Organ donation and surrogacy: a Mothers' Day story

Donor gives more than just kidney to Northbrook family
"A little more than 6½ years ago, Fink, then 43, started dialysis after her kidneys failed. Soon after, the Northbrook resident learned the devastating news: her life expectancy made it unlikely she'd live beyond March of this year. But after she found a kidney donor through a Web site -- and after that donor's wife agreed to be a surrogate mother for Fink and her husband -- Gail is not only alive, she is thriving. So are her twin 2½ year-old sons."

Happy Mothers' Day out there.

China’s Arranged Remarriages

The NY Times reports on China’s Arranged Remarriages among widows and widowers whose spouses died in the devastating earthquake that destroyed towns in Sichuan on May 12, 2008.
It is an unusual demographic event, which created a thick pool of potential (re)marriage partners.
"Coaxing earthquake survivors into remarriage has become a community obligation. Unlikely volunteers have joined in the matchmaking efforts, from former in-laws to the leaders of the local Communist “work units” to which every family in this part of rural Sichuan is still assigned. Behind them is the Chinese government. The state, which has long seen fit to intervene in the most private aspects of people’s lives, including reproductive rights, has avidly promoted — and in some cases even arranged — what it dryly calls “restructured families.”
By the end of 2008, less than eight months after the earthquake, 614 survivors from Beichuan alone had already remarried, according to Wang Hongfa, a local civil-affairs official. (The number across Sichuan’s earthquake zone, though not made public, is estimated to be well into the thousands.) That so many earthquake survivors have already remarried is not surprising in itself; but in many cases, these are widows marrying widowers, two survivors striving to get back onto solid ground. "

Gifted programs for pre-kindergarten in NYC

I like the first paragraph of this story: More Pre-K Pupils Qualify for Gifted Programs

"The number of students qualifying for gifted kindergarten programs in New York City public school districts rose by 10 percent this year, and those qualifying for the elite citywide program jumped by a third, raising the possibility that parents and their children have begun to master an admission process that was retooled three years ago."

School choice in NYC, a problem facing large school systems

The most demanded schools are very hard to get into, even for very well qualified students, some of whom can have trouble matching: For Many, High School Match Game Continues.

"Although most of the city's 86,000 eighth graders were matched with a high school this year, every year thousands of students don't get in anywhere and it doesn't matter whether they have good grades, test scores and attendance records. They have to apply all over again, with a much more limited list of schools to choose from."

The full process in NYC, in which in the initial round students can list no more than 12 programs to apply to, is described in this paper: Abdulkadiroglu, Atila, Parag A. Pathak, and Alvin E. Roth, "Strategy-proofness versus Efficiency in Matching with Indifferences: Redesigning the NYC High School Match,'' American Economic Review, 99, 5, Dec. 2009, pp1954-1978.

And the following paper uses the fact that the proportion of unmatched students doesn't go to zero as the school system gets large, so in a very large school system like NYC, the number of initially unmatched students won't be tiny. (That doesn't mean that allowing longer lists wouldn't help.)

Kojima, Fuhito, Parag A. Pathak, and Alvin E. Roth, " Matching with Couples: Stability and Incentives in Large Markets," working paper, April 28, 2010.

Same sex spouses versus Defense of Marriage Act

The clash between repugnant and protected transactions will have its day in court, starting today: Gay Couples Challenge Defense Of Marriage Act

"Six years after Massachusetts became the first state in the nation to legalize gay marriage, a group of married same-sex couples will be in federal court in Boston on Thursday, arguing that their marriages should also be recognized by the federal government. "...

"Bush, Ritchie and 17 other plaintiffs argue that the federal government can't just ignore some marriage certificates and recognize others. Their lawyer, Gary Buseck with Gay and Lesbian Advocates and Defenders, says DOMA violates the equal protection clause of the Constitution because it is discriminatory.
When Congress passed the law in 1996, Buseck says, members "simply had a knee-jerk reaction that we have to bar the doors of the federal government in every conceivable way from the invasion of married gay people. I mean, they let it all hang loose."
Indeed, in heated congressional debate over DOMA in 1996, supporters argued the stakes couldn't be higher. One of DOMA's authors, former Republican Rep. Bob Barr, proclaimed, "The flames of hedonism and the flames of self-centered morality are licking at the very foundations of our society."
Barr, now a libertarian, has since called for DOMA's repeal, saying it violates states rights. President Obama also supports repeal. But his administration is in the awkward position of having to defend the law in court. As a Department of Justice official put it, we "can't pick and choose which federal laws [to] defend based on any one administration's policy preferences."
So, while government lawyers go out of their way in their legal papers to call DOMA “discriminatory,” they’re also arguing Congress did have good reason to want to preserve the status quo."

Here's my earlier post: When a protected transaction meets a repugnant one: The MA suit over the Defense of Marriage Act

Compensation for bone marrow donors: opposing views

In November I wrote about a lawsuit to overturn the ban on compensation for bone marrow donors: Compensating donors: how about bone marrow? . Commentary in support of the lawsuit suggested that perhaps bone marrow had been unintentionally included in the more general ban on compensation for organ donors.

More recently, some of the organizations connected with bone marrow have come out against compensation: Leading Transplant and Transfusion Organizations Join Forces in Effort to Keep Bone Marrow Donation Voluntary .

"Voicing concern about the potential impact on patient and donor safety, nine leading international health organizations have formed a coalition to oppose compensating people who provide bone marrow for transplantation.

"The organizations — each a leader in the field of transplantation and transfusion therapies — have joined forces in the face of a lawsuit aimed at overturning current U.S. law regarding bone marrow donation. The Institute for Justice is seeking to reverse the National Organ Transplant Act of 1984, as it applies to the prohibition on compensating bone marrow donors. ...

"The coalition includes the NMDP, America’s Blood Centers, AABB (formerly American Association of Blood Banks), the American Society for Blood and Marrow Transplantation, American Society of Histocompatibility and Immunogenetics, the American Society of Transplantation, International Society of Cellular Therapy, The Transplantation Society, and the World Marrow Donor Association.
They oppose changing the current law, citing these reasons:
Protecting Recipient and Donor Safety
A complete and truthful health history is critical to ensure that individuals are eligible to donate and that donated cells are free from infectious diseases. There is a substantial body of experience that people wanting to sell their body parts are more likely to withhold medical details and information that could harm patients.
Maintaining Altruistic Motivations
Studies have shown that compensating donors would deter those who are willing to donate for purely altruistic reasons. The eight million members of the Be The Match Registry® — in addition to the five million volunteer donors on international registries — are proof that people do not need material incentive to save a life. Current law already allows donors to be reimbursed for out-of-pocket expenses and lost wages. The NMDP and other organizations maintain funds expressly for this purpose.
Avoiding the Creation of Markets in Marrow Donation
Compensation has the potential to create markets for marrow, which could have detrimental effects for both donors and patients. Sellers influenced by possible financial gain could ignore the health risks associated with donation or be coerced by third-party organizations that would profit from a marrow sale. In addition, markets put physicians in the morally dubious position of carrying out medical procedures solely so that sellers may profit.
”The creation of markets is likely to elicit criticism from groups that oppose treating the human body and its parts as property,” said Art Caplan, professor of bioethics at the University of Pennsylvania. “To risk potentially undermining support for marrow donation by allowing donor compensation is irresponsible and short-sighted.”
Ensuring Patients’ Access to Treatment
While the Institute for Justice’s lawsuit alleges compensation might increase patients’ access to bone marrow, the opposite is true.
Changing the U.S. law to allow compensation for marrow donors would set a precedent that could hurt the current voluntary systems for organ and blood donation, potentially undermining some patients’ access to safe organ transplants and blood transfusions. If donors were compensated, the United States would no longer conform to international standards for the use of volunteer donors in cell therapies. Thus, patients in the United States may be unable to have access to the worldwide search process. This would restrict Americans’ chances of finding a match and lives may be lost. "

Kidney exchange time series

What is this sequence? 2, 4, 6, 19, 34, 27, 74, 121, 240, 304...

It is the number of "Non-Biol,unrel: Paired Exchange" kidney transplants in the OPTN database, i.e. the number of kidney transplants in which the donor was not a blood relative or married to the recipient, arranged by kidney exchange, in the years 2000-2009, by year. (Kidney exchange is also called paired kidney donation, kidney paired donation--KPD, and paired kidney exchange.)

Note the accelerating upward trend: the number of transplants through kidney exchange has grown by a factor of 9 since a comprehensive integration of living and deceased transplantations through both cycles and chains was proposed in 2004. For logistical reasons, the New England Program for Kidney Exchange (NEPKE) and the Alliance for Paired Donation (APD) initially started with exchanges between just two pairs. But soon larger exchanges and chains started to be commonplace, and today a nonnegligible part of the most recent growth is due to non-simultaneous chains.

The best practices seem to be spreading from hospital to hospital pretty well, organized by growing regional and other networks that coordinate exchanges. Sometimes there's some mis-coordination. There is still talk of a national exchange, although medical and other politics at a national level have so far raised some obstacles that need to be overcome.

In some moods I'm surprised that it has come so far so fast. In other moods I'm frustrated at how very slowly things have progressed. There's still lots of room to grow, and the need for kidney transplants keeps growing faster than the supply.

update: the OPTN data report requires a number of clicks once you get to their website, it is from the report "Living Donor Transplants By Donor Relation U.S. Transplants Performed : January 1, 1988 - February 28, 2010 For Organ = Kidney.
Starting from the web page http://optn.transplant.hrsa.gov/data/ , I choose “national data,” then choose category transplant, organ kidney, then click on Living Transplant by Donor Relation…

Moral judgments about economic transactions: Luke Coffman

Lucas (Luke) Coffman defended his dissertation yesterday. He's an eclectic experimenter, and one of his papers looks at the assignment of credit or blame, and how that is influenced by the presence of intermediaries. For example (to pick a Harvard-centric one), is Harvard viewed differently if it hires janitors directly at a low wage than if it contracts with a janitorial services company that employs the janitors?

The baseline condition of one of his experiments is easy to describe: one participant (who you can think of as Harvard) is endowed with $10, which he can divide with a second participant (who you can think of as a janitor), or instead can sell the right to divide the $10 to a third participant (who you can think of as the janitorial services company). Luke then elicits a judgment of the transaction from a fourth party, who is able to punish the first party by reducing his payoff. The results are clear: for a given (low) amount delivered to the “janitor,” punishments are considerably reduced if it is delivered indirectly, through a third party, rather than directly.

Luke designed and conducted many careful controls to better understand what is going on, and rule out plausible alternative hypotheses. (For one thing, choosing to use an intermediary doesn’t seem to fool anyone; people correctly anticipate that using an intermediary will be bad for the lowest paid member of the group, but they nevertheless find it less blameworthy.) One way to think about his results is that they suggest that fairness judgments may be very narrowly framed, and confined more than we had any reason to suspect to very direct interactions, so that intermediated interactions are judged differently than direct interactions.

Luke will be an assistant professor of economics at The Ohio State University next year.

Welcome to the club, Luke.

Angel donors and angel flights in a NEPKE kidney exchange chain

One man's gift of a kidney brings hope to four people*: A NEPKE simultaneous chain, starting with a non-directed donor at Dartmouth.

My close colleague Jerry Green flew two of the kidneys in this exchange, first one from Lebanon, NH to Philadelphia, and then one from Philadelphia to Boston, as part of the Angel Flights program. (He's a private pilot, and his wife Pam accompanies him on these trips as his turbulence control officer...).

*Update: that link doesn't work anymore, but here's the story

Read more »

The slave trade had sellers as well as buyers

In a NY Times oped, Ending the Slavery Blame-Game, Henry Louis Gates Jr. writes about the slave trade.

"While we are all familiar with the role played by the United States and the European colonial powers like Britain, France, Holland, Portugal and Spain, there is very little discussion of the role Africans themselves played. And that role, it turns out, was a considerable one, especially for the slave-trading kingdoms of western and central Africa. These included the Akan of the kingdom of Asante in what is now Ghana, the Fon of Dahomey (now Benin), the Mbundu of Ndongo in modern Angola and the Kongo of today’s Congo, among several others.
For centuries, Europeans in Africa kept close to their military and trading posts on the coast. Exploration of the interior, home to the bulk of Africans sold into bondage at the height of the slave trade, came only during the colonial conquests, which is why Henry Morton Stanley’s pursuit of Dr. David Livingstone in 1871 made for such compelling press: he was going where no (white) man had gone before.
How did slaves make it to these coastal forts? The historians John Thornton and Linda Heywood of Boston University estimate that 90 percent of those shipped to the New World were enslaved by Africans and then sold to European traders. The sad truth is that without complex business partnerships between African elites and European traders and commercial agents, the slave trade to the New World would have been impossible, at least on the scale it occurred."

Prizes as a spur to innovation: a White House memo

A March 2010 White House memo "Guidance on the Use of Challenges and Prizes to Promote Open Government," promotes the use of prizes by agencies of the U.S. government.

"[I]t is Administration policy to strongly encourage agencies to:
• Utilize prizes and challenges as tools for advancing open government, innovation, and the agency’s mission;
• Identify and proactively address legal, regulatory, technical, and other barriers to the use of prizes and challenges;
• Select one or more individuals to identify and implement prizes and challenges, potentially in partnership with outside organizations, and to participate in a government-wide "community of practice" led by the Office of Management and Budget and the Office of Science and Technology Policy; and
• Increase their capacity to support, design, and manage prizes, potentially in collaboration with external partners.
To support agencies in the execution of prizes that further the policy objectives of the Federal Government, the Administration will make available a web-based platform for prizes and challenges within 120 days. This platform will provide a forum for agencies to post problems and invite communities of problem solvers to suggest, collaborate on, and deliver solutions. Over the longer term, the General Services Administration (GSA) will also provide government-wide services to share best practices and assist agencies in developing guidelines for issuing challenges. Additionally, GSA will develop, as expeditiously as possible, a contract vehicle to provide agency access to relevant products and services, including technical assistance in structuring and conducting contests to take maximum benefit of the marketplace as they identify and pursue contest initiatives to further the policy objectives of the Federal Government. "

See also a discussion of prizes in a McKinsey report called “And the winner is …” Capturing the promise of philanthropic prizes .

Herodotus on repugnance

Apparently it all depends on what you're used to.

From The History of Herodotus , III.38 (Written 440 B.C.E, Translated by George Rawlinson):

"Darius, after he had got the kingdom, called into his presence certain Greeks who were at hand, and asked- "What he should pay them to eat the bodies of their fathers when they died?" To which they answered, that there was no sum that would tempt them to do such a thing. He then sent for certain Indians, of the race called Callatians, men who eat their fathers, and asked them, while the Greeks stood by, and knew by the help of an interpreter all that was said - "What he should give them to burn the bodies of their fathers at their decease?" The Indians exclaimed aloud, and bade him forbear such language. "


cited by John O'Neill

It's 20 years since 1990 (and there's a conference to prove it)

A conference with the daunting title
Roth and Sotomayor: Twenty Years After has been organized at Duke next week by Atila Abdulkadiroglu, Parag Pathak, Tayfun Sonmez, William Thomson, and Utku Unver.

It turns out they're referring to our book*, not our demise. The conference website comes with a schedule and a list of participants.

I have to admit that 1990 doesn't seem so long ago to me, although a lot of game theory and market design has happened in the interval.

*This book: Roth, A.E. and M. Sotomayor Two-Sided Matching: A Study in Game-Theoretic Modeling and Analysis, Econometric Society Monograph Series, Cambridge University Press, 1990. (Winner of the 1990 Lanchester Prize.) Paperback edition, 1992.

Polygamous marriage in Gaza

A report from Gaza in The Economist focuses on a polygamous wedding agency.

"In his crisp fourth floor office, Mr Atiri and I leafed through four albums of photos classified according to girls aged 15-25, spinsters aged 26 and above, divorcees and the depressingly fat file of widows. Waiving his finder’s fee of 50 shekels, he offered me a form where I could list the specifications for my ideal bride, according to height, weight, eye colour, education, and financial means. No matter, said Mr Atiri, that I already had a wife. Polygamous marriages were increasingly popular—and now comprised half of his business. It was, he explained, a social service for women who might otherwise be left on the shelf or bereft of a family as well as a sign of fertility and status. After all, Gaza's burly interior minister, he noted, had six wives, though in accordance with Islamic tenets he had had to let two of them go. For the sake of appearances, Mr Atiri felt obliged to set a good example, though in a nod to gender equality had let his first wife select his second. (She picked a divorcee 12 years his junior.) "How can I promote Islamic dress, if I don't wear it myself," he asks."
...
"Poverty remains a biting issue for many–husbands who used to provide second homes for their second wives now house them in second rooms. "

Dan Ariely in Forbes

Dan Ariely known for his creative experiments (and now famous for his book Predictably Irrational, and with another book on the way) is profiled in a Forbes column called The Empirical Economist.

The article begins with a picture that is worth a thousand words. (It suggests that Dan must have had a very classical economics education, if he read Mandeville's Fable of the Bees.:)

Artificial intelligence and market design

Abe Othman, a grad student in CS at CMU (who took my market design course when he was an undergrad at Harvard), has a new, not always pc blog, Constructive Economics.

Subscription dating sites: matching versus recruiting

The proprieters of the (apparently no-fee) online dating site OKCupid have a blog in which they analyze their copious data in interesting ways. A recent entry analyzes the business plans of their bigger competitors: Why You Should Never Pay For Online Dating

They argue that the number of members advertised by eHarmony and Match.com is very much larger than the number of their paying subscribers, with the result that most messages are sent to non-subscribers (who they hope will be enticed to subscribe in order to answer). This contributes, they argue, to a death spiral in which men (who send the most messages) find that most of their messages go unanswered, so they increase the number of people they message to, which makes the messages more formulaic, which decreases the response rate (because women are inundated with many impersonal messages from less than likely matches), etc.

Makes you think some kind of scarce-resource signaling would be useful, doesn't it?

Misc. repugnant transactions

Repugnant transactions are those that some people don't want others to engage in. Here are a few that caught my eye recently.

Double fees buy spot on college’s fast track: Bristol deal with for-profit eliminates waiting list, raises questions of fairness
"Bristol Community College is teaming up with a for-profit education company to offer classes in popular allied health programs, a first-of-its-kind partnership that will allow students to bypass waiting lists — provided they pay double the tuition.

The initiative, which the college will offer with The Princeton Review at its New Bedford campus beginning next fall for some programs, has stirred criticism among some educators, who say providing a fast-track education only to students who can afford to pay more than $8,000 a year runs counter to the mission of the state’s community colleges: a commitment to access and equity for all.
“It’s just unfair,’’ said Joe LeBlanc, president of the Massachusetts Community College Council. “I would be quite upset if a student who could pay two times as much jumped to the head of the line to take Bristol Community College classes. Public education, in my mind, means you’re keeping your costs as low as you possibly can. We serve everyone, and in particular, the have-nots.’’
But college officials say the partnership is a creative way for the school to meet burgeoning demand to train health care workers. Enrollment in Massachusetts community colleges has jumped 10 percent in the past year, the largest increase in recent years. And education officials expect similar collaborations on other public campuses in Massachusetts and around the country in coming years.
“In an age of scarce resources, we’re just not going to get money from our state to expand our enrollments,’’ said John Sbrega, president of Bristol Community College. “Such public-private partnerships are the wave of the future.’’"

Drug addicts offered cash to stop reproducing: Addicts are being offered up to £200 cash to be sterilised so they do not give birth to drug dependent children.
"A controversial American charity is now offering the service to addicts in the UK and has set up a helpline for those interested.
Pro-life campaigners said the offer was "inhuman". "


How do morals change? (Yale psychologist Paul Bloom, writing in Nature):
"Where does morality come from? The modern consensus on this question lies close to the position laid out by the eighteenth-century Scottish philosopher David Hume. He thought moral reason to be “the slave of the passions”. Hume's view is supported by studies that suggest that our judgements of good and evil are influenced by emotional reactions such as empathy and disgust. ...

"All this leaves little room for rational deliberation in shaping our moral outlook. Indeed, many psychologists think that the reasoned arguments we make about why we have certain beliefs are mostly post-hoc justifications for gut reactions. As the social psychologist Jonathan Haidt puts it, although we like to think of ourselves as judges, reasoning through cases according to deeply held principles, in reality we are more like lawyers, making arguments for positions that have already been established. This implies we have little conscious control over our sense of right and wrong.
I predict that this theory of morality will be proved wrong in its wholesale rejection of reason. Emotional responses alone cannot explain one of the most interesting aspects of human nature: that morals evolve. The extent of the average person's sympathies has grown substantially and continues to do so. Contemporary readers of Nature, for example, have different beliefs about the rights of women, racial minorities and homosexuals compared with readers in the late 1800s, and different intuitions about the morality of practices such as slavery, child labour and the abuse of animals for public entertainment. Rational deliberation and debate have played a large part in this development."

12-year-old bride’s divorce prompts marriage age review in Saudi Arabia
"A girl aged 12 has won a divorce from her 80-year-old husband in Saudi Arabia in a case that may help to introduce a minimum age of marriage in the kingdom for the first time. The girl’s unusual legal challenge to the arrangement generated international media attention and scrutiny of Saudi Arabia’s record of child marriages.
It also prompted the state-run Human Rights Commission to appoint a lawyer to represent her. The commission has capitalised on the case and pushed for a legal minimum age for marriage of at least 16. "

Belgium to vote on face veil ban
"Belgian lawmakers are set to vote on a proposed ban on wearing face-covering veils in public, a day after neighbouring France proposed enacting similar legislation."

Faculty-student liasons repugnant at Yale

From the Yale alumni magazine: University bans faculty-student sex


"After more than a quarter century of debate, Yale faculty members are now barred from sexual relationships with undergraduates—not just their own students, but any Yale undergrads.
The new policy, announced to faculty in November and incorporated into the updated faculty handbook in January, is “an idea whose time has come,” says Deputy Provost Charles Long, who has advocated the ban since 1983.
In his decades at Yale, Long has seen many faculty-student romances. Most turn out fine, he says, but others are destructive to students. “I think we have a responsibility to protect students from behavior that is damaging to them and to the objectives for their being here.”
Previously, the university had prohibited such relationships only when the faculty member had “direct pedagogical or supervisory responsibilities” over the student. That remains the rule for affairs between faculty and graduate or professional students, and between grad students and undergrads."

College rankings: how they influence applicants, and colleges

A recent paper discusses the impact of the US News and World Report rankings of colleges:

"Why is First Best? Responses to Information Aggregation in the U.S. News College Rankings," by Michael Luca and Jonathan Smith, both grad students at BU.

Here is the abstract: "We present robust evidence that the U.S. News college rankings causally affect college choice beyond their informational content about school quality. Using multiple identification strategies, we estimate that an exogenous one rank improvement leads to a 0.3%-0.9% increase in applications. We explore two potential explanations of the rank effect, showing evidence that students use rankings to improve coordination and to reduce cognitive costs of information processing. Using a novel natural experiment, we then consider the incentives that rankings create for schools. Our results suggest that the rankings caused significant changes to admissions policies, causing schools to favor students who do well along dimensions used in the rankings."

The final section of the paper, called "Rankings as a Mechanism Design Problem" concludes:
"While gaming of the USNWR rankings has come to have a very negative connotation, the rankings also present a mechanism that will only grow in importance over time. In particular, the mere presence of information provides incentives for schools to change their behavior. Further, USNWR provides one of the largest and most sophisticated examples of rankings as an accountability mechanism for schools. We have shown that the existence of the rankings led schools to focus more on attracting students who come from the top 10% of their class and have high SAT scores, probably at the expense of good students who performed worse along these observable measures. However, we have also shown that the rankings led to higher graduation rates. In net, the rankings have served their purpose by holding schools accountable for their decisions. The rankings created high powered incentives to which schools respond. This shows hope that information provision can become an important part of improving schools, especially in settings where there is school choice. As high schools and elementary schools around the country continue to look for new mechanisms in the challenging problem of school accountability, USNWR can help to highlight some of the positive and negative consequences that we should expect to see.