Swap clothes on swapdom.com

Swapdom is a site for trading clothes.

It came to my attention through this blog post:  Swapping clothes instead of kidneys

Financial Incentives for Living Kidney Donation: Ethics and Evidence

That's the title of a recent letter by Matthew B. Allen and Peter P. Reese at Penn, motivated by an article suggesting that payment to donors could be welfare improving,

1. Barnieh L, 
2. Gill JS, 
3. Klarenbach S, 
4. Manns BJ

: The cost-effectiveness of using payment to increase living donor kidneys for transplantation. Clin J Am Soc Nephrol   2013

Allen and Reese (may be gated) review arguments pro and con, and conclude:

Given the promise of a cost-effective strategy provided by Barnieh’s group—and a lack of empirical evidence that ethical concerns about incentivizing live donors would manifest—we propose a research agenda and necessary elements for a limited trial of incentives. First, using modeling, researchers should examine the comparative effectiveness of different incentive strategies, such as reimbursement for lost wages and expenses or provision of insurance. Expense reimbursement is a promising alternative to fixed payment. Estimates of donor financial burden range from $907 to $3089, and compensation would help ensure that donors do not suffer financially from donation (8). Because potential donors would not stand to benefit financially, expense reimbursement could ease concerns about undue and unjust inducement, but it might also fail to generate a meaningful increase in the supply of organs (5). Moreover, in contrast with fixed payment for donation, expense reimbursement is legal in the United States (1).

Second, a limited, real-world trial of regulated incentives should be conducted. Ideally, the effect of a direct payment intervention could be contrasted with expense reimbursement and usual care. A geographically limited trial should assess (1) the effect of different payment models on the number of donors (to assess the program’s benefits), (2) the socioeconomic and general health status of potential and actual donors (to assess unjust inducement), and (3) donor comprehension of risks and evidence of donor coercion (to assess undue inducement). If incentives are provided for only a subset of donors, evidence of crowding out should also be assessed. The trial should measure psychological, financial, and physical outcomes after donation. Existing protections for potential live donors will be necessary, such as use of independent donor advocates, separation of donor and recipient evaluation teams, and ability to opt-out from donation with dignity at any time (5). Additional protections may also be needed, such as a “cooling off” period between evaluation and donation to allow transplant teams multiple opportunities to assess donor motives and comprehension.

The barriers to conducting such a trial are significant. In the United States, these barriers include the National Organ Transplant Act (1). Removing the legal prohibition on payment for donation would require persistent advocacy by diverse stakeholders. So far, surveys suggest a lack of consensus for organ markets among the general public, and a minority of transplant surgeons support paying for living donation (9,10).

Current trends regarding the use of financial incentives in medicine suggest that the time is ripe for new consideration of payments for living kidney donation. The last decade has witnessed rising interest in behavioral economics and well-designed clinical trials using financial incentives to change diverse health behaviors, including smoking and weight loss (11–13). In the meantime, this work by Barnieh et al. may allow advocates to make a financial case for incentives in the realm of living kidney donation. Reassurance about the ethical concerns, however, can come only through empirical evidence from actual experience.

Preferences for randomness in German university admissions

Here's a paper that pushed a lot of my buttons: theory, experiments, and institutional detail on university admissions to study medicine (and some other disciplines) in Germany: Flipping a Coin: Theory and Evidence, by Nadja Dwenger, Dorothea Kubler, and Georg Weizsacker

Abstract: We investigate the possibility that a decision-maker prefers to avoid making a decision and instead delegates it to an external device, e.g., a coin flip. In a series of experiments our participants often choose stochastically dominated lottery between outcomes, contradicting most theories of choice such as expected utility. A large data set on university applications in Germany shows a choice pattern that is consistent with a preference for randomization, entailing substantial allocative consequences. The findings are consistent with our theory of responsibility aversion.

Here's some of the institutional description:

"Admissions to German undergraduate university programs in the medical subjects are centrally administered by a clearinghouse. The clearinghouse assigns applicants according to the following three procedures that are implemented in a sequential order:

(1) Procedure A admits students who are top of the class to up to 20% of seats.

(2) Procedure W admits students with long waiting times to up to 20% of seats.

(3) Procedure U represents admission by universities according to their own criteria to the

remaining (at least 60% of) seats.

For each of the three procedures, applicants are asked to submit a preference ranking of universities, which may either be identical or di fferent across procedures. All rank-order lists are submitted at the same moment in time. The central clearinghouse employs the three procedures in a strictly sequential order: all applicants who are matched in procedure A are firmly assigned a seat at their matched university and do not take part in subsequent procedures. All remaining applicants enter procedure W. Likewise, after procedure W, all applicants who are still unmatched enter procedure U. The fact that applicants can submit three (potentially different) rank-order lists of universities, each of which may be relevant, is a unique property of the German mechanism and makes it suitable for our analysis."

Procedure A is apparently an immediate-acceptance ("Boston") algorithm that takes only the preferences of the students as inputs, while procedure U is a university-proposing deferred acceptance algorithm.  While there are strategic reasons for students to submit different preferences in A and U, the authors argue that these can be identified and removed from the data, and that there remain students who order their choices differently in the two procedures, in the manner of experimental subjects who display a preference for introducing some randomness into their assignment.

Georg W. further writes to me as follows:
"Arguably the most important and most interesting strategic motives in the German application system appear because of the multi-stage nature of the mechansim: Applicants need to be careful that they are not matched in the first stage of the mechanism, in cases where they plausibly have a chance to get a better match on subsequent stages."

Nalini Ambady, RIP

Stanford psychology professor Nalini Ambady passed away after a long search for a matching bone marrow donor:
Nalini Ambady, Stanford psychology professor, dies at 54
"A distinguished social psychologist, Ambady was well known for her research that showed that people can form accurate first impressions about others based only on seconds-long observations of their nonverbal behavior."

"Nalini Ambady, a Stanford professor of psychology, died Oct. 28 after a long battle with leukemia. Her passing followed a yearlong, worldwide effort by family, friends and students to find a bone marrow donor match."
**************

Professor Ambady's students and friends organized an active campaign to help her find a bone marrow donor, which you can follow here: http://ambadylab.stanford.edu/helpnalininow/

Here's a story from New Delhi TV (NDTV) that in passing emphasizes how the inability to compensate donors can make the search tragically difficult (emphasis added): Professor Nalini Ambady's death highlights lack of awareness on bone marrow transplants in India

"Because of genetic markers, a person is likely to find a match from one's own ethnic gene pool. In Ms Ambady's case her match would most likely have been from someone from her birthplace - Kerala.

"For the past six months, the Ambady family has been carrying out drives in India to encourage people to sign up for the bone marrow registry in the hopes of finding her a potential match.

"But in a country of 1.2 billion, only about 45,000 people have signed up to be bone-marrow donors. In comparison, there are over 10 million donors on the United States' National Marrow Donor Program.

"This is despite the fact that becoming a bone marrow donor is simple. All it takes is a swab test-rubbing an ear bud on the inside of one's cheek. An actual transplant is as painless as donating blood. Still, because of ignorance, lack of awareness, cultural taboos or psychological fears Indian's don't sign up to become donors.

"Ms Ambady found at least six potential matches from India. But they all dropped out. According to a childhood friend Ann Ninan, "It was heart breaking for the family."

"Ms Ambadi's family will not be able to celebrate this Diwali with her but during this festive season let's all sign up as donors. It's a few minutes of your time but it could save someone's life."
***************

My colleague Muriel Niederle, who took a class from Professor Ambady at Harvard, reflects on her passing here.

See some of my other posts on bone marrow donation, and the ongoing political/legislative/legal disputes concerning whether bone marrow donors can be compensated, or whether this should be forbidden as a repugnant transaction. (Long story short: The conventional interpretation that paying bone marrow donors was outlawed by the National Organ Transplant Act was upset by a decision of the 9th Circuit Court of Appeals, but the Department of Health and Human Services is taking steps to change the relevant regulations so that it will continue to be illegal despite the court ruling.)

The law and politics of bone marrow and compensation for donors

The Department of Health and Human Services is proposing new regulations that would put bone marrow more clearly into the class of organs for which payment is forbidden by the National Organ Transplant Act of 1984. This is in response to the decision by the Ninth Circuit to make compensation legal for bone marrow donations made through the harvesting of blood stem cells directly from the blood.

Here's the relevant page from the Federal Register: Federal Register/ Vol. 78, No. 191 / Wednesday, October 2, 2013 / Proposed Rules

Here are my earlier posts on the courts and compensation for bone marrow donation.

Since I'm not licensed to practice law in North Carolina or anywhere else, I wrote to Kim Krawiec to ask whether HHS could simply overrule the Ninth Circuit with a regulation, or whether Congress would have to get involved.

Here is Kim's reply:
"... new legislation is probably not needed to overturn the 9th circuit ruling -- that is certainly the position of HHS.  Here is the relevant language from NOTA (with emphasis mine): (1) The term “human organ” means the human (including fetal) kidney, liver, heart, lung, pancreas, bone marrow, cornea, eye, bone, and skin or any subpart thereof and any other human organ (or any subpart thereof, including that derived from a fetus) specified by the Secretary of Health and Human Services by regulation.  

The only question would be whether HHS exceeded its authority in some way through this change. I'm sorry to say that such a claim would be an uphill battle.  One might imagine, for example, a claim that the statute only permits the addition of "organs" and HSCs drawn from peripheral blood are not an organ (as the 9th Circuit concluded).  But courts are extremely deferential to agencies on these questions of interpretation (the term is "Chevron deference", named after a Supreme Court case establishing the standard). Courts are very reluctant to overturn agency interpretations of this sort and defer to the agency interpretation unless it is unreasonable.  Hopefully the interpretation (assuming the proposed reg is enacted) will be challenged, but I think this one will be a tougher fight than the first case."

HT: Bob Slonim

A new NBER paper makes use of some of the random elements of the New York City high school assignment algorithm to understand the effect of small schools:

Small High Schools and Student Achievement: Lottery-Based Evidence from New York City

Atila Abdulkadiroğlu, Weiwei Hu, Parag A. Pathak

NBER Working Paper No. 19576
Issued in October 2013
NBER Program(s):   ED   LS   PE 

One of the most wide-ranging reforms in public education in the last decade has been the reorganization of large comprehensive high schools into small schools with roughly 100 students per grade. We use assignment lotteries embedded in New York City's high school match to estimate the effects of attendance at a new small high school on student achievement. More than 150 unselective small high schools created between 2002 and 2008 have enhanced autonomy, but operate within-district with traditional public school teachers, principals, and collectively-bargained work rules. Lottery estimates show positive score gains in Mathematics, English, Science, and History, more credit accumulation, and higher graduation rates. Small school attendance causes a substantial increase in college enrollment, with a marked shift to CUNY institutions. Students are also less likely to require remediation in reading and writing when at college. Detailed school surveys indicate that students at small schools are more engaged and closely monitored, despite fewer course offerings and activities. Teachers report greater feedback, increased safety, and improved collaboration. The results show that school size is an important factor in education production and highlight the potential for within-district reform strategies to substantially improve student achievement.

A Finnish team takes top honors at 2013 North American wife carrying championship

Sometimes when I talk about dwarf tossing (which is illegal in many places), I also talk about wife carrying, which is not.  Here's the latest from the North American championships: Results from the 2013 North American Wife Carrying Championship

It includes a video of the competition

School choice in Washington DC: some schools jockey for position before the start...

Here's some news on charter schools joining the new DC school choice system, or not...

Some charters opt out of unified enrollment lottery

"All DCPS schools and most charter schools have agreed to a common enrollment lottery that will take effect for school year 2014-15. The new process will cut down on duplicate applications and student reshuffling at the beginning of the year. Why, then, have some charters opted not to participate?

"For years now, observers of the DC education scene have been calling for a unified enrollment process, either for all charter schools or for both charters and DCPS schools. The benefits seem clear: parents will be able to file a single application and rank schools in the order of their preference. Schools will no longer find students leaving in September as they get into other schools off waiting lists, or simply decide they would be happier at another school where they also secured a spot.

"But when the deadline for joining the common lottery arrived at the end of September, a dozen charter schools were missing from the list. The charters who are participating account for nearly 90% of charter slots, but the ones who opted out include some highly sought-after schools, such as Washington Yu Ying and Latin American Montessori Bilingual (LAMB). Clearly, some parents will continue to apply to those schools separately, in addition to or instead of applying through the common process.
...
"Patricia Ragland, the enrollment coordinator at Tree of Life PCS in Ward 5, said the school draws many of its students by word-of-mouth or because their siblings are already enrolled. The school's executive director decided not to participate in the unified lottery because it would have made it easier for families to find other options, Ragland said.
...
"As for LAMB, a Tier 1 school in Ward 4, its Executive Director, Diane Cottman, said in an email that the school is "hesitant to join a system that has not yet been finalized."

"With a more cautious approach," she wrote, "LAMB hopes to avoid the uncertainty that comes with a work in progress."

But, as project manager Bhat points out, DC is not the first city to implement a unified enrollment lottery. Denver and New Orleans have had similar programs in place for several years, and New York has instituted a common application system. And the same company that designed all three of those systems, the Institute for Innovation in Public School Choice, is designing the one in DC. Newark and Philadelphia are also working on plans for common lotteries."

Repugnant markets in drugs used for legal executions

The New Republic has the story: Big Pharma May Help End the Death Penalty

"Thirty-two states retain the death penalty in the U.S., but a new obstacle is making it increasingly difficult for them to carry it out. Pharmaceutical companies are taking a moral stand. The manufacturers of the drugs required by state departments of corrections for executions are saying they will not allow their products to be employed in this way. Manufacturers in the UK, US, Denmark, Israel, Switzerland, Germany, Austria, and India have taken steps to prevent their drugs being used in executions.

This has had an astonishing effect. Shortages of lethal injection drugs and attendant litigation have resulted in moratoria—an official halting of executions—in Arkansas, California, Kentucky, Louisiana, Maryland, Missouri, Montana, Nebraska, North Carolina, Oregon, and Tennessee. Historically, state entities do not move directly from having the death penalty to abolition. They begin with a moratorium on killing and then, when the population has grown unused to executions, the death penalty can be abolished. Of the states mentioned above, Maryland abolished the death penalty this year and abolition bills have been put forward in Nebraska, Colorado, and California. California came very close to passing its abolition bill—voting against by 52 to 48. Meanwhile, the media coverage of the issue has exposed the unsavoury details of the execution process and created opportunities for serious debate about abolition."

HT: Jason Poulos

MIT celebrates Vahideh Manshadi and her work on kidney exchange

Vahideh Manshadi is a postdoc at MIT, working with Itai Ashlagi on kidney exchange. Here's a recent article about her work: Miracle Matches.

She is on the job market this year--you could hire her...
Below (from her web page) is the link to and description of her jobmarket paper.

• Job Market Paper: Kidney Exchange in Dynamic Sparse Heterogenous Pools, with Itai Ashlagi and Patrick Jaillet,Management Science (Revise and Resubmit).
• Extended abstract appeared in The 14th ACM Conference in Electronic Commerce (EC), 2013. [slides in pdf]
• Software: Kidney Exchange Developed primarily by Itai Ashlagi. Please check his homepage for instructions and updates.
• Summary: One of the main challenges in the current practice of kidney exchange is matching highly sensitized patients. These patients are very unlikely to be compatible with a random donor. Current pools of patient-donor pairs are not too large and they contain many such hard-to-match patients. Therefore, the compatibility graphs associated with these pools are sparse (or sometimes called thin). One way to create a thicker pool is to wait for many pairs to join before matching (finding a set of disjoint exchanges), and a major decision clearinghouses are facing is how often to search for allocations. On one hand, waiting is costly; while patients are waiting, they are on dialysis and their health conditions deteriorate. On the other hand, in the current programs, matching too frequently may reduce the number of matched pairs, especially highly sensitized ones. 
  
  In this project, we study this intrinsic tradeoff between the waiting time and the number of matches by analyzing a class of algorithms (which are used in practice) that search periodically for allocations. We perform sensitivity analysis on the amount of waiting given different types of allocations (using 2-ways, 3-ways, or chains). We find that if only 2-way cycles are conducted, in order to gain a significant amount of matches over the online scenario (matching each time a new incompatible pair joins the pool) the waiting period should be very long. If 3-way cycles are also allowed we find regimes in which waiting for a short period also increases the number of matches considerably. Finally, a significant increase of matches can be obtained by using even one non-simultaneous chain while still matching in an online fashion. Our theoretical findings (based on random graph models and motivated by clinical data) and computational experiments (using clinical data from some of the largest exchange programs in the US) lead to policy recommendations.

The price of freshman seminars ought to be going down...

According to this story in the Stanford Daily there are more freshman seminars this year, but no more applicants than last year.

"Though there was an overall increase in the number of Introductory Seminars (IntroSems) offered this year, the number of applications for and enrollments in fall quarter seminars stayed relatively the same as last year, according to Russell Berman, faculty director of the Stanford Introductory Seminars (SIS) program.

This year, 257 classes are available over the course of three quarters—more than the 221 classes offered last year—some of which are also eligible to fulfill the new Ways of Thinking/Ways of Doing breadth requirement.

Some fall quarter seminars attracted extraordinary application volume, making entry more difficult.

“These very popular courses sometimes create a problem for the program insofar as students apply for these and nine out of 10 are going to get turned down,” Berman said. “Sometimes students only apply to those courses that have strong enrollments, and then they get turned down multiple times.”

Berman noted several courses from all disciplines with competitive entries this quarter, including ME26N: Think Like A Designer, taught by Shilajeet Banerjee M.S. ‘00, associate professor of mechanical engineering at the d.school; Psychology Professor Carol Dweck’s PSYCH12N: Self Theories; and ECON26N: Who gets what? The New Economics of Matchmaking and Market Design, taught by Alvin Roth M.A. ‘73 Ph.D. ‘74, a professor of economics who won the 2012 Nobel Prize in Economic Sciences.

The professors who had to review hundreds of applications to their popular classes developed their own acceptance policies. Roth specifically asked his prospective students to write about something they had experienced related to the course’s subject matter.

“I chose students who wrote about something interesting,” Roth said."

Early admissions glitches on the Common App

As the Common App becomes more common, it creates some stress as it struggles with congestion: Common App Says 2 Causes of Admissions Lags Fixed

"After a rocky roll-out of a new online computer program, the Common Application said it fixed two big snags that had left students across the country struggling to file applications before early admission deadlines.

The Common Application allows students to apply to multiple schools at once; more than 500 colleges and universities accept it, and it is run by a nonprofit with the same name."

The Common App has some struggling competitors like the Universal College Application; maybe this will be good for them, and will encourage universities to diversify the portals through which they accept admissions.

Payday loan shops to be taxed to fund cheaper alternatives

The Guardian has the story:

Labour vows to impose new tax on payday lenders

Ed Miliband says his party would double the £13m a year given to fund capacity of credit unions and other low-cost institutions

Slavery around the world in 2013

This ancient, repugnant transaction is not abolished yet, according to the Global Slavery Index 2013, published by the Walk Free Foundation. (Here's a link to the full report.)

"The Global Slavery Index 2013 measures the size of the modern slavery problem, country by country. The Index provides a quantitative ranking of 162 countries around the world according to the estimated prevalence of slavery, that is, the estimated percentage of enslaved people in the national population at a point in time. The Global Slavery Index also examines the risk factors and outlines the strength of the government responses in the fight against modern slavery."

Mauritania and Haiti are high per capita, India is big on total numbers

Experimental Economics (ESA) conference in Santa Cruz

Here's the program for the 2013 Regional ESA Conference, October 24-26, 2013, Santa Cruz, California.

I'll be speaking at 8am Saturday morning:(

(and notice that you might instead want to go to the NBER market design conference that was scheduled for exactly the same days at Stanford.)

Matchmaking and courtship for the rich and busy

If attending Ted talks isn't working for you...The High-End Matchmaking Service for Tycoons

But
"“A lot of older women we don’t take — and they’re fabulous, but it’s too hard to match them,” Jill Kelleher said the morning after the party, at the company’s headquarters in Corte Madera, Calif., which was filled with impeccably groomed young female matchmakers (many of whom have marriage- and family-therapy degrees or a background in life coaching, Sunya Andrews said). “We need to find a system to bring in the men.”

Organ donation in China: optimism and skepticism on new policies

The American Journal of Transplantation carried this account of China's moves to end its reliance on executed prisoners for transplant organs, in its 24 Sept 2013 issue:

China's transplantation system has undergone a substantial makeover that may end its longstanding reliance on executed prisoners for organ transplants. A new national program for deceased-organ donation based on Chinese cultural and societal norms was announced by Chinese health officials, who say the new system adheres to World Health Organization (WHO) guiding principles and is compliant with the Declaration of Istanbul. Health officials say that with the new program, the use of organs from executed prisoners will be phased out within two years.

The transplant program is based on pilot trials that took place between 2010 and 2012 in 19 of the 31 provincial regions in China, in which organs were obtained from donors after circulatory death.

According to an interview with Haibo Wang, MD, director of the Chinese Organ Transplant Response System Research Center of the Ministry of Health, that appeared in the Bulletin of the World Health Organization in November 2012, “It is not customary—in term of our culture, law and medical practice—to take brain death as the definition of death in China.”[1] For this reason, the new national program will respect Chinese cultural and social values with three categories of donation: 1) organ donation after brain death; 2) organ donation after circulatory death; and 3) organ donation after brain death followed by circulatory death.

The third category “is an important approach that is very unique to China due to its social and cultural perspective regarding death,” says Jiefu Huang, MD, China's former Vice Minister of Health and current head of the Organ Transplant Committee of the National Health and Family Planning Commission (NHF-PC) of the country's Ministry of Health. “The data from the pilot program indicated that China Category in accounted for approaching 50% of overall deceased donors,” says Dr. Huang.

He adds that “another issue is that the final decision making of organ donation rests on family wishes, regardless of the individual's wish before death. This is to respect the Chinese culture, which is very family centered.”

Waitlists, Registries and Allocation

An important aspect of the program is use of a computerized waitlist developed and maintained by the Chinese Organ Transplant Response System based at the University of Hong Kong, which also runs the Chinese Liver Transplant Registry. The kidney registry is based at the 309th Hospital of the People's Liberation Army, the heart registry at The Fuwai Cardiovascular Disease Hospital and the lung registry at Wuxi People's Hospital.

Although the Red Cross Society of China oversaw donation during the pilot trials, there is currently “a battle for the authority to distribute organs,” said Frank Delmonico, MD, president of The Transplantation Society, in a commentary in the July issue of the journalTransplantation.2 He quoted an article published earlier this year in the Journal of Medical Ethics that said the Red Cross would pay families of the deceased for donor organs.[3] Additionally, the Beijing News reported in July that the Red Cross charges hospitals the equivalent of $16,000 US to receive an organ for transplant.[4]

Another option for organ allocation might be one of the registries. Gabriel Danovitch, MD, director of the Kidney and Pancreas Transplant Program at the University of California, Los Angeles, says the international transplant community strongly advocates “the standards of access, transparency, fairness and justice in allocation that is appropriate for a nation as important as China.” He adds, “I sincerely hope that the Chinese Liver Transplant Registry will be given the opportunity to provide access and transparency of allocation for organ transplants within China.”

Jump to…

KEY POINTS

• China says the new program adheres to WHO guidelines and Declaration of Istanbul principles.
• The program includes three categories of donation, and use of a computerized waitlist.
• Transplant professionals have expressed guarded optimism and areas of concern about the new program.

Guarded Optimism or Skepticism?

While Drs. Delmonico and Danovitch have expressed guarded optimism, they note areas of concern. “One is the continued use of donation by execution,” Dr. Danovitch says. “The second is commercialization of organ donation from both deceased- and living-donor sources.” Dr. Delmonico notes that the financial compensation program for deceased-donor organs suggested in the Journal of Medical Ethics article may undermine the trust of families in the determination of death and a societal trust that organs are being distributed fairly.[3]

Three frequent critics of Chinese transplantation say they remain skeptical. Torsten Trey, MD, PhD, co-editor of State Organs: Transplant Abuse in China, and executive director of Doctors Against Forced Organ Harvesting, says that “with the continuous lack of transparency, the new program is as vague as the Chinese Medical Association pledge to the World Medical Association in 2007,” in which China agreed to end organ sourcing from prisoners. Dr. Trey says he's concerned that “prisoners of conscience, in particular unjustly detained Falun Gong practitioners, are forcibly enrolled into the organ donation program. In order to meet international standards, openness to scrutiny is indispensable. Chinese officials often speak of ending China's reliance on prisoners, yet ending reliance—defined (by them) as less than 50%—does not guarantee a complete end.”

David Kilgour, co-author with David Matas of the 2007 report Bloody Harvest: Revised Report into Allegations of Organ Harvesting of Falun Gong Practitioners in China, is also skeptical. He says he doesn't believe China will phase out the use of organs from executed prisoners in the next two years. “The party-state in Beijing knows that governments, legislators, medical professionals and ordinary people across the world are increasingly aware of its inhuman organ pillaging, mainly from Falun Gong prisoners of conscience in forced labor camps, and thus wants to create for the naive the impression that trafficking in organs will soon end,” he says. “All persons of good will wish it would, but it has now gone on since 2001 and still shows no sign of ending.”

Matas says, “I can't predict the future. I'm skeptical for a number of reasons. One is that they are complaining about cultural inhibitions. But this has never been an issue for anything else with the Communists.” He adds, “Will the numbers in the new system ever be sufficient to replace the numbers they are getting from prisoners? It's not clear. I don't think we should take the assurances of the Chinese government that everything is going to be fine and just give us time. I don't think that's an acceptable answer.”

In China, Dr. Huang says “the success of the new deceased organ donation program is the key to end China's reliance on prisoners' organs.” After the pilot trials, “many hospitals decided to abandon the practice of prisoner organ use,” he adds. “The capacity of the new deceased-organ donation is far beyond the prisoner organs and certainly will ease the donor shortage if we can build an effective OPO [organ procurement organization] system in a relatively short time.”

International Forums

A step toward that development took place in May with the First Chinese Organ Procurement Organization International Forum, held in Shenzhen, China. It was announced that the National Italian Transplant Center will help China build and maintain its national organ distribution and safety monitoring system for donors and recipients, as well as provide training on advanced organ donation practices used in the European Union. A five-year cooperative agreement with the Spanish Transplant Procurement Management and Donation and Transplantation Institute will include training programs with Chinese medical staff in China and overseas.

“In May 2014, one year after the kickoff meeting of the new deceased donor program,” Dr. Huang says, “NHFPC is going to host an international conference to create a platform for international and Chinese transplant communities to exchange knowledge from their own experience and, more importantly, work together to review and improve the design of the new deceased-organ donation program.”

Jump to…

References

• 1
  Fleck F. New era for organ donation and transplant in China. Bull WHO November 2012. who.int/bulletin/volumes/90/11/12-031112/en. Accessed September 4, 2013.
• 2
  Delmonico FL. A welcomed new national policy in China. Transplantation 2013; 96: 3–4.

  • Find it @ Stanford
• 3
  Wu X, Fang Q. Financial compensation for deceased organ donation in China. J Med Ethics 2013; 39: 378–379.

  • Find it @ Stanford
• 4
  Agence France-Press. China Red Cross in cash for organ allegations: media, afp.com/en/node/1000950. Updated July 9, 2013. Accessed September 4, 2013.

Surrogacy is big business in India

The BBC has a story: Living inside the house of surrogates

"Commercial surrogacy is estimated to be worth more than $1bn a year in India. While pregnant, some surrogate mothers live in dormitories - which critics call baby factories. They give childless couples the family they have longed for, but what is it like for the women who carry someone else's child for money?"

How dead must a deceased donor be?

How dead do you have to be to be a deceased organ donor, and how dead can you be? Deceased donation of organs for transplantation stretches definitions, because you can't be so very dead that your organs are dead too.

Two recent papers in the New England Journal of Medicine raise this uncomfortable question...

The Dead-Donor Rule and the Future of Organ Donation

Robert D. Truog, M.D., Franklin G. Miller, Ph.D., and Scott D. Halpern, M.D., Ph.D.

N Engl J Med 2013; 369:1287-1289October 3, 2013DOI: 10.1056/NEJMp1307220

The ethics of organ transplantation have been premised on “the dead-donor rule” (DDR), which states that vital organs should be taken only from persons who are dead. Yet it is not obvious why certain living patients, such as those who are near death but on life support, should not be allowed to donate their organs, if doing so would benefit others and be consistent with their own interests.

Life or Death for the Dead-Donor Rule?

James L. Bernat, M.D.

N Engl J Med 2013; 369:1289-1291October 3, 2013DOI: 10.1056/NEJMp1308078

The increasing disproportion between the supply of donor organs and the demand for transplants as well as the tragic deaths of patients awaiting organs have encouraged the development of creative solutions to increase the donor supply. In the domain of donation from deceased donors, the protocols for organ donation after the circulatory determination of death (DCDD) have been one such response. Most U.S. organ-procurement organizations have seen organs from DCDD protocols account for a growing percentage of all organs donated from deceased donors (see graphOrgan Donation in the United States by Donor Status, 2002–2011.). In England, DCDD organs currently constitute a greater percentage than organs donated after the determination of death by brain criteria (“donation after the brain determination of death,” or DBDD).

Another innovative strategy is the kidney-donation protocol recently proposed by Paul Morrissey of Brown University.1 This protocol permits a lawful surrogate decision maker for a patient with a severe, irreversible brain injury (but who is not “brain dead”) to authorize withdrawal of life-sustaining treatment and premortem donation of both kidneys. Whereas DCDD protocols entail removal of organs after the cessation of life-sustaining therapy and the subsequent declaration of death, the Morrissey protocol provides for procuring organs while the patient remains alive. Life-sustaining treatment is withdrawn after the donation has been accomplished. The patient dies of the respiratory complications of the original brain injury, which is fatal in the absence of life-sustaining treatment.

Ads to promote kidney donation in Brazil

Chris Masse alerts me to the interesting site Ads of the World, and points to some of the ads being used to promote kidney donation in Brazil. There's a superhero series that includes Captain America and Spiderman...