. Although presumed-consent countries have somewhat better procurement rates on average than informed-consent countries, Healy concludes that this is not because of any direct effect of the law on individual choices. Instead, improved donation rates appear driven by substantial investment in the logistics of organ procurement – better training, clear delegation of responsibility, and a strong presence in hospitals, for example. "
...
[The article on presumed consent] "is a comparative study of rates of cadaveric organ procurement in seventeen OECD countries between 1990 and 2002. Those in the United States (and other countries, including the UK) concerned with insufficient cadaveric donor rates frequently advocate a switch to a presumed-consent legal regime (as opposed to the US informed consent regime), as a quick fix to the problem of under-supply. This seems logical enough – in other contexts we have reason to believe that alterations to the default rule, and particularly from an opt-in to an opt-out regime, may meaningfully impact behavior. This is especially plausible when the law functions as some sort of signaling device about societal norms or when, as in the case of organ donation, choosing involves scenarios – death – that one prefers not to contemplate, perhaps causing inertia.
But in the case of cadaveric organ donation an additional argument is typically put forward in favor of presumed consent: the removal of next of kin from the decision-making process. Though the Revised Uniform Anatomical Gift Act specifies that family consent or concurrence is not required, the reluctance of procurement organizations in the U.S. to proceed with organ retrieval against next-of-kin wishes has been generally recognized.
Yet Healey finds that presumed consent laws do not make a material difference to the procurement rate. Importantly, presumed consent laws typically do not remove the next of kin from the procurement process. Although presumed-consent countries have somewhat better procurement rates on average than informed-consent countries, Healy concludes that this is not because of any direct effect of the law on individual choices. Instead, improved donation rates appear driven by substantial investment in the logistics of organ procurement – better training, clear delegation of responsibility, and a strong presence in hospitals, for example. "
Friday, April 2, 2010
Fortune-telling is repugnant in Saudi Arabia (and a capital crime)
This headline caught my eye this morning: Lebanese Not to Be Beheaded Friday for Witchcraft
"A Lebanese man condemned to death for witchcraft by a Saudi court will not be beheaded Friday as had been expected, his lawyer said.
Attorney May al-Khansa said Lebanon's justice minister told her that her client, Ali Sibat, will not be executed in Saudi Arabia on Friday -- the day executions are typically carried out in the kingdom after noon prayers.
She said it is still unclear whether the beheading had been waived or only postponed. "
...
"Sibat, a 49-year-old father of five, made predictions on an Arab satellite TV channel from his home in Beirut.
He was arrested by the Saudi religious police during his pilgrimage to the holy city of Medina in May 2008 and sentenced to death last November for witchcraft.
The Saudi justice system, which is based on Islamic law, does not clearly define the charge of witchcraft.
Sibat is one of scores of people reported arrested every year in the kingdom for practicing sorcery, witchcraft, black magic and fortunetelling. The deeply religious authorities in Saudi consider these practices polytheism. "
(Presumably the ability of fortune tellers to predict the future is imperfect, since otherwise Mr Sibat might have skipped this trip.)
Update 4/24/10: "But fraud, while a crime, is not punishable by death, said Mr. AlGasim, the retired judge. Only actual sorcery is a crime.
“You have to differentiate between acts that cheat or deceive people for money, which deserve to be punished, and dealing with magic,” he said. “There is no mechanism to prove it, and any confession is open to doubt, especially if someone confesses in prison.” "
"A Lebanese man condemned to death for witchcraft by a Saudi court will not be beheaded Friday as had been expected, his lawyer said.
Attorney May al-Khansa said Lebanon's justice minister told her that her client, Ali Sibat, will not be executed in Saudi Arabia on Friday -- the day executions are typically carried out in the kingdom after noon prayers.
She said it is still unclear whether the beheading had been waived or only postponed. "
...
"Sibat, a 49-year-old father of five, made predictions on an Arab satellite TV channel from his home in Beirut.
He was arrested by the Saudi religious police during his pilgrimage to the holy city of Medina in May 2008 and sentenced to death last November for witchcraft.
The Saudi justice system, which is based on Islamic law, does not clearly define the charge of witchcraft.
Sibat is one of scores of people reported arrested every year in the kingdom for practicing sorcery, witchcraft, black magic and fortunetelling. The deeply religious authorities in Saudi consider these practices polytheism. "
(Presumably the ability of fortune tellers to predict the future is imperfect, since otherwise Mr Sibat might have skipped this trip.)
Update 4/24/10: "But fraud, while a crime, is not punishable by death, said Mr. AlGasim, the retired judge. Only actual sorcery is a crime.
“You have to differentiate between acts that cheat or deceive people for money, which deserve to be punished, and dealing with magic,” he said. “There is no mechanism to prove it, and any confession is open to doubt, especially if someone confesses in prison.” "
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