Organ donor registry mishap in Britain

The Telegraph reports: Organs removed without consent after IT blunder

"The records of 800,000 people were affected by an error that meant their wishes about the use of their organs after death were wrongly recorded.
An investigation has found that 45 of those for whom wrong records were stored have since died – and in approximately 20 cases organs were taken where consent had not been given.

Donors can give permission for any of their organs to be taken, or provide more specific agreements. A glitch in the system more than a decade ago removed the distinctions expressed by people.
Many donors have strong views about what can be taken. Often consent is not given for eyes to be removed, while some people who agree to donate organs are uncomfortable with the idea of their body tissue being used in research.
Joyce Robins, from the pressure group Patient Concern said: "This Government has got an absolutely dreadful record when it comes to data, but it is absolutely horrific that such sensitive details were handled in such a careless way."
The NHS is about to contact approximately 20 families who allowed organs to be taken from their relations after being misinformed about what consent had previously been given.
It is illegal to remove organs without prior consent from the person who died or their next of kin. A view is sought from relations before decisions are taken. In the cases where errors were made, it is understood that families were asked for permission, but their decisions were based on misinformation about the wishes of their relations.
After detecting the fault last year, NHS Blood and Transplant, which holds the organ donation register, was able to correct 400,000 of the flawed records. But 400,000 more people will shortly be contacted to be told that the wrong information may be held about them, and asked to provide consent again.
Until fresh consent is obtained, organs will not be taken from any of those people in the event of death. "

Deceased organ donation, misc. links

Number of Americans willing to donate organs rises, but still not keeping pace with need: Survey reveals pervasive donation myths "The online survey of 5,100 U.S. adults, which was supported by Astellas Pharma US, Inc., also uncovered some pervasive myths regarding donation. For example, the majority (52 percent) of respondents were open to the idea that doctors may not try as hard to save their lives if their wish to be organ donors is known, and 61 percent are open to the idea that it is possible for a brain dead person to recover from his or her injuries. In addition, 8 percent believe that organ or tissue donation is against their religion."
...
"Additional survey findings include: More than three-fourths of adults (78 percent) correctly realize there are more people who need organ transplants in the U.S. than the number of donated organs available. 61 percent of adults would donate the organs or tissue of a family member if they died suddenly without indicating their wishes. The number of African Americans who wish to donate all their organs and tissue has increased to 41 percent versus 31 percent in 2009 – encouraging news as African Americans comprise nearly 35 percent of the national kidney transplant waiting list."


Why New Yorkers Don’t Donate Organs. Susan Dominus writes in the NY Times: "When I started thinking about writing about New York State’s exceptionally low number of registered organ donors — 13 percent of people 18 and older — I remembered that I had never signed up on the official registry to designate myself a donor. So I went online, assuming I would be able to click somewhere quickly, and was delighted at the prospect. ...
"Except that it was nowhere near as easy as getting broccoli delivered to my door. I had to print out a form and mail it....What, specifically, did I want to donate, it wanted to know: Bone and connective tissue? Heart with connective tissue? Pancreas with iliac vessels? ...
"Were I not writing about the subject, I would quite likely have avoided it forever — which puts me in good (or, I should say, equally flawed) company, said Elaine Berg, president of the New York Organ Donor Network. In her opinion, the snail-mail process is a major barrier to increasing New York’s low rate of registration. All but 5 of the 49 states that have organ donor registries — Vermont is the holdout — allow for an electronic signature. That enumerated list of donation options is another hurdle. “It even turns me off,” Ms. Berg said. “It becomes a visual.” Only four states rank lower than New York on the recently released national report card from Donate Life America, a national advocacy group. ...
"But the department maintains that the enumerated list is the best way to meet the requirements of the legislation governing the registry, which was established in 2000 but became binding in 2008. The law states that “the registry shall provide persons enrolled the opportunity to specify which organs and tissues they want to donate.” So let them, Ms. Berg said. As many other states do, give would-be donors a blank space in which they can specify, or give them two options: “All” and “Everything except (blank).” As a journalist, I’m all for full disclosure, except for full disclosure about the gory details of a gesture I’d like to make regarding my organs in the event that I end up brain-dead on a respirator. It’s amazing how a matter of marketing can mean so much for a matter of life and death. In the downstate region of New York, which includes the city, Long Island and the five counties immediately north of the city, Ms. Berg said, 8,000 people are waiting for organs. In the downstate region, about 600 people die a year under circumstances conducive to organ donation (the typical qualifying donor is a middle-aged stroke victim); in these emergency circumstances, New York has around a 50 percent consent rate — much better than the 13 percent on the official registry, but still below the 67 percent rate nationally. And yet cynicism plays in: New Yorkers are more likely than the average American to think doctors put less effort into saving the lives of organ donors, Donate Life America reports. "


Should Laws Push for Organ Donation? discussion and commentary of a proposed NY law to shift to presumed consent. Interesting followup discussion by Alex Tabarrok at MR: Presumed Consent and Organ Donation

Informal money transfer networks: "hawala"

The informal money transfer system known as Hawala (or hundi) is in the news with the arrest of three Pakistani men in New England who are believed to have provided funds to the Times Square bomber. The Boston Globe reports Possible ties to murky finance system examined
"An informal money-exchange network known as “hawala’’ — a centuries-old system that operates outside conventional banking networks — is at the center of the investigation into three Pakistanis arrested Thursday in Massachusetts and Maine with alleged ties to the suspect in the failed Times Square bomb plot, law enforcement officials said yesterday."
...
"Hawala, which originates from the Arabic word for change or transform, is a practice that predates modern banking systems and has been around for centuries. There are believed to be thousands of hawala brokers operating in the United States, and they are not necessarily operating outside US laws if they register with the US Department of Treasury. Many don’t, however, operating more like black-market, cash-based versions of Western Union.
Relying on an informal network of brokers who use designated couriers, the networks are used to transfer money in relatively small amounts in and out of developing nations where modern financial systems are scarce, such as in South Asia, the Middle East, and Africa. Transactions often can be completed within 24 hours and at a lower cost than a traditional wire transfer or bank draft that could take as long as a week and require official paperwork.
Hawaladars, as the brokers are known, often operate out of cash-intensive businesses such as restaurants, convenience stores, or gas stations, the officials said."

The informal nature of the transfers, which circumvent banks and regulated record keeping, and the fact that the broker on one end doesn't know the customer on the other end, have made the hawala system a concern for law enforcement involving money laundering. Here's a report from Interpol: The hawala alternative remittance system and its role in money laundering

Piracy and anti-piracy: recent developments

Russian Destroyer Frees Hijacked Oil Tanker (May 6, 2010)

"Cmdr. John Harbour, a spokesman for the European force, said Thursday that the Russian warship had freed the tanker, the Moscow University, after its crew members locked themselves into the rudder compartment of the ship."

South Africa's president on monogamy, polygamy, infidelity, and AIDS

Zuma’s Frank Talk Starts AIDS Dialogue in South Africa
"During a 45-minute interview on Thursday, Mr. Zuma, who has three wives and a fiancée, talked about his personal relationships with startling directness and laid out his belief that a polygamous marriage in which H.I.V. is openly discussed is safer than a monogamous union in which a man has hidden mistresses. "

Ernst Fehr in New Scientist

Ernst Fehr: How I found what's wrong with economics

Least expected line: "However, as a former Austrian national wrestling champion, Fehr doesn't give up easily."

Job prospects for new law graduates

The WSJ reports: Bar Raised for Law-Grad Jobs: Employment Prospects Dim as Firms Retrench, Derailing Career Paths for Many

"Many 2009 law graduates who were offered jobs just started work this year. And many graduates hired in 2010 won't start until 2011. So even when the economy picks up, firms would first have to absorb their backlog of recent hires."

...

"Law firms had an average of 16 summer internship positions to offer this year, about half the number of the previous year, according to a March report by the National Association for Law Placement Inc.
Employers last year offered 69% of summer interns a full-time job, down from about 90% in the previous five years."

Market design seminar tomorrow (Friday May 13 2010)

If you're not on Peter Coles' distribution list, here's the announcement.

Hello Market Design Community:

The speakers in Friday’s HBS Market Design Workshop (the last of the semester!) are

** IAN KASH, "An Auction Design for Sharing Wireless Spectrum," Harvard Center for Research on Computation and Society

** SCOTT KOMINERS, "Concordance Among Holdouts" [with E. G. Weyl], Harvard Business Economics

We’ll meet tomorrow, Friday May 14, from 3-5PM in HBS Baker Library Room 102. The workshop features an informal format for presenting early-stage work, and is intended to encourage the Boston area market design community to meet and interact. Sushi will be provided.

Thanks, and we look forward to seeing you.

Peter Coles / Ben Edelman / Al Roth

College admissions after May 1

The Chronicle of Higher Education reports Good Seats Are Still Available at many colleges.
"On Wednesday, the National Association for College Admission Counseling released its annual "Space Availability Survey," listing the colleges and universities that still have openings for this fall's first-year class. As we move past May 1, the traditional deadline for students to submit enrollment deposits, the survey is a good reminder that the admissions calendar isn't the same at every college."

InsideHigherEd.com has a similar story from the perspective of the colleges: The Early Word on Yield. That story offers some interesting perspectives on the business of finding and recruiting students, e.g.:
"Across the state, Mike Frantz, vice president of enrollment at Robert Morris University, is also looking at vastly different yields for different programs. ...Over all, the university is thrilled "beyond our wildest dreams" because those numbers for the year -- in which overall yield is 17.6 percent, down less than a point -- come from a much larger applicant pool and more admittances. Applications were up 40 percent. The key, Frantz said, was that the college bought names of prospective students at the beginning of their senior year in high school. In the past, Robert Morris stopped buying new names when students reached their junior year, a common practice, feeling that potential students would be identified by then. "But the vast majority of our new applicants, and many of our new students, came from these pools, whose names aren't being purchased traditionally," he said."

The market for divorce

Tyler Cowen at MR links to a NY Times story about a divorce themed trade fair in Italy: Divorce Trade Fair Shows Changing Italian Culture
It notes that until recently divorce was a repugnant transaction in Italy. "Italy ratified divorce only in 1974 in a referendum, and critics complain that Italian legislators have not kept up with changing times. "


A much more aggressive component of the market for divorce is reported by the Times of London in a story from Japan. Sex, lies and splitting up: Want to dump a troublesome husband, or unsuitable boyfriend? Just call Osamu Tomiya and his team of splitter-uppers...

The article focuses on "Osamu Tomiya — a member of a peculiarly Japanese profession, part-private investigator, part-prostitute, known as wakaresase-ya — the “splitter-uppers”.
The function of the wakaresase-ya is the direct opposite of a dating agency: with great ingenuity, and the right fee, they will prise apart human relationships. Do you have a troublesome ex-boyfriend who won’t leave you alone? A beloved son who is getting engaged to an unsuitable girl? A dead-loss employee who refuses to take the hint and retire? All of these difficult situations can be resolved by the splitter-uppers.
The broken-hearted ex will be visited by the girl’s “new boyfriend”, a muscular gangster-type who explains why he would be wise to nurse his broken heart alone. The undesirable daughter-in-law-to-be will be lured into a drunken one-night stand with a handsome and mysterious man who appears from nowhere — photographs of their tryst will find their way to her fiancé. The stubborn employee will find himself confronted with evidence of gambling debts, or nights in massage parlours — and resign to avoid embarrassment. In each case, the dirty work — of threatening, seducing and investigating — has been done by a splitter-upper.
But most common of all are complications surrounding marriages. In Japan, the idea of a “no-fault” divorce has never caught on and when a marriage breaks down, it is helpful to be morally in the right. When it comes to maintenance, division of common property and custody of children, the betrayed partner is at a great advantage over the betrayer. And this is where the splitter-uppers come in.
For a wife who wants shot of her husband, it would be disastrous just to own up to a long-term lover and throw herself on the mercy of the courts. Instead, she hires someone such as Mr Tomiya, a 40-year-old former sushi chef, to set up the honeytrap that will put her husband in the wrong and enable her to go before the judge as the injured party, with photographs to prove it."

Misc. organ transplant commentary and news

The Times of London reports on how one deceased donor can donate many organs: How one organ donor can save the lives of nine people
There is a worrying shortage of organ donors — and gaining consent from grieving relatives is a delicate task

A living donor is unhappy with the way they have been treated: The Hypocrisy of OPTN's Committee Goals "UNOS has had the OPTN contract since 1986 (yet they cared so little for us they didn't even collect LD social security numbers til 1994); they've had policy to collect follow-up data on living donors since 2000 (but the transplant centers were 50-80% non-compliant), yet it wasn't until 2005 they decided it should be "clinically relevant and validated". And since 2005, independent researchers, UNOS officials and SRTR personnel have all criticized UNOS' data collection as 'woefully inadequate', and worthless as far as any meaningful analysis goes. "

A columnist quotes Adam Smith in support of making compensation for donors legal: Dying people shouldn’t be beggars "It is not from the benevolence of the butcher, the brewer or the baker that we expect our dinner, but from their regard to their own interest. ... Nobody but a beggar chooses to depend chiefly upon the benevolence of his fellow-citizens."
—Adam Smith, "Wealth of Nations"


A living donor is declined by a hospital: Kidney Donation Canceled Because Donor and Recipient ‘Bonded’ and THE MATCH (UN)MAKERS: Why did Einstein halt life-saving transplant? both report a hospital's decision not to accept a donation from a donor who had met his potential recipient via the matchingdonors.com website. The WSJ piece says, by way of of explanation: "As the WSJ has reported, hospitals may be reluctant to agree to this kind of altruistic donation, fearing that donors may have been paid or that participants won’t make it through the rigorous psychological evaluation process, or because the practice sidesteps the official organ waiting lists."

Alex Tabarrok at MR reports on Changing Views on Organ Prohibition and reports that the anthropologist Nancy Scheper-Hughes, who has studied black markets for organs, is in favor of careful trials of ways to ethically compensate organ donors.

California, New York mull changes to organ donor laws
"A California bill may soon create a living donor registry -- the first for any state.
Spurred by Apple co-founder and transplant recipient Steve Jobs, the bill has gained support from major politicos, including California Gov. Arnold Schwarzenegger, and is expected to land on his desk this summer.
Meanwhile, on the East Coast, a far more sweeping transplant bill would make every person an organ donor who doesn't opt out. This would create an organ donation system in New York similar to the ones used in several European countries, but the measure is already facing opposition."
The California bill seems to be aimed primarily at promoting kidney exchange...

Surrogacy, payments, and parental rights in Britain

Couples who pay surrogate mothers could lose right to raise the child: High court could refuse recognition to people who flout law by paying disproportionate fees to a surrogate mother overseas.

"Childless couples who acquire a baby using a surrogate mother abroad risk not being recognised as its parents in Britain if they flout British law by paying fees, fertility lawyers have warned.
Such payments, which can be as high as £30,000, could lead to those who have made them being refused permission by the high court to become the child's legal parents, specialist solicitors say.
The Human Fertilisation and Embryology Act 1990 allows couples entering into deals with a surrogate mother overseas to pay her only what is allowed here – "expenses reasonably incurred", such as compensation for time off work, medical bills and living expenses."
...
""The risk couples face if they pay a disproportionate amount in expenses is that the high court may refuse to authorise those expenses. That could result in the parental order application failing and in turn they would have no status as parents under English law," said John Randle, a leading surrogacy lawyer."
...
"International surrogacy is hugely controversial. "It's unethical and exploitative because the trade is all one-way," said Breedagh Hughes, a Royal College of Midwives spokeswoman, on the ethics of childbirth. "It reduces babies to the level of commodities." "

"Jonathan, a 32-year-old nurse, tells how he and his civil partner, Colin, 33, a financier, spent $150,000 (£98,000) on surrogacy to become the parents of Harriet, who was born in California last year. They live in London.
"We began discussing having a child in 2006, when we were deciding to become civil partners. I was feeling broody, and had always wanted to have my own biological child. We opted to pursue surrogacy in California because we would get legal custody there of the child before it was born and the surrogate would have no legal relationship to the baby.
"My sperm was introduced to eggs left by an egg donor: they were fertilised in an IVF clinic in Los Angeles and two of the embryos were implanted into the surrogate. She simply carried the child for nine months.
An agency in LA found both the egg donor and the surrogate. We never met the egg donor or knew who she was, but knew her medical history, results of her genetic tests, what she looked like and so on. We did meet and get on well with the surrogate, who was called Jennifer. She had two daughters of her own and had been a surrogate once before. There was no coercion. We had a contract, and Jennifer specified things in that like that she wanted back massages and a big hotel room for her family to stay in when she was giving birth.
Agencies in California quote a price of $100,000 to $150,000 to do everything relating to a child. The whole process wasn't too difficult, and cost us about $150,000. We paid the embryologist $60,000, though that included the harvesting of the donor's eggs, the IVF and the transfer of the embryos into the surrogate. It was $40,000 for the surrogate and $10,000 for the egg donor, plus $10,000 to the agency, who supplied the donor and the surrogate. Then there was $10,000 for our lawyer, $5,000 for the medical and psychological screening and another $5,000 for medication for both the donor and the surrogate, to ensure they were in cycle at the same time.
"Bringing Harriet into the UK nine months later was incredibly difficult, though, and we engaged lawyers to help us. She had to come in as an immigrant on a US passport on a six-month tourist visa. When we later filled in a form to get her British citizenship, we put 'not known' in the section headed 'mother'. She now has dual nationality and is legally ours under Californian law. If we do apply, it could be an issue that we paid well over the 'reasonable expenses' limit – that is, we paid a fee. That's illegal in this country, but allowed under Californian law.
"We shouldn't have to seek a parental order. She was conceived and born in California as our child, and her birth certificate says who her parents are, so the courts here should respect Californian law.
Having to apply for a parental order, where there'd be an assessment of Harriet's welfare and Colin would have to prove that he's no danger to her, is an inequity. Anybody else can go out, get drunk, get pregnant, bring up a child appallingly and face no intervention or legal barriers.
I resent people saying that British couples who resort to surrogacy are buying babies abroad. We didn't buy Harriet: she's not picked off a shelf. She's not a 'designer baby'.
We had our own child and had a great team to help us. All we did was rent a woman to carry her. We paid for the services of an embryologist and an incubator who walks and makes good babies – but we didn't buy a baby. She's my daughter biologically, and she's our baby.
A lot of heterosexual couples in the UK spend a lot of money having many cycles of IVF at £5,000 a time – is that not buying a baby?" "

HT: Nick Feltovich

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.