Living versus deceased donor kidneys (LD kidneys last longer...)

It appears that even a not so well matched living donor kidney lasts longer than a deceased donor kidney...

Living Donation Has a Greater Impact on Renal Allograft Survival Than HLA Matching in Pediatric Renal Transplant Recipients
Marlais, Matko MRCPCH; Hudson, Alex MSc; Pankhurst, Laura MSc; Fuggle, Susan V. D.Phil.; Marks, Stephen D. MD
TRANSPLANTATION, Dec. 2016 Volume: 100  Issue: 12  Pages: 2717-2722

Background: Living donor (LD) kidney transplantation accounts for around half of all pediatric renal transplant recipients and results in improved renal allograft survival. The aim of this study was to determine the effect of HLA matching on deceased and LD renal allograft outcomes in pediatric recipients.

Methods: Data were obtained from the UK Transplant Registry held by NHS Blood and Transplant on all children who received a donation after brain death (DBD) or LD kidney-only transplant between 2000 and 2011. HLA-A, HLA-B and HLA-DR mismatches were categorized into 4 levels and 2 groups. Data were fully anonymized.

Results: One thousand three hundred seventy-eight pediatric renal transplant recipients were analyzed; 804 (58%) received a DBD donor kidney, 574 (42%) received an LD kidney. Five-year renal allograft survival was superior for children receiving a poorly HLA-matched LD kidney transplant (88%, 95% confidence interval [95% CI], 84-91%) compared with children receiving a well HLA-matched DBD kidney transplant (83%, 95% CI, 80-86%, log rank test P = 0.03). Five-year renal allograft survival was superior for children receiving an LD kidney with 1 or 2 HLA-DR mismatches (88%, 95% CI, 84-91%) compared with children receiving a DBD kidney with 0 HLA-DR mismatches (83%, 95% CI, 80-86%, log rank test P = 0.03).

Conclusions: In children, poorly HLA-matched LD renal transplant outcomes are not inferior when compared with well HLA-matched DBD renal transplants. It is difficult to justify preferentially waiting for an improved HLA-matched DBD kidney when a poorer HLA-matched LD kidney transplant is available.

You can register as an organ donor in MN when you get a fishing license

Organ donation isn't just for drivers' licenses in Minnesota:
Fish, hunt, save lives: MN first to offer organ donor option on fishing license

"Organ donation through the Department of Natural Resources license registration website went live March 1, and already 4,300 people have checked the donor box. It’s only available online, not in stores, and works the same as the organ donation option on a driver’s license."

recovering more deceased donor kidneys

Here's a post from the American Society of Neprology (ASN):
Old Age Should Not Exclude Organ Donation After Death
Kidneys from elderly deceased individuals can function for years after transplantation
"New research suggests that age cut-offs for deceased organ donors prevent quality kidneys from being available to patients in need of life-saving transplants. A study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN) found that even kidneys from donors ≥80 years of age can function for years after transplantation."
The article, entitled “Long-term Outcomes and Discard Rate of Kidneys by Decade of Extended Criteria Donor Age,” will appear online at http://cjasn.asnjournals.org/ on December 15, 2016, doi:10.2215/CJN.05990616. 

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And from the journal Transplantation
Diagnosing the Decades-Long Rise in the Deceased Donor Kidney Discard Rate in the U.S.  by Stewart, Darren E. M.S., UNOS; Garcia, Victoria C. M.P.H., UNOS; Rosendale, John D. M.S., UNOS; Klassen, David K. M.D., UNOS; Carrico, Bob J. Ph.D., UNOS

"Abstract--Background: The proportion of deceased donor kidneys recovered for transplant but discarded increased steadily in the U.S. over 2 decades, from 5.1% in 1988 to 19.2% by 2009. Over 100,000 patients are waiting for a kidney transplant, yet 3,159 kidneys were discarded in 2015.
...

"Results: This study found that at least 80% of the discard rate rise can be explained by the recovery of kidneys from an expanding donor pool and changes in biopsy and pumping practices. However, a residual discard rate increase could not be explained by changes in these factors. From 1987 to 2009, median donor age rose from 26 to 43 years; median KDRI increased from 1.1 to 1.3. Our findings suggest the increase from 10% to 30% in the proportion of kidneys pumped during the 2000's served as a buffer keeping the discard rate from rising even higher than it did.


"Conclusions: The majority of the kidney discard rate rise can be explained by the broadening donor pool. However, the presence of an unexplained, residual increase suggests behavioral factors (e.g., increased risk aversion) and/or allocation inefficiencies may have played a role. Reducing risk aversion, improving allocation, and more often pumping less-than-ideal, yet potentially transplantable kidneys, may help reverse the trend."

The job market for economists: Planet Money podcast (24 minutes)

If you want to relive (or anticipate) your experience on the job market for new Ph.D. economists, here is the podcast for you.  Journalists Adrian Ma and Robert Smith follow  a brave new Ph.D. who talked to them while he interviewed for jobs. They also talk to many other people at the AEA meetings in Chicago, and discuss how some candidates might fall through the cracks. They talk to me (around minute 15) about the signaling mechanism that the AEA introduced. (The candidate they followed signaled the Census Bureau, just before the federal government announced a hiring freeze, but is now gainfully employed:)

#769: Speed Dating For Economists

We visit a job market created by economists, for economists. It's a hyper-efficient, optimized system, tested by game theorists, tweaked by a Nobel Prize winner, but it requires comfortable shoes.

Assisted suicide--the musical

A Theatrical Rebuttal to the Farce of ‘Dignicide’
The creator of ‘Assisted Suicide: The Musical’ says euthanasia denies the value of people who have illnesses or disabilities.

Liz Carr, an actress with disabilities created a popular London musical to speak out against assisted suicide...

So she created a musical. Much of “Assisted Suicide” involves Ms. Carr taking on her alter ego, a character named Documentary Liz. Film footage shows Documentary Liz living a humdrum disabled life, while a lachrymose melody plays and a narrator dourly describes the scene: “Liz feels trapped, imprisoned by her difficult circumstances. Liz has few freedoms, few choices on a day-to-day basis.”

Onstage, the real Ms. Carr rolls her eyes and provides a running commentary, acidly mocking the documentary clichés. “Music is always used very manipulatively,” she tells me. “The music feeds the emotional journey. It tells you, ‘This is a tragedy. This has one way to go.’ ” The aim is to normalize a choice that was unthinkable a generation ago, with the result that people like her are impelled to conclude: “You know what, my life isn’t worth living.”

Growing up with a severe disability, Ms. Carr recalls, “life was bleak.” She excelled at academics, but no amount of therapy seemed to improve her physical ability. She was never consciously suicidal, “but I didn’t see a future or an escape. I couldn’t see a point. So in that sense I’ve been to very dark places.” She pressed on, however, and now enjoys national prominence as an actress and disability activist.

Ms. Carr, who was born in 1972, considers herself lucky that euthanasia wasn’t on the cultural radar when she was young. “Assisted suicide has become part of the narrative of death, of illness, of disability,” she says. That was the work of euthanasia proponents, who knew that “it takes 15 to 20 years to get social support and to get the culture to change—then you pass the law.”

Interview about Who Gets What and Why, in Portugese

The Portugese translation of Who Gets What and Why is called Como Funcionam Os Mercados (How markets work)

Here's an interview about it:
O novo mundo dos mercados
 Google translate: "The new world of markets"

A non-directed kidney donor speaks about his experience (which started with a Freakonomics podcast)

Here's more on Ned Brooks, the non-directed donor who heard about kidney exchange chains on a Freakonomics podcast:

Ned Brooks: Donating His Kidney was Life-Changing. For Him

“The concept of leverage was absolutely the driver for me, “ recalls Ned. “The idea that my one wholly redundant kidney could impact multiple lives, not just the patients themselves but their children, their parents, was huge.”

And the idea of starting a kidney donation chain touched his competitive side: “How many lives could my kidney donation impact?”
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See my earlier post

Friday, February 26, 2016

A Freakonomics listener was inspired to become a non-directed kidney donor by the podcast on kidney exchange

Highlights from the Barcelona GSE 10th Anniversary Celebration

You can find videos and photos from the 10th anniversary celebration of the Barcelona Graduate School of Economics (BGSE) here.  (The celebration took place on March 31 and April 1.)

I took part in a set of presentations on "The Practical Influence of Economic Research," with  Richard Blundell,  Matt Jackson, Anne Krueger, me, and Chris Sims ." BGSE Director Teresa Garcia-Milà moderated the discussion.

You can watch and listen to the whole thing here.



My remarks are from minute 33:50 to minute 45:00. (Among other things, I recall one of my first talks on kidney exchange, given almost 15 years ago at the Barcelona Clinic, a leading transplant center, and discuss how kidney exchange has come to account for a large percentage of living donor kidneys in Spain, as well as in the U.S.)

William J. Baumol (1922-2017)

Many will remember Baumol for his explication of why labor costs go up in industries in which productivity does not. I mostly think about his theory of contestable markets, that markets can achieve perfect competition even if made up by big, strategic players, so long as entry into the market is easy, so that prices are disciplined by the need to keep out entrants.

Here's Vox:
William Baumol, whose famous economic theory explains the modern world, has died  May 4, 2017

Here's his List of Publications

Milliman Lecture in Economics at UW, May 4

If you're in Seattle this evening...

2017 Biennial Endowed Milliman Lecture in Economics

Alvin Roth, 2012 Nobel Laureate in Economic Sciences and Professor of Economics, Stanford University
"Markets and Marketplaces: The New and Not So New Economics of Market Design

Thursday, May 4, 2017

6:30 p.m., Dempsey Hall 302 (Anthony's Executive Forum)

Free, but registration is required

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Here's an announcement with some other details...

Nobel Laureate Alvin Roth to Give 2017 Milliman Lecture in Economics

Mike Rees in India to help remove obstacles to kidney exchange

The Times of India reports:
Paired kidney donations may mitigate patients’ agonizing wait

"On Tuesday, at an event organized by Gift Your Organ Foundation, Dr Michael Rees, CEO, Alliance for Paired Kidney Donation, USA, and Dr Eric Velez, founder of ProRenal, a Mexico-based organization, discussed the possibilities of paired kidney transplants that can be a solution for Indian patients. The duo played key roles in making the world's first-ever global paired transplant possible.
...
"The US, in 2017, brought required amendments to its National Organ Transplant Act (NOTA) to allow paired donations. Alliance for Paired Kidney Donation has a transplant matching software that does the matching between donors and recipients.

"In Mexico, 1.2 lakh people suffer from end-stage renal disorder and only 2600-2800 patients undergo transplants every year, said Dr Eric Velez.

"Shalini Rajneesh, principal secretary, health and family welfare, said Alliance for Paired Kidney Donation agreed to share their software with the Jeeva Sarthakate Society of Karnataka (earlier known as ZCCK) for free. The state-owned society works on organ transplants and coordinates with patients awaiting organs through the registry. "The software does a perfect match between donors and recipients to allow the swap transplant," she said.

"Asked if the legal framework allows live kidney donation between unrelated donors, she said as a long-term plan, the government will look into the issues and bring in required amendments. The main barrier is people do not want to donate and there is a need to create awareness, she added.

"Currently, transplants among unrelated donors are put through a series of checks to ensure that it does not lead to kidney racket.

'Transplants between spouses getting tougher'

"Dr Sankaran Sundar, a nephrologist who has coordinated more than 2,500 transplants so far, said the existing legal framework makes it difficult for patients to pursue transplants among unrelated donors.

"Karnataka has seen only six swap kidney transplants. Even among the spousal donors (when the couple want to share a kidney), it's been difficult to get approval from the authorization committee. When the kidney transplant is between a father/mother and son/daughter, or between siblings, it's easy to establish relationship. But when it is between a couple, it's tough, as marriage certificate has also been found to have been doctored in many cases," said Dr Sankaran Sundar."
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Here's another account, from the Deccan Chronicle
Bengaluru: Path-breaking tech to facilitate kidney transplants

The threshold structure of Top Trading Cycles (TTC) by Leshno and Lo

A new look at top trading cycles:

The Simple Structure of Top Trading Cycles inSchool Choice
Jacob D. Leshno and Irene Lo  April 25, 2017

Abstract: "Many cities determine the assignment of students to schools through a school choice mechanism. The prominent Top Trading Cycles (TTC) mechanism has attractive properties for school choice, as it is strategy-proof, Pareto efficient, and allows school boards to guide the allocation by specifying priorities. However the combinatorial description of TTC makes it non-transparent to parents and difficult for designers to analyze. We give a tractable characterization of the TTC mechanism for school choice: the TTC assignment can be simply described by n^2 admission thresholds, where n is the number of schools, and these thresholds can be easily observed after running the mechanism. To calculate these thresholds, we de fine TTC through trade balance equations. In a continuum model these equations correspond to a differential equation whose solution can give closed form expressions for the admission thresholds.

The model allows us to compute comparative statics, and evaluate welfare. As applications of the model we solve for optimal investment in school quality, explore the design of the priority structure, and provide comparisons between TTC and other school choice mechanisms that help explain empirical findings. To validate the continuum model we show that it gives a good approximation for strongly converging economies. Our analysis draws on an interesting connection between continuous trading procedures and continuous time Markov chains."

School choice in Chicago: GoCPS

Here's an account from New Schools for Chicago:
Chicago Board of Education Approves the Single Application
"Yesterday, the Chicago Public Schools Board of Education voted unanimously in favor of moving to a single application for all public high schools in the city. This decision comes just after a recently released report from the Institute for Innovation in Public School Choice (IIPSC) and New Schools for Chicago outlining the feedback and recommendations of parents from across the city. "

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And here's a news story from WTTW:

CPS Aims to Simplify High School Applications With New ‘GoCPS’ Model

"The Board of Education voted unanimously Wednesday to approve a new common application for students entering district high schools this fall. The new model, called “GoCPS,” is aimed at transparency and efficiency in that application process, according to CPS Chief Education Officer Janice Jackson.

“We cannot have a system that allows some people to feel that they can access with ease while others feel like it’s too complicated and choose to disengage," she said. "So moving forward, GoCPS allows us to bring more people into the fold, but it also allows us an opportunity to use technology to support them.”

In the current system, students can fill out multiple applications and receive offers from high schools.

With GoCPS, students will fil out a single application, rank their school choices and receive a maximum of two offers – one each from a selective and non-selective school. If they choose to reject those offers, students would go through the process a second time and receive new offers.

If those too are rejected, the student would be placed in their neighborhood school with the option to apply for a transfer within the first 20 days of the school year."

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And here's the IIPSC report: 

Parents Discuss their ChallengeswithPublic School Choice in Chicago

Prepared in February2017 by The Institute for Innovation in Public School Choice

Paul Milgrom on the history of spectrum auctions

How obscure science led to spectrum auctions that connected the world
BY PAUL MILGROM,  04/30/17 07:00 AM EDT

"The incentive auction I helped design is an innovation building on decades of economic theory research on auctions dating back to the Nobel-prize winning work of William Vickrey and to work by my own research advisor, Robert Wilson, in the 1960s with funding from the Atomic Energy Commission. What interest did this Cold War era agency have in theoretical auctions? Well, nothing, but they were highly interested in advancing the field of game theory – a then obscure branch of mathematics used in economics that aims to understand how individuals strategize and act in competitive situations.


Over more than 30 years, Wilson, I, and others continued to advance this seemingly esoteric field, until the FCC issued its first proposed rulemaking on developing a spectrum auction that referenced our work. Together with Preston McAfee, who had independently been developing similar ideas, we worked with the FCC to design the first spectrum auction in 1994. The simultaneous multiple round auction we invented has since been used for dozens of spectrum auctions here and around the world. Collectively, these have been called the greatest auction in history, delivering more than $60 billion for the federal government since the early 1990s and enabling the robust wireless communications we enjoy today.

In 2014, the three of us received a Golden Goose Award for our work in this obscure field of social science and its unexpected application to spectrum auctions. None of us envisioned such an auction when we began our study, we were driven by a curiosity in human behavior and markets, not data flying around the country. But the auctions we designed have nonetheless helped change the way we all communicate, consume media, and do our work.

The auction that closed last month was the first of its kind, both because it was two-sided, engaging both TV broadcasters as sellers and mobile operators as buyers, bidding in a single auction, and because the choices of which TV broadcast rights to buy and how to reassign continuing broadcasters needed to respect more than a million constraints to avoid interference among uses. Designing such a complex process brought together a new generation of researchers in both economic and computer science.

When the dust had settled, we were able to repurpose channels 38-51 from broadcast TV uses to free 70 megahertz of spectrum for the growing mobile broadband sector (plus 14 megahertz for wireless microphones). This will enable continuing innovation in broadband and bring better coverage to rural communities. The auction also raised nearly $20 billion in revenue, with more than $7 billion to federal coffers to be used for debt reduction.

Our work on auction design is just one example of how research that may sound obscure or even silly has often benefited society. The Golden Goose Award was founded five years ago to celebrate stories like ours, and it has recognized colleagues of mine like Al Roth whose studies of how to make perfect marriage matches now informs medical residency assignments and kidney exchanges, among many other researchers. In each case, a small investment of federal money returned huge benefits to our nation. And all led to outcomes the researchers never would have predicted when they started."

The 28th Jerusalem School in Economic Theory: Mechanism Design, June 27 - July 6, 2017

The 28th Jerusalem School in Economic Theory

Mechanism Design

Event date: June 27 - July 6, 2017 

Organizers:

Eric Maskin, General Director (Harvard University)
Elchanan Ben-Porath, Codirector (The Hebrew University)
Stephen Morris (Princeton University)







Mechanism design is the “reverse engineering” part of economic theory. Normally, economists study existing economic institutions and try to predict or explain what outcomes the institutions generate. But in mechanism design we reverse direction: we start by identifying the outcomes we want and then ask what institutions could be designed to achieve those outcomes. The theory has found wide application in auction design, pollution control, public good provision, and elsewhere.


List of speakers:


NAME	AFFILIATION	EMAIL
Elchanan Ben- Porath	The Hebrew University of Jerusalem	benporat@math.huji.ac.il
Ben Brooks	The University of Chicago	babrooks@uchicago.edu
Sylvain Chassang	New York University	chassang@nyu.edu
Eddie Dekel	Northwestern University and Tel-Aviv University	eddiedekel@gmail.com
Sergiu Hart	The Hebrew University	hart@huji.ac.il
Jason Hartline	Northwestern University	hartline@northwestern.edu
Emir Kamenica	The University of Chicago	emir.kamenica@chicagobooth.edu
George Mailath	University of Pennsylvania	gmailath@econ.upenn.edu
Jakub Kastl	Princeton University	jkastl@princeton.edu
Eric Maskin	Harvard University	emaskin@fas.harvard.edu
Stephen Morris	Princeton University	smorris@princeton.edu
Tim Roughgarden	Stanford University	tim@cs.stanford.edu
Ariel Rubinstein	Tel-Aviv University and New-York University	rariel@post.tau.ac.il
Vasiliki Skerta	University College London	v.skerta@ucl.ac.uk
Balazs Szentes	London School of Economics	b.szentes@lse.ac.uk

Israel transplant investigation

The Israeli organization Matnat Chaim (Gift of Life), founded by Rabbi Yeshayahu Heber, is under investigation about whether it encouraged families to contribute to the organization in order to receive a shorter waiting time for a kidney transplant.

Organ donor organization suspected of moving donors to head of line for money
Police currently investigating an organization specializing in organ donor mediation, on suspicion of receiving money to provide donors with organs before others in line for transplants.
Omri Efraim & Rotem Elizera|Published:  31.03.17 , 15:06

"Israel Police is carrying on an investigation into Matnat Chaim, an organization that helps find organ donations for those in need of a transplant. The investigation is centered on claims that the organization charged for a "donation" intended to push forward those who paid it, despite there being other people in front of them in line waiting for the same organ donation.
...
"The police stressed that the investigation is a very delicate one, involving people who are suspected of paying the extra fee out of a wish to facilitate a vital transplant that for a member of their family.

Matnat Chaim stated that "We know nothing about the investigation carried against (the organization—ed), and so we do not find it necessary to respond." The organization has so far aided in some 400 transplants in Israel. It only works with organ donors wishing to donate organs for zero pay."
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Here's another story with a bit more detail:

Police launch inquiry into kidney transplant organizationCops investigating claims that Matnat Chaim bumped patients to top of recipient list in exchange for donations

"The probe follows a complaint from the Health Ministry that recipients were bumped to the top of the list in exchange for donations to the organization.

Police have taken evidence from organ recipients, their families and other sources in the ongoing investigation.

A police spokesperson explained that the investigation was complex and sensitive. The organization is suspected of encouraging relatives of those in need of transplants to make donations to the organization in order to shorten the waiting time to receive a kidney.
...
"Over 400 healthy people have donated a kidney through the organization.
...
"In the past, the organization has said that it had never agreed to accept donations in exchange for promoting a patient in the waiting list. It said that “it completely rejects any suggestion of any hint of wrong-doing.”

Talking to nephrologists about kidney exchange

Most conversations about kidney exchange (aka kidney paired donation, kpd) are with transplant professionals. But kidney patients start out being referred to a nephrologist, and so it was good to be able to talk to nephrologists at the recent meeting of the National Kidney Foundation.

My talk was about how kidney exchange has made a lot of progress, and become a standard part of transplantation, but that there's still room for it to grow and help more patients get transplants.   In that regard I focused on two recent initiatives, starting a non-directed donor chain with a deceased donor kidney, and global kidney exchange to bring developing world patient-donor pairs into American kidney exchange to the mutual benefit of both kinds of pairs.

Here's a news story from Nephrology News (with a headline that unfortunately disses the many pioneers of kidney exchange):

Father of kidney exchange says it’s time for a refresh

And here's a story that focuses on starting kidney exchange chains with a deceased donor kidney, from the Dutch Nier nieuws (Kidney news)

'Start donatieketting met overleden donor'
("Start donation chain with deceased donor")

Bobby Pakzad-Hurson defends his dissertation

Bobby Pakzad-Hurson defended his dissertation yesterday. (Successfully:) You can find his papers at the link. This celebratory photo was taken by Susie Gilbert.

Here's Bobby (in the suit, holding the bottle) with his committee: Fuhito Kojima, me, Nick Bloom, Matt Jackson and Itai Ashlagi.

Bobby's job market paper (with Zoe Cullen) was on pay transparency. He'll be going to Brown next year.

Welcome to the club, Bobby.

Organ transplantation in Iran

Robert Gutman draws my attention to this article from the English language Iranian Financial Tribune:  Sunday, April 23, 2017 Strides in Organ Transplant

I'm not sure where the claim in the first sentence of 50,000 organ transplant "surgeries" comes from, but the rest of the article (which seems to talk about a total closer to 5,000 transplants) is an interesting view of the situation in Iran.


"Over 50,000 organ transplant surgeries were conducted during the last fiscal year that ended on March 20.

Around 2,500 kidney, 802 liver, 119 heart, 30 pancreas and several intestine and lung as well as 1,040 bone marrow transplants were performed in Iran during the period, said Seyyed Mohammad Kazemeini, head of the Organ Transplant Management Office at the Health Ministry.

“This impressive number of transplant surgeries has helped save many lives as well as more than $1.8 billion in foreign exchange, as patients would otherwise have paid huge amounts for the medical help abroad. Some were even treated free,” the official was quoted as saying by ISNA.

However, he regretted that insurance companies still refuse to cover expenses of organ transplants despite a government directive last year.

“Insurance companies are not complying and the Health Ministry has to draw on its own resources to provide free services for some patients,” he said and hoped the ministry’s support would continue.

“During this year’s New Year holidays (March 21- April 2), 93 transplants were performed,” which shows the preparedness of the medical fraternity.

Iranian organ transplant teams are capable of providing assistance and training to neighboring countries, he said.

Last year a team of experts from Mashhad, capital of the northeastern Khorasan Razavi Province, carried out 47 renal transplants in Afghanistan, and medical teams from Shiraz, capital of the southwest Fars Province, conducted 20 operations in Pakistan and Tajikistan.

Shiraz University of Medical Sciences is known for its accomplishments in liver transplants and the hospitals under its coverage are among the top medical centers in the world with regard to the number of surgeries performed. On average, 500 liver transplants and 300 kidney surgeries are annually undertaken in Shiraz, which also has the distinction of performing the first kidney transplant in Iran in 1968 at the prestigious Namazi Hospital.

A specialized hospital is now planned to be established in Shiraz for organ transplants.

Iran ranks third worldwide in organ donation and is the only country in the world that has addressed the shortage of transplant organs through a legal payment system since 1988 when living non-related donation (LNRD) was legalized,  making it the only country where organ sale is legal.

There are currently 46 organ transplant centers in the country and 25 facilities for organ donation.

  Increase in Brain-Dead Organ Donation

According to Kazemeini, people’s tendency to donate organs of brain-dead patients in their families has increased significantly.

“Last year, 57% of transplant kidneys were donated by brain-dead patients,” he said.

In the past organ donation or sale by living people was predominant. The acceptance of organs of brain-dead patients has improved remarkably due to legal and religious decrees and widespread awareness campaigns on the issue.

Organ transplant is a medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ.

Today, over 1.4 million people have voluntary organ donation cards in the country. On average, 700 organ donations (nine per million people) are made annually according to official statistics.

Organs that have been successfully transplanted include heart, kidney, liver, lung, pancreas, intestine, and thymus. Worldwide, kidneys are the most commonly transplanted organs, followed by liver and heart. Organ donors may be living, brain dead, or dead via circulatory death.

In the fiscal year that ended in March 2016, from among the 8,000 people confirmed as brain dead at Iranian hospitals, 1,400 kidneys (and 2,300 organs) were donated.

Kidney transplants account for nearly 75% of all organ replacement surgeries while liver and heart transplants comprise 22% and 3% of the total number. More than half of all transplanted kidneys (56%) were from brain-dead donors and 44% were from living people.

Kazemeini had earlier pointed to Iran’s top position in the field of kidney transplant in the Middle East. On average, 3,000 kidney transplants are conducted every year and Iranian surgeons have transplanted over 35,000 kidneys so far."

Medical marijuana is now legal in half the U.S.

The Washington Post points out that this will be hard to reverse, even though that may be the position of the Trump administration:  If Jeff Sessions wants to crack down on medical marijuana, he’ll have to battle more than half the country