Misc. non-simultaneous kidney exchange chains

Allegheny General part of multistate kidney exchange
Wednesday, April 14, 2010, By Jill Daly, Pittsburgh Post-Gazette
"Twelve donors and 12 recipients with advanced renal disease will be part of the chain when it is completed."

A discussion in the Student BMJ of kidney exchange in England: Would you donate your kidney to a stranger? Donors give a kidney to strangers in paired, pooled, and chain kidney transplants

A big kidney exchange involving four DC area hospitals, organized at Georgetown U. Hospital, including a June 15 video on the Early Show with the crowd of patients and donors.

The National Kidney Registry, a private organization, has generated a report about some of their successful activities in organizing kidney exchanges in partnership with a number of hospitals, including many nonsimultaneous chaings: The National Kidney Registry: transplant chains--beyond paired kidney donation by Veale J, and Hil G., Clinical Transplants. 2009:253-64. [I haven't been able to find the whole article yet: Pub Med lists it as "in process," but here's the abstract:]
"Abstract: The National Kidney Registry (NKR) has facilitated more than 100 transplants at 24 centers in the past 2 years and the numbers are rapidly increasing. The NKR has inherent capability for rapid change as innovations are developed and incorporated in the approach to matching donors and recipients in transplant chains. Kidneys are shipped with geotracking devices utilizing existing OPO procedures whenever patients are willing to accept them. This reduces the need for donor travel and increases the geographic area where matches can be made. Out-of-sequence transplants can be performed to improve logistics. Matching software is designed to facilitate chain transplantation and incorporates metrics that help transplant centers develop strategies to improve the chances that their patients can be transplanted. Daily match runs and close attention to repairing broken chains have been critical to growing the number of transplants that can be facilitated. A number of new innovations are expected to increase the opportunities for patients and their potential living donors."

See a chain of stories on chains here.

Father's day

Father's Day is a great academic holiday, if you think of academics as being concerned not just with ideas and institutions, but with their whole history and earliest conception. Other kinds of coauthors sometimes have difficulty figuring out who did what. But my wife agrees that my contributions were seminal. She was the biggest contributor in the subsequent, germinal stages. The division of labor has been less clear in the happy, fast decades since.

Happy Fathers' Day to all you fathers and children out there.

Indian weddings in New England: the hotel market

The Boston Globe reports: For hotels, a perfect match--Recession-hit hosts embrace Indian weddings.

"On a hot, sunny Saturday in early May, a raucous wedding procession of women in bright, shimmery saris and men in long embroidered kurtas and sunglasses danced through a hotel parking lot behind a van blaring bhangra beats. The groom brought up the rear on a dappled white horse.

"It was the first time the Marlborough Best Western had hosted a traditional Indian wedding and, in keeping with Indian culture, it was an elaborate, all-day affair, with 450 guests.

"Best Western is among the many hotels actively pursuing this lucrative market as they struggle to make up for last year’s recession-diminished revenues.

"The InterContinental Hotel, the Ritz-Carlton, the Taj Boston, and the Westin in Waltham have all hosted Indian wedding expos in the past year. Hyatt Hotels Corp. developed an Indian wedding webinar to educate staff about ceremonial customs, cuisine, even popular brands of alcohol.

"And India New England, a newspaper published in Waltham, has had so much demand from advertisers that it put out two wedding supplements instead of one last year and plans to do the same this year.

“Literally, this market is just exploding,’’ said publisher Upendra Mishra."

..."The weddings, [wedding planner and decorator Shobha Shastry] said, typically range from $50,000 to $150,000 and can go as high as $300,000.

"The average cost of a wedding in Massachusetts, by comparison, is closer to $30,000, according to the research company the Wedding Report Inc."

..."There are about 1,500 Indian weddings a year in the region, according to India New England — more than double the number 10 years ago."

Unraveling of day care

The WSJ reports on the increasingly early reservations being made for day care:Day Care? Take a Number, Baby

"These days, many parents are so intent on getting high-quality care for their kids, that they are signing up at popular child-care centers at the moment they know they are expecting a baby—or before. Some child-care centers don't even offer applications, but merely hand parents a wait-list form. That means some kids spend the first two years of their lives on a day-care wait list.

"With more women than ever in the work force, many of the country's roughly 11,000 nationally accredited child-care centers are full to capacity. The rules governing wait lists are roughly the same for all of them: Slots are assigned on a first-come, first-served basis. Infant care usually has the longest wait lists. Siblings of children who are already enrolled typically get first dibs on openings, to keep families together.

"Even so, the decision-making process behind filling these coveted slots is complex.

"Directors must match up age groupings so classmates' napping and eating routines are similar. And they must coordinate children's admission to match the unpredictable "graduation" dates of older children.

"To secure a slot, directors advise wait-listing your child at least a year or more before you expect to need care. Jessica Cavens put her baby-to-be on a child-care wait list last August, as soon as she got the results of her home-pregnancy test. The child-care center director got the good news even before the baby's grandparents. Now, one year later, Ms. Cavens's baby, Peyton, has been promised a coveted slot in August in the infant-care room at Primrose School at Stapleton, Colo.

"Some child-care centers allow parents to wait-list children not yet conceived. At centers franchised by Goddard Systems Inc., with 362 schools in 37 states, directors generally accept a wait-list entry before conception as long as parents pay a refundable deposit, usually of about $200, says Joseph Schumacher, chief executive of the King of Prussia, Pa., company.

"Other directors accept wait-list entries with no questions asked. "I can't do a pregnancy test," says Vallerie Tribble, director of Innovation Station Child Development Center, Alexandria, Va., owned by Bright Horizons Family Solutions, Watertown, Mass.

"Alyssa Soper, director of Bright Horizons at the Prudential Center in Boston, where wait lists are about a year long, says she gets wait-list requests from families who say "they're trying or thinking about" having a baby.

"It pays to enroll all your kids at the same center. Even signing up an older sibling for after-school care or summer camp at your target center may be enough to earn his or her younger sib a slot."

HT: Benjamin Kay at UCSD

Misc. kidney exchange news

A May 17, 2010 story: Innovative Transplant Procedure at Emory Opens Door to More Patients in Need

"The Emory Transplant Center at Emory University Hospital in Atlanta has recently opened its innovative Paired Donor Kidney Exchange Program, providing greater hope for patients in need of kidney transplants."
...
"Dr. Newell and his team this past month completed the third paired donor exchange surgeries involving a total of six patients - three donors and three recipients - from Texas, Colorado and Georgia. As part of this, as well as one of the two previous exchanges, Emory partnered with the Texas Transplant Institute in San Antonio, the largest independent paired donor program in the country. The program is led by Adam Bingaman, MD, a former Emory trainee who completed both his residency in general surgery and his PhD work at Emory School of Medicine. "To get the ball rolling initially on our program here at Emory, one of the first things we did was partner with the Alliance for Paired Donation," says Dr. Newell. "APD maintains a database of patients who have incompatible donors from over 50 other transplant centers, and the Alliance runs a computer program once a month to find matches between them.
"After about a year, we decided to focus on developing our own database rather than depending on APD's, and we naturally approached Dr. Bingaman about collaborating," says Newell. "Now, building our own listing of donor-recipient pairs remains paramount, an effort expedited by weekly meetings and consultations. Whenever new candidates are added, the data is shared with Dr. Bingaman's program, further increasing each patient's chance of receiving a compatible kidney from a living donor.""

Here's a paper in the June 2010 American Journal of Transplantation:
Ethical Considerations for Participation of Nondirected Living Donors in Kidney Exchange Programs
E.S. Woodle, J. A. Daller, M. Aeder, R. Shapiro, T. Sandholm, V. Casingal, D. Goldfarb, R. M. Lewis, J. Goebel and M. Siegler ; for the Paired Donation Network

ABSTRACT Kidneys from nondirected donors (NDDs) have historically been allocated directly to the deceased donor wait list (DDWL). Recently, however, NDDs have participated in kidney exchange (KE) procedures, including KE 'chains', which have received considerable media attention. This increasing application of KE chains with NDD participation has occurred with limited ethical analysis and without ethical guidelines. This article aims to provide a rigorous ethical evaluation of NDDs and chain KEs. NDDs and bridge donors (BDs) (i.e. living donors who link KE procedures within KE chains) raise several ethical concerns including coercion, privacy, confidentiality, exploitation and commercialization. In addition, although NDD participation in KE procedures may increase transplant numbers, it may also reduce NDD kidney allocation to the DDWL, and disadvantage vulnerable populations, particularly O blood group candidates. Open KE chains (also termed 'never-ending' chains) result in a permanent diversion of NDD kidneys from the DDWL. The concept of limited KE chains is discussed as an ethically preferable means for protecting NDDs and BDs from coercion and minimizing 'backing out', whereas 'honor systems' are rejected because they are coercive and override autonomy. Recent occurrences of BDs backing out argue for adoption of ethically based protective measures for NDD participation in KE.

Paying It Forward
Tulane surgeons performed what is believed to be the first “domino” paired-donor kidney exchange in Louisiana at Tulane Medical Center. Three patients in dire need of a kidney transplant received new organs from people they had never met.

Online labor markets, as an experimental lab

There are a growing number of online labor markets (for a description of a wide range, see Work the New Digital Sweatshops By Jonathan Zittrain).


A recent paper explores their use for conducting experiments: The Online Laboratory: Conducting Experiments in a Real Labor Market by John Horton, David Rand and Richard Zeckhauser . They suggest that Amazon's Mechanical Turk is a convenient venue to do experiments, with some natural advantages (e.g. it's possible to recruit large numbers of participants, who don't need to know they are in an experiment), in which adequate control is possible.


"Abstract: "Online labor markets have great potential as platforms for conducting experiments, as they provide immediate access to a large and diverse subject pool and allow researchers to conduct randomized controlled trials. We argue that online experiments can be just as valid – both internally and externally – as laboratory and field experiments, while requiring far less money and time to design and to conduct. In this paper, we first describe the benefits of conducting experiments in online labor markets; we then use one such market to replicate three classic experiments and confirm their results. We confirm that subjects (1) reverse decisions in response to how a decision-problem is framed, (2) have pro-social preferences (value payoffs to others positively), and (3) respond to priming by altering their choices. We also conduct a labor supply field experiment in which we confirm that workers have upward sloping labor supply curves. In addition to reporting these results, we discuss the unique threats to validity in an online setting and propose methods for coping with these threats. We also discuss the external validity of results from online domains and explain why online results can have external validity equal to or even better than that of traditional methods, depending on the research question. We conclude with our views on the potential role that online experiments can play within the social sciences, and then recommend software development priorities and best practices. "

Renting art at Brandeis

Can a university profit from artwork it owns (that has been donated to it)? Last year Brandeis University raised a storm by proposing to close its museum and sell its art (see my posts here and here.) Now it has proposed renting some of its art (here's the story from the Brandeis student newspaper, The Justice), and that too has generated some criticism. But the Globe thinks renting rather than selling is supportable, here's their editorial:Brandeis: Renting out art for art’s sake

"Brandeis University is raising eyebrows in the museum world with its plans to lend out artworks for money, but exploring this option is a reasonable way to preserve the financially strapped school’s collection.
"Last year, Brandeis considered closing the renowned Rose Art Museum and selling off some of its 7,500 objects. Had that happened, both the school and the region would have been worse off for it. Now, the Globe recently reported, the school is hiring auction house Sotheby’s as a lending broker. Collecting fees from institutions that might want to display some of the museum’s works could generate badly needed funding and might even increase awareness of the Rose as well."

Update: [6:14:18 AM] Bettina Klaus writes "saw your blogpost on renting art and remembered that my Maastricht neighbors are renting some http://www.bonnefanten.nl/en/art_lease (Bonnefanten Art Lease Contemporary art at your home)

The market for shorthand

When I was in high school in New York City in the 1960's, there was a department called Secretarial Studies that taught typing and shorthand (in two flavors, Gregg and Pitman). The students were mostly girls planning on looking for work as secretaries.

Well, recording machines changed the way people dictated letters (and computers of course changed it again), and nowadays the WSJ reports that you need a translator to recover the contents of old shorthand notes:Do You Know, Offhand, Anyone Who Knows Shorthand?As a Skill Fades, Translators Are in Demand; Ms. Sanders Charges 20.5 Cents a Word

It's probably also hard to find someone to repair buggy whips, not to mention recovering files stored in WordPerfect on floppy disks...

If anyone needs someone who once mastered Scribe (since displaced by TeX), let me know.

Heart transplant pro golfer

Until I read the story, I wasn't sure how to parse this AP headline: Heart Transplant Survivor Gets Shot at US Open

It turns out the headline means the golfer Erik Compton got _a_ shot at playing in the Open. He's a survivor of two heart transplants who wants to make a living playing golf. He's one of 156 players in possession of what he calls a Golden Ticket -- a tee time this week at Pebble Beach to play in the U.S. Open."

Universities and culture

A Campus Where Unlearning Is First reports on the challenges facing the American University in Cairo in its quest to offer an American style education to Egyptian students. It starts with what the university president calls "disorientation."

"During disorientation, the students — 85 percent of them Egyptians — are taught to learn in ways quite at odds with the traditional method of teaching in this country, where instructors lecture, students memorize and tests are exercises in regurgitation."


See this earlier post touching on university culture and national culture: Worldwide university rankings, compared to GNP .

Live Liver donation tragedy

The Boston Globe reports: At the Lahey, a stunning, rare tragedy--Donor dies in liver transplant attempt.

"A man who agreed to donate part of his liver to help a sick relative died while undergoing the transplant procedure at Lahey Clinic in Burlington two weeks ago, the hospital said yesterday.

"It was only the third death of an adult living liver donor in the United States in the two decades since the first procedure was done, according to two leading transplant surgeons. A total of 4,036 have been performed.

"While any surgery carries risks, specialists said the death of a living donor is especially upsetting because they are generally young and healthy and are undergoing an operation they do not need for the benefit of a family member or close friend."

..."“The safety of the donor is foremost in everyone’s mind,’’ said Dr. James Markmann, chief of transplant surgery at Massachusetts General Hospital. “It is a very safe operation, but the risk is not zero. If you do enough [of these operations], it will happen. Our thoughts go out to the donor’s family. They did a wonderful thing, and it’s tragic that it ended up this way.’’

"Markmann put the risk of death at one or two in 1,000 operations and said the risks to donors are like those for any type of major surgery, including infection, but generally are less because patients are healthy. He said these risks are weighed against the benefits to recipients: 10 to 15 percent of people waiting for a liver donation die each year because of a shortage of cadaver donors. About 1,500 liver transplant candidates died last year across the United States."

"Dr. Giuliano Testa, director of liver transplantation at the University of Chicago Medical Center, said there have been just three deaths of adult liver donors, the last in 2002 at Mount Sinai Medical Center in New York. He called the Lahey team one of the most “experienced and most expert’’ in the country."

..."Until 2001, the number of liver transplants from living donors in the United States had been growing, reaching a peak of 524 that year. Since then the number has declined, with 219 operations performed last year. Of those, 24 were done at Lahey.

"Surgeons said that the Mount Sinai death may have had a chilling effect on living liver donor transplants, but that in 2002 the cadaver liver allocation system was reorganized so that organs went to the sickest patients. This change reduced the need for living donors.

"Of the 323 living donor liver transplants done in Massachusetts since 1994, 215 were performed at Lahey. This is the first donor death since the program began in 1999, the hospital said."

Organs for sale? Repugnance as controversy to sell magazines

Mohammad Mahdian points out this ad for the Economist magazine, entitled
"Trading Human Organs Should Be Allowed"

Dating sites that limit your options

A new paper by my HBS colleagues Hanna Halaburda and Misiek Piskorski discusses why a dating/matrimony site that limits your options (like eHarmony) might be attractive. Their paper is called Platforms and Limits to Network Effects

The idea is that, even if you would prefer to have lots of options yourself, you might prefer to be one of a small set of options your dating partners are considering.

Abstract:We model conditions under which agents in two-sided matching markets would rationally prefer a platform limiting choice. We show that platforms that offer a limited set of matching candidates are attractive by reducing the competition among agents on the same side of the market. An agent who sees fewer candidates knows that these candidates also see fewer potential matches, and so are more likely to accept the match. As agents on both sides have access to more candidates, initially positive indirect network effects decrease in strength, reach their limit and eventually turn negative. The limit to network effects is different for different types of agents. For agents with low outside option the limit to network effects is reached relatively quickly, and those agents choose the platform with restricted number of candidates. This is because those agents value the higher rate of acceptance more than access to more candidates. Agents with higher outside option choose the market with larger number of candidates. The model helps explain why platforms offering restricted number of candidates coexist alongside those offering larger number of candidates, even though the existing literature on network effects suggests that the latter should always dominate the former.

College admissions and "demonstrated interest"

Signaling is important, says a recent article in the Chronicle of Higher Ed: The Dynamics of Demonstrated Interest

"This year, American University received a record 17,000 admissions applications, a 13 percent increase over last year.

.... as colleges become more selective, they often find themselves competing with institutions a rung or two higher on the ladders of selectivity and desirability, at least for the top students.

Although there's prestige in this kind of association, there's also uncertainty. How many applicants would turn down a super-selective, big-name college to attend a somewhat less-selective, less-famous one? How do you know whether a student considers your college a top choice or a "safety school"? How does an applicant's sense of "fit" with a college relate not only to matriculation, but also retention?

"In recent years, such questions have prompted American's admissions team to look more closely at "demonstrated interest," the popular term for the contact students make with a college during the application process, such as by visiting the campus, participating in an interview, or e-mailing an admissions representative. In theory, it's a way to measure the likelihood that an applicant will matriculate—and succeed if they do.

"The practice is not new, but its importance has grown at some selective colleges in this era of ballooning applications and economic uncertainty. From 2003 to 2006, the percentage of colleges rating demonstrated interest as a "considerably important" factor increased to 21 percent from 7 percent, according to an annual survey by the National Association for College Admission Counseling. Since then, that number has held steady (another 27 percent of colleges now deem it "moderately important"). ...

"Recently, American has created more opportunities for students to do just that. The admissions office has broadened its recruitment strategies to include online chats for prospective applicants. Participation is noted in each student's file. ...

"Demonstrated interest often dovetails with another strategy for managing uncertainty: the waiting list. This year, American offered a spot on its waiting list to about 2,000 students, a seemingly large number considering that the university had accepted approximately 7,300 students for its freshman enrollment target of 1,450.

"Applicants who received waiting-list invitations from American fit a range of descriptions. Some were less competitive than the applicants the university accepted, but others were top-notch students who did not seem like a good fit for the university. In some cases, the reason was a lack of demonstrated interest, Ms. Alston says."

Teachers who tamper with standardized test scores

"John Fremer, a specialist in data forensics who was hired by an independent panel to dig deeper into the Atlanta schools, and who investigated earlier scandals in Texas and elsewhere, said educator cheating was rising. “Every time you increase the stakes associated with any testing program, you get more cheating,” he said."

From the NY Times story: Under Pressure, Teachers Tamper With Test Scores, reporting that "investigations in Georgia, Indiana, Massachusetts, Nevada, Virginia and elsewhere this year have pointed to cheating by educators. Experts say the phenomenon is increasing as the stakes over standardized testing ratchet higher — including, most recently, taking student progress on tests into consideration in teachers’ performance reviews."

Afghan child weddings

The NY Times writes about the floggings administered to twp runaway child brides, in a story that also includes some interesting background: Child Brides Escape Marriage, but Not Lashes.

The case of Khadija Rasoul, 13, and Basgol Sakhi, 14, from the village of Gardan-i-Top, in the Dulina district of Ghor Province, central Afghanistan, was notable for the failure of the authorities to do anything to protect the girls, despite opportunities to do so.Forced into a so-called marriage exchange, where each girl was given to an elderly man in the other’s family, Khadija and Basgol later complained that their husbands beat them when they tried to resist consummating the unions. "

Super duper

Duper of Harvard Got Into Stanford
Student Accused of Lying to Harvard Was Admitted to Stanford, Too

"Adam Wheeler, the Delaware man charged with lying about his credentials to get into Harvard and to secure nearly $50,000 in financial aid and prizes, was later admitted to Stanford as a transfer student, Massachusetts prosecutors said in court documents released Wednesday."
"Cara O’Brien, a spokeswoman for Middlesex Superior Court in Massachusetts, told my colleague Abby Goodnough that the documents reveal that Mr. Wheeler was admitted to Stanford this year as a transfer student for the 2010-11 school year. Massachusetts authorities have said that Mr. Wheeler left Harvard last fall after university officials confronted him with allegations that much of his application for a Rhodes Scholarship had been plagiarized."

See my earlier post for the background: College admissions fraud, at Harvard

Update: and here's the Dec. 16, 2010 Globe story covering his guilty plea and sentencing.

Personal data for sale

Web Start-Ups Offer Bargains for Users’ Data

The budgeting Web site Mint.com, for example, displays discount offers from cable companies or banks to users who reveal their personal financial data, including bank and credit card information. The clothing retailerBluefly could send offers for sunglasses to consumers who disclose that they just bought a swimsuit. And location-based services like Foursquare and Gowalla ask users to volunteer their location in return for rewards like discounts on Pepsi drinks or Starbucks coffee.

These early efforts are predicated on a shift in the relationship between consumer and company. Influenced by consumers’ willingness to trade data online, the sites are pushing to see how much information people will turn over."...

"New companies including WeShop, Aprizi, Blippy and Dopplr are trying to exploit the data that people seem so willing to give up. Some are even allowing shoppers to set what terms they want — free shipping, half-price discounts, only fair-trade products. They can also list what they are shopping for, like a gray cashmere sweater under $100, for instance, and let the retailers fight it out for the right to make a sale.

“The whole privacy debate has grown up around people using your data without your permission,” said Antony Lee, chief executive of WeShop. “If you want to use your data to your benefit, that’s for you to do,” Mr. Lee said."

Experimental economics and market design

As I prepare my chapter on that subject for volume 2 of the Handbook of Experimental Economics, I've belatedly posted a related paper, which has a section on experiments in market design from which I'll cheerfully borrow:

Roth, Alvin E. " Is Experimental Economics Living Up to Its Promise? , in Frechette, Guillaume and Andrew Schotter (editors), in The Methods of Modern Experimental Economics , Oxford University Press, forthcoming.

Outsourcing online courtship

The Washington Post has a story about services (like Virtual Dating Assistants) that allow online courtship to be outsourced: Online dating assistants help the lonely and busy

"Last June, Valdez, now 25, founded Virtual Dating Assistants -- a company that "specializes in making the dating dreams of busy individuals come true."

"Author Timothy Ferriss popularized the concept when he wrote about outsourcing his online dating accounts to teams of competing writers in his 2007 book, "The 4-Hour Work Week."

"Valdez's Atlanta-based firm is hardly the only outfit to offer such services. Dozens of profile-writing shops such as Arlington County-based TargetLove have popped up in the past few years, and dating coaches are increasingly managing their clients' online pursuits. Not to mention the well-intentioned friends and relatives who have taken over the process for the hapless singles in their lives.

"But Valdez and his team of 45 freelance writers, including Hartshorn, do it all: write a client's profile, pick out potential matches, send introductory e-mails and message back and forth until a date is confirmed. Then they turn over the correspondence and tell the lucky fellow where and when he's meeting Madame X. (And it's almost always that gender dynamic; 80 percent of the firm's clients are men.)...

"Mark Brooks, founder of Online Personals Watch, a site that tracks Internet dating trends, says this type of outsourcing is an ethically questionable form of "misrepresentation." Still, he expects the field to grow.

"Professional matchmakers often charge $5,000 or more a year and have a limited pool of matches. Online dating sites are populated with countless singles but can require more attention than some users are willing to devote. "It may look like instant gratification, like you dive into the pool and instantly come up with a fish, but it doesn't really work like that," Brooks says. "You've got to tap, tap, tap on the keyboard quite a lot to get anywhere."