Global Kidney Exchange: a reply to some skeptics, forthcoming in the AJT

Our recent paper in the American Journal of Transplantation about the first Global Kidney Exchange chain was accompanied by a skeptical editorial, and has now also drawn some letters to the editor.  Our reply is forthcoming, and is now online here:

Global Kidney Exchange: Financially Incompatible Pairs Are Not Transplantable Compatible Pairs
Authors
M. A. Rees, S. Paloyo, A. E. Roth, K. D. Krawiec, O. Ekwenna, C. L. Marsh, A. J. Wenig, T. B. Dunn.   Accepted manuscript online: 31 July 2017

Here is the full text pdf file.

Here are the first sentences and the main paragraph.

"Honest debate makes ideas better; we appreciate our colleagues’ engagement. We agree with Wiseman and Gill that Global Kidney Exchange (GKE) must be conducted in an ethical manner that is sensitive to the possibilities of commodification and exploitation and, that it is important to be both careful with and transparent about how patient-donor pairs are selected from developing countries.1,2 We further agree that GKE should continue to be run in a way that enhances rather than competes with local medical services. However, Wiseman and Gill approached GKE from their American and Canadian perspective of near universal access to healthcare for end stage renal disease. They view GKE through a lens of commodification and exploitation...
...
"Let us be clear: without GKE the Filipino husband was never going to receive his spouse’s kidney. Without GKE, the husband was going to die, the wife was going to lose her spouse, and their son was going to be fatherless. That is exactly how the story was going to end without GKE. The goal of GKE is to change this fate for emotionally-related pairs referred by our medical collaborators in their home country when financial barriers prevent transplantation. Our selection process aims to provide a transplant for every GKE-eligible pair that creates enough savings to pay for a GKE transplant.  It is not scalable to propose that GKE could take place without consideration of the savings produced by transplanting patients in the United States. There are not unlimited philanthropic resources available to overcome the needs of patients facing financial barriers to transplantation. By creating and utilizing a portion of the savings produced by reducing the cost of dialysis in the United States through accelerated access to renal transplantation, GKE becomes scalable. However, the net savings produced by GKE must exceed the overall cost in order for US-based healthcare payers to participate. Thus, if we want to achieve GKE’s first goal: to help impoverished patients by overcoming financial barriers to transplantation, GKE must take account of the savings produced. We have now performed four GKE transplants—all funded by philanthropy. We simply evaluated every patient who presented for evaluation and moved forward with every instance where the projected savings from accelerated transplantation of American incompatible pairs in the Alliance for Paired Donation (APD) pool exceeded the cost of the GKE by an amount greater than the anticipated cost. To scale this concept, we are working to produce an ethical and legal process, built on sound business principles, so that it can scale to help as many rich and poor patients as possible. In this first case, an easy-to-match unsensitized blood type A GKE candidate with a blood type O donor easily produced more transplants/savings in the APD pool than without their participation.  No alternative existed for this Filipino pair and millions more like them.3 GKE did not exploit this Filipino couple—it provided the mechanism for the wife to literally save her husband’s life. They could not afford dialysis. Two months prior to travelling to the US and after their identification and evaluation for participation in GKE, their Filipino physician called to say that if the APD did not pay for the husband’s continued dialysis in the Philippines, that he was going to die as no additional funds were available to pay for dialysis. At a societal level, did American patients with access to dialysis really disproportionally benefit from the APD’s “exploitation” of this patient by paying for two months of dialysis in the Philippines? When the husband lived instead of dying, was the Filipino donor’s kidney really undervalued? We ask Wiseman and Gill to seriously consider whether the Filipino wife feels she disproportionately benefited American patients rather than her own family. For three years on Father’s Day the couple’s child has written our team to thank us for saving his daddy’s life. Two and a half years after this first GKE transplant, both the Filipino donor and recipient have normal renal function, countering the editorial’s accusation that “limited post-transplant care provided to the Filipino recipient were probably inequitable.” While the gratifying success of the first case does not guarantee the same outcome for all future patients, it does demonstrate how GKE—even if inequitable—is able to add years of life to patients who would have died without it."
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There's a lot more that can be said, and I have an inkling that I'm going to have the opportunity to say a lot more, as there are going to be more critiques and objections.  Issues of repugnance deserve to be taken seriously.  The many positive responses (like this and this from Mexico) that GKE has received gives me cautious hope that we'll be able to move forward in a way that addresses the chief concerns and  commands broad support.  There are lots of families in which someone has kidney failure whose life could be saved by giving them access to a transplant through kidney exchange.
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Here are all my posts on Global Kidney Exchange

Organ donation in Israel

The Israeli Ministry of Health has a number of interesting web pages concerning organ transplantation.

Here is the one on the compensation of living donors for related expenses:

Compensating Live Organ Donors

The compensation is given to donors when the donation and transplant surgery is performed in Israel.

For this purpose, the following refunds are given: 

• Refund due to loss of earnings - A sum equivalent to the benefit paid by the National Insurance Institute to a person serving in reserve duty for a period of less than 40 days: minimum NIS 7,841, maximum NIS 57,563 
• Refund of travel expenses - In a standard and set sum of NIS 2,676, with no need to produce receipts.
• Psychological treatment - Refund for 5 treatments to the value of up to NIS 428 per treatment, subject to the presentation of receipts proving that the treatment was performed, and subject to the treatments being conducted within a period of up to 48 months after the donation.
• Recovery leave - Refund for vacation in a hotel for a period of 7 consecutive days at a value of up to NIS 535 per day. Subject to the presentation of receipts and subject to the vacation being taken within a period of up to 90 days after the donation is made.

Insurance refunds

• Private medical insurance or supplementary insurance of healthcare organizations - Refund to the value of up to NIS 59 per month for a period of 60 months, subject to presentation of the policy and receipts proving purchase of the insurance. It is advisable to purchase this insurance before the operation or in the first three months after the operation.
• Loss of working capacity insurance - Refund to the value of up to NIS 203 per month for a period of 60 months, subject to presentation of the policy and receipts proving purchase of the insurance.
• Life insurance - Refund to the value of up to NIS 128 per month for a period of 60 months, subject to presentation of the policy and receipts proving purchase of the insurance.

All of the insurance payments above will be made from the end of the first year of the donation and for 60 months (5 years). Before the end of the first year from the day of donation, the donor will receive a reminder to send the insurance forms, according to the breakdown appearing in the directions and forms for submitter of an application for expenses file.

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Here is the page on kidney exchange:

National Exchange Program for Live Kidney Donors

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And here's a page on deceased organ donation from the point of view of Jewish religious law:

According to Halacha…

2017 Subjective Probability, Utility and Decision Making (SPUDM 26) at the Technion

I'm on my way to SPUDM26 (The 26th Subjective Probability, Utility, and Decision Making Conference) August 20th-24th 2017, hosted by the Industrial Engineering and Management Faculty of the Technion in Haifa, Israel.

Here's the program.

My talk will be called Repugnant transactions and Forbidden Markets.

I’m planning to talk a bit about repugnant transactions generally, and why I think they are important, and perhaps also about black markets. But I’ll use kidneys as my main example, and some of the repugnance issues we’re encountering as we try to move forward with Global Kidney Exchange, in which we’ll include patient-donor pairs from poor countries in American kidney exchange…

Interview in London's Jewish Chronicle

Wait for this, they have a column called Jewniversity Corner:

Al Roth: Matching the market from dates to organs
In his latest Jewniversity Corner column, David Edmonds examines the theories of economist Al Roth

Notable quote (even though they put the apostrophe in the wrong place): "Born in New York City in 1951, Roth was raised in New York City, in the borough of Queens (which explains why, he told The JC, he speaks the Queen’s English). "

The ASSA / AEA meetings, preliminary program

This year's ASSA preliminary program is now online:  https://www.aeaweb.org/conference/2018/preliminary 
The AEA sessions were organized by President Elect Olivier Blanchard (and his program committee).  David Laibson will give the Ely lecture.

Here are two sessions that caught my eye from just the first page (of 11).

Thursday, Jan. 4, 2018   5:30 PM - 7:00 PM
 Marriott Philadelphia Downtown, Grand Ballroom Salon H
 Econometric Society Presidential Address

Drew Fudenberg, Massachusetts Institute of Technology 

Inner Workings of Organ Markets and Organ Allocation

Paper Session

• Chair: Eric Budish, University of Chicago

The Inner Workings of Kidney Exchange Markets

Nikhil Agarwal

,

Massachusetts Institute of Technology

Itai Ashlagi

,

Stanford University

Eduardo Azevedo

,

University of Pennsylvania

Clayton Featherstone

,

University of Pennsylvania

Omer Karaduman

,

Massachusetts Institute of Technology

Abstract

The market for kidney exchange was created to address the shortage of kidneys for donations. The market allows patients with a willing but incompatible live donor to swap donors, so that they can perform transplants, and has grown to about 800 transplants per year. This paper uses detailed administrative data to describe the functioning of this market. The most striking finding is that the market is fragmented into dozens of small platforms instead of working in a single large platform, with most transactions happening in platforms that operate within a single transplant center. This may lead to substantial inefficiency if there are increasing returns to scale to matching patients in a large, thick market.

A Regulated Market for Kidneys

Mohammad Akbarpour

,

Stanford University

Abstract

The persistent shortage of kidneys for transplantation is a global problem for end-stage renal disease (ESRD) patients. Many countries have tried to address this issue by increasing deceased donation, by introducing kidney exchange programs, and by optimizing the allocation algorithms. Despite such efforts, the problem of shortage is growing in most countries, with more than 100,000 people waiting for a kidney transplant only in the U.S. Iran is the only country in the world that has introduced a different program of living unrelated renal donation, which includes two kinds of monetary compensation of donors: a "gift for altruism" from the government to donors, as well as an additional compensation from the patients themselves. We will discuss the impacts of this program on waiting times, organ shortage, and its equilibrium effects on other kinds of live donation.

Strategic Behavior in the Kidney Waitlist

Nikhil Agarwal

,

Massachusetts Institute of Technology

Itai Ashlagi

,

Stanford University

Paulo J. Somaini

,

Stanford University

Abstract

A transplant can improve a patient's life while saving several hundred thousands of dollars of healthcare expenditures. Organs from deceased donors, like many other common pool resources (e.g. public housing, child-care slots, publicly funded long-term care), are rationed via a waitlist. The efficiency and equity properties of design choices such as penalties for refusing offers or object-type specific lists are not well understood and depend on agent preferences. This paper establishes an empirical framework for analyzing the trade-offs involved in waitlist design and applies it to study the allocation of deceased donor kidneys. We model the decision to accept an offer from a waiting list as an optimal stopping problem and use it to estimate the value of accepting various kidneys. Our estimated values for various kidneys is highly correlated with predicted patient outcomes as measured by life-years from transplantation (LYFT). While some types of donors are preferable for all patients (e.g. young donors), there is substantial heterogeneity in willingness to wait for good donors and also substantial match-specific heterogeneity in values (due to biological similarity). We find that the high willingness to wait for good donors without considering the effects of these decisions on others results in agents being too selective relative to socially optimal. This suggests that mild penalties for refusal (e.g. loss in priority) may improve efficiency. Similarly, the heterogeneity in willingness to wait for young, healthy donors suggests that separate queues by donor quality may increase efficiency by inducing sorting without significantly hurting assignments based on match-specific payoffs.

Discussant(s)

Utku Unver, Boston College

Glen Weyl, Microsoft Research

Benjamin R. Handel, University of California-Berkeley

A still-skeptical view of transplantation in China

My recent post on transplantation in China reported on optimistic assessments of the move away from using executed prisoners as a source of organs. Not everyone is optimistic: here's a recent editorial from the BMJ:

Engaging with China on organ transplantation
BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j665  (Published 07 February 2017)
by Wendy A Rogers, Matthew P Robertson, and Jacob Lavee

It starts with a story from the bad old days, and then turns to the current environment, saying in part:

"Since January 2015, China has vowed to halt the use of organs from executed prisoners. After a pilot in 2010-14, a procurement programme using donated organs from people who meet circulatory death criteria was rolled out nationally. There are now national transplantation registries and organ procurement organisations. Yet there is no new law or regulation in China banning the use of organs from executed prisoners. Nor have existing regulations permitting the use of prisoners’ organs been rescinded. Prisoners remain a legal source of organs if they are deemed to have consented before execution, thus permitting ongoing retrieval of organs from prisoners executed with or without due process.1

"The transplant registries are not open to public scrutiny or independent verification. Inexplicably high volumes of transplantation continue to take place in China,8 and wealthy foreigners can still obtain liver and heart transplants, booked in advance.11 The Transplantation Society’s former president Francis Delmonico acknowledged under oath at a recent US Congressional hearing that he cannot verify claims about reform in China. The main evidence for reform has simply been the public assertions of Huang Jiefu and other government officials."

Harm reduction: decriminalizing drugs to reduce overdoses?

From the Toronto Star:
Should Toronto push to decriminalize all drugs? The city’s medical health officer ready to consider it
The city is convening a committee of health and drug policy experts to explore “a different approach that puts the health of the community first,” Dr. Eileen De Villa said.

"Toronto’s new Medical Officer of Health is calling for a public discussion on the merits of decriminalizing all drugs in the wake of the ongoing overdose epidemic.

“It’s clear that our current approach to drugs in this city and this country doesn’t seem to be having the desired impact,” Dr. Eileen De Villa told reporters Friday at a briefing on how the city is responding to drug users overdosing and, in some cases, dying.
...
"On Friday, following Thursday’s emergency meeting of city partners, De Villa reviewed with reporters the city’s overdose prevention strategies which include asking police to carry the fentanyl antidote and speeding up the opening of three safe injection sites.

De Villa said among the 10 key strategies in Toronto’s Overdose Action plan is a call for a public health approach to drug policy that puts the health of the community first, “rather than looking at this as an issue of criminal behavior and or an area for law enforcement.”

The city is convening a committee of health and drug policy experts to explore “a different approach that puts the health of the community first,” she said.

While acknowledging the city doesn’t have the power to change the Criminal Code, “Toronto has always been a leader … in policy and I don’t see why we wouldn’t continue to be a leader on this front,” said De Villa, who stepped into her high-profile position four months ago."
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Not everyone is interested in this kind of harm reduction. Here's a Washington Post story about a different point of view expressed by an Ohio sheriff (I think this is a point of view that also comes up in opposition to e.g. making clean needles available to drug addicts):

Why this Ohio sheriff refuses to let his deputies carry Narcan to reverse overdoses

"No one has come up with a solution to the opioid epidemic that has decimated Rust Belt states, but for people who overdose, Naloxone is about as effective an antidote as there is. The results of the opioid antagonist, which is sprayed up a person's nose and reverses the effect of opioid overdoses, have been likened to resurrecting someone from the dead.

"Paramedics and firefighters routinely carry the easy-to-administer medication in their vehicles. For police officers in the nation's hardest hit areas, like southwest Ohio, the Food and Drug Administration-approved nasal spray, known by the brand name Narcan, can be as common as handcuffs. Even some librarians have learned to use the drug to revive people who overdose in their stacks.

"But Richard K. Jones, the sheriff of Butler County, Ohio, raised eyebrows recently when he said that his deputies will never carry the medication.
...
"Jones said Narcan is the wrong approach for a war on opioids that “we're not winning,” and said he favored stronger prevention efforts to prevent people from first using the drug."

Surrogacy in France (and IVF for unmarried folks)

Surrogacy has long been illegal in France, but the fact that it is legal elsewhere in the world (such as California) has put pressure on French authorities to recognize French parents and children who have come through surrogacy.

Here's a post from frequent surrogacy-watcher Ellen Trachman at Above the Law on recent progress:
French Gay Dads Win A Surrogacy Victory

"Many European countries have either completely banned surrogacy, or at least severely limited its legality. France is among those European countries that have outlawed surrogacy within its borders. But despite the ban, high demand by French citizens — including gay couples who want a biologically-linked child — has led to many French citizens conceiving children abroad via surrogacy, and in some cases, turning to desperate measures.
...
"Last week, the Court of Cassation — which is apparently what they call France’s highest court of appeals — ruled on a surrogacy dispute. (Here’s the French manuscript for my fluent followers.) In the case, four couples with children born via surrogacy outside of France asked the court to require the government to recognize their (and especially the non-biological parent’s) parental rights to their child.

At Least It’s Not Three Years Ago. Fortunately, the couples at least had one parent with recognized rights to the child. Three years ago, France was refusing to recognize any French parental rights or French citizenship for a child born elsewhere via surrogacy. The European Court of Human Rights chastised the French government, finding that such a stance was a violation of human rights — specifically for the parentless, and possibly country-less, child. That 2014 ECHR ruling allowed a genetically-linked father to a surrogate-born child to be recognized as the legal parent, and the child be given French citizenship.

...

"[Last week]...the court agreed to a middle route, and ruled that the non-bio partner could adopt the surrogate-born child. 

...  [and on to IVF]

"While campaigning, President Emmanuel Macron took the position that single women and same-sex female couples should be eligible to use assisted reproductive technology services to conceive. Currently, the country allows those services to be available only for heterosexual couples. ...

... Macron hedged his position by saying that he would wait for the National Consultative Ethics Committee to issue a recommendation on the matter before acting. ... last week, after considering the issue for over three years, the Committee finally issued its opinion. It concluded that, indeed, singles and same-sex couples should be permitted to use assisted reproductive technology services. "

Iran's Parliament considers government distribution of drugs to addicts

Here are several English language stories that report on recent events in the Iranian Parliament that suggests a legalizing of certain forms of drugs, to allow government distribution to addicts.  It appears that the law may switch from the death penalty to imprisonment for small dealers as well.

Iran: Increased Number of Addicts Pushes Toward Bill on Drugs
Asharq Al-Awsat

"Days after the Judicial Committee of the Iranian Parliament’s House spokesman Hassan Norouzi approved a bill that would allow the Iranian government to distribute drugs among addicts, an official in the Expediency Discernment Council of the System revealed that 17 percent of Iranians tend to abuse drugs while 220,000 to 250,000 others are drug traffickers.

Head of a working group on drugs in the Expediency Council Saeed Safatian defended a new project that permits the Iranian government to distribute drugs on addicts to curb this phenomenon.

“A total of 17 percent of Iranians tends to abuse drugs,” said Safatian, adding that five percent of them are already addicts while the remaining 12 percent will fall for the trap if the consumption of drugs wasn’t controlled.

Norouzi announced that the parliament approved last Friday the draft, which was also endorsed by decision-making centers.

Commenting on the draft, he added that penalty has been reduced from execution to imprisonment for those possessing less than 100 kilograms of antidote, producing two kilograms of synthetic drugs or carrying five kilograms of it.

Ali Hashemi, head of the counter-drugs committee, stated to Iranian Students News Agency (ISNA) on Saturday that distributing drugs by the government reduces dirty money possessed by traffickers.

He added that adopting the policy of bringing down demand on drugs helps decrease the amount of money earned by gangs from selling drugs."
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Iran Mulls State Drug Distribution
Radio Farda

"After thousands of executions and countless other deaths related to addictive drugs, Iran appears to be on the verge of overhauling its drug-related policies.

While a new bill is being amended in parliament to stop the execution of petty drug smugglers, another plan is also under study for allowing state organs to distribute drugs -- primarily opium -- among addicts.

“The main purpose of the plan is to cut off the connection between drug smugglers and their addicted victims,” said Hassan Norouzi, spokesman for the Iranian Parliament’s Judicial and Legal Commission."
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Iran plans to decriminalise drug use allowing government to give diluted drugs to addicts
The Independent

"Iran could be on the verge of decriminalising some forms of drug use to allow the government to distribute drugs to addicts.

By allowing the government to give out diluted rugs to addicts, the proposal aims to cut the relationship between drug addicts and drug traffickers.

“The plan to distribute [low-grade] drugs is similar to what used to be implemented before the [1979 Iran’s Islamic] Revolution,” said Hassan Norouzi, the spokesperson for the Parliament’s Judicial and Legal Commission, according to IFPNews."

Podcast on matching markets and more from Social Science Bites

David Edmonds interviewed me in London for Social Science Bites, mostly about matching markets, but also about interdisciplinarity, and whether it's fun to win a Nobel prize:

The system that runs the ride-sharing company Uber doesn’t just link up passengers and drivers based on price. It also has to connect the two based largely on where they are geographically. It is, says Nobel laureate Stanford economist Alvin E. “Al”  Roth, a matching market.

In this Social Science Bites podcast, Roth explains to interviewer David Edmonds some of the ins and outs of market matching, starting with a quick and surprisingly simple definition.

“A matching market is a market in which prices don’t so all the work,” Roth details, “So matching markets are markets in which you can’t just choose what you want even if you can afford it – you also have to be chosen.” But while the definition is simple, creating a model for these markets is a tad more complex, as Roth shows in offering a few more examples and contrasting them with commodity markets.

“Labor markets are matching markets. You can’t just decide to work for Google – you have to be hired. And Google can’t just decide that you’ll work for them – they have to make you an offer.” And like say university admission, matching markets require something to intervene, whether it be institutions or technology, to make this exchange succeed. In turn Roth himself helped engineer some high profile matches in areas where the term ‘market might not traditionally have been used: kidney donors with the sick, doctors with their first jobs, refugees with asylum, or students and teachers with schools. Or even the classic idea of ‘matchmaking’ – marriage.

Roth turned to game theory to help explain and understand these markets, and his work won he and Lloyd Shapley the 2012 Nobel Memorial Prize in Economic Sciences. Roth has always had an eye on the real world implications as he pioneered market design, and as the Nobel Committee outlined:

Lloyd Shapley studied different matching methods theoretically and, beginning in the 1980s, Alvin Roth used Lloyd Shapley’s theoretical results to explain how markets function in practice. Through empirical studies and lab experiments, Alvin Roth demonstrated that stability was critical to successful matching methods.

Roth is currently president of the American Economics Association, and sits as the Craig and Susan McCaw professor of economics at Stanford University. He is also the Gund professor of economics and business administration emeritus at Harvard University.

To download an MP3 of this podcast, right-click HERE and save.

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Is it repugnant to give money to poor people?

Chris Blattman's weekly report includes a guest post by Jeff Mosenkis of Innovations for Poverty Action containing this interesting section on whether cash transfers to the poor are starting to be regarded as repugnant...

"Seema Jayachandran did a very popular Reddit Ask Me Anything about her Science paper on cash transfers for not cutting down trees (the AMA landed her on the front page of Reddit for the second time). In answering questions from the public, she was struck by how many people people had a moral objection to paying people not to do something (as opposed to traditional conditional cash transfers which reward people for doing something, like enrolling their children in school).

• Similarly, NPR reports that despite an evaluation showing massive benefits to giving poor people cash in Zambia, moral objections from the public to giving “lazy” people free money limited the program eventually to just the “deserving” poor, such as the elderly, and people who can’t work.
• Rich countries aren’t immune to this kind of thinking. A Vox The Weeds podcast (and parallel article) on the legacy of welfare reform from last year talks about how U.S. social safety net policy changed based on the public’s image of a single mother. At first, the U.S. image of a single mother was a widow trying to raise her children by herself. At that time it was seen as virtuous to help her stay home and raise her kids. When the public image of a single mother changed to a poor minority woman, programs began to see her as someone who should be out working and the design of the benefits changed.
• Those of us who work in the world of evaluating the economics of anti-poverty programs are used to thinking about effectiveness and cost as the primary determinants policymakers need to know, but these are good reminders that the moral view of the design of the program may be just as important in determining whether a program gets implemented or gathers dust on a shelf."

HT: Benjamin Roth

Is it repugnant to write books for children and young adults that deal explicitly with sex?

Is it repugnant to write books for teenagers that deal explicitly with sex?  How about for four year olds?

From the NY Times:
Want Teenage Boys to Read? Easy. Give Them Books About Sex.
By DANIEL HANDLER
"I write books for children under the pen name Lemony Snicket, and I’ve noticed that when I go to Lemony Snicket events, the crowds are about evenly split between boys and girls. But I also write young adult books, and if more than one boy shows up at one of my teen book club events, it’s notable, if not a miracle. Something happens once a young man hits puberty.
...
"It is a gross generalization, of course, to say that what young men want to read about is sex — or to imply that the rest of us aren’t as interested — but it’s also offensive to pretend, when we’re ostensibly wondering how to get more young men to read, that they’re not interested in the thing we all know they’re interested in. There’s hardly any real sex in young adult books, and when it happens, it’s largely couched in the utopian dreams or the finger-wagging object lessons of the world we hope for, rather than the messy, risky, delicious and heartbreaking one we live in."
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And from Haaretz:
Israelis debate: Is it okay for a children’s book to say sex is pleasurable?
The latest work by celebrated Israeli children's author Alona Frankel tells preschoolers how their parents do it. Israeli lawmakers are worried

"About two weeks ago the Knesset Committee on the Rights of the Child held a discussion on sex education for preschool children. The reason was the Hebrew-language book by the author and illustrator Alona Frankel: “A Book Full of Love – How Naftali Came Into the World.”
In the book, Frankel describes how people meet, fall in love and have sex – in one case leading to the birth of Naftali, the curly-haired protagonist of her stories whom every Israeli knows from her popular book published 40 years ago and since translated, “Once Upon a Potty.”
But MK Yifat Shasha-Biton (Kulanu), who heads the Committee on the Rights of the Child, said "How Naftali Came Into the World" raised many questions for her, including whether its descriptions were “a little too much for 3- and 4-year-olds.” Shasha-Biton objects mainly to the description of the sex act in the book, which was published two years ago by the Steimatzky publishing house.
As Naftali’s mother puts it in the book, “When people love each other, they want to be very close. We embraced, we caressed, we kissed, and it was sweet and pleasant. We were wrapped around each other and very close, when the penis on the body of Naftali’s father slipped into my vagina. And inside my body it was warm, enjoyable and exciting. A flood of sperm was ejected from him and became attached to a tiny egg that was waiting in the uterus, a special place inside my tummy.”
During the discussion, Frankel was attacked by the committee’s chairwoman, Shasha-Biton, who although she did not deny the importance of sex education for children, worried about the way it was being presented to preschoolers."

Organ transplants in China: an optimistic assessment

There are optimistic statements about China's progress on developing a system of voluntary organ donation (to replace the prior system of obtaining organs for transplant from executed prisoners.)   Some of these statements originate with the Chinese press. The Vatican is also optimistic.  The Vatican also has wide ranging diplomacy with China concerning quite different issues.  The stories below collectively reflect each of these things.

Here's a story in the SF Chronicle
China to lead in organ transplants by 2020

"China is on track to lead the world in organ transplant surgeries by 2020 following its abandonment of the much-criticized practice of using organs from executed prisoners, the architect of the country’s transplant program said Wednesday.
Chairman of the China Organ Donation and Transplantation Committee Huang Jiefu said the voluntary civilian organ donations had risen from just 30 in 2010, the first year of a pilot program, to more than 5,500 this year.
That will allow around 15,000 people to receive transplants this year, Huang said. The U.S. currently leads the world in organ transplants, with about 28,000 people receiving them each year.
“We anticipate according to the speed of the development of the organ donation in China, the momentum, in the year 2020, China will become the No. 1 country in the world to perform organ transplantation in an ethical way,” Huang said in an interview at his office in an ancient courtyard house inside Beijing’s old city.
China is seeking to expand the number of willing organ donors, but it has run up against some cultural barriers: Family members are still able to block a donation, even if the giver is willing, and Chinese are averse to registering as donors by ticking a box on their drivers’ licenses, considering it to be tempting fate.
Instead, authorities are partnering with AliBaba, China’s virtually ubiquitous online shopping and payment platform, to allow people to register in just 10 seconds, Huang said. Huang said more than 210,000 Chinese have expressed their willingness to become donors, although that’s a drop in the bucket compared with the country’s population of 1.37 billion.
...
"Huang said China has adhered to a complete ban on the use of organs from executed prisoners that went into effect in 2015, although some in the field outside China have called for the country to allow independent scrutiny to ensure it is keeping to its pledge.
Critics have questioned China’s claims of reform and suggested that the World Health Organization should be allowed to conduct surprise investigations and interview donor relatives. The U.N. health agency has no authority to enter countries without their permission.
Chinese officials say China shouldn’t be singled out for such treatment while other countries are not.
Further moving on from the days when foreigners could fly to China with briefcases of cash to receive often risky, no-questions-asked transplant surgeries, China has also taken measures to stamp out organ trafficking and so-called “transplant tourism,” including by limiting transplants to Chinese citizens."
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China’s organ transplantation reform hailed by international community

"By CGTN’s Yang Jinghao

A sensitive issue just a decade ago, organ donation and transplantation in China has seen a remarkable shift during the past few years. A total of 7,000 organs were voluntarily donated between January and July this year, according to a conference on organ transplantation held in China over the weekend.

Comparatively, the number in 2010 was just 34 for the whole year.

The conference, held in Kunming, southwest China’s Yunnan Province, gathered top organ transplant professionals from major international organizations. They reviewed the achievements China has made and discussed how to strengthen international cooperation."
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And here's a story from Crux (whose subhead is "Taking the Catholic Pulse")
Chinese state media highlights Vatican official at organ trafficking conference in Beijing

"In a sign of the slow thawing of relations between China and the Vatican, a Chinese state newspaper reported positively on a Vatican official’s remarks at an organ trafficking conference taking place in Beijing.
Argentine Bishop Marcelo Sánchez Sorondo, the chancellor of the Pontifical Academies of Sciences and Social Sciences, attended the conference on Thursday, part of China’s ongoing efforts to convince the world it has reformed its organ donation procedures.
In 2015, the communist country announced it was stopping the practice of using organs from executed prisoners. In 2016, official statistics stated surgeons in China had harvested organs from 4,080 donors and performed 13,263 transplant surgeries, the second highest in the world. Officials said all donors were through a registered volunteer donor system. By 2020, China is expected to surpass the United States to take the top spot.
Last month the Pontifical Academy of Sciences, the World Health Organization , the Transplantation Society (TTS), and the Declaration of Istanbul Custodian Group (DICG) - four of the most influential societies in promoting global ethical practices in organ transplantation - sent a letter expressing their appreciation for China’s efforts in organ donation and transplantation reform.
Despite the assurances of the government, many human rights activists are skeptical such numbers could be achieved through an exclusively voluntary system, especially after decades of reliance on the organs of prisoners."
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Here are comments from Chancellor Marcelo Sanchez Sorondo commending the development of the China Model

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And here's a story about another realm in which China and the Vatican are simultaneously engaged.

Vatican official hints at unofficial agreement with China on bishops
"HONG KONG (CNS) -- A senior Vatican official has hinted there is an unofficial agreement between the Holy See and Beijing on the appointment of bishops, even as negotiations to formalize arrangements continue to hit roadblocks, reported ucanews.com.

Argentine Bishop Marcelo Sanchez Sorondo, who attended a conference on the sensitive topic of organ donation and transplants in the southern Chinese city of Kunming, offered the hint during an interview with state-run Global Times Aug. 4.
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Here are my earlier posts on the positions taken by the Pontifical Academy regarding transplantation.

"Demonstrated interest" as costly signaling in college admissions

Costly signals are valuable as signals because they are costly to send. But of course they may be more costly for some to send than others.


"Demonstrated interest: Signaling behavior in college admissions" (by James Dearden, Suhui Li, Chad Meyerhoefer, and Muzhe Yang) Contemporary Economic Policy (2017)

Abstract

In college admission decisions, important and possibly competing goals include increasing the quality of the freshman class and making the school more selective while attaining the targeted size of the incoming class. Especially for high-quality applicants who receive multiple competing offers, colleges are concerned about the probability that these students accept the offers of admission. As a result, applicants' contacts with admissions offices, such as campus visits, can be viewed positively by the officers as demonstrated interest in the colleges. We provide empirical evidence on the effects of demonstrated interest on admission outcomes. Specifically, we use unique and comprehensive administrative data, which include all contacts made by each applicant to the admissions office of a medium-sized highly selective university during two admission cycles. We find that an applicant who contacts the university is more likely to be admitted, and that the effect of the contact on the probability of admission is increasing in the applicant's Scholastic Assessment Test score, particularly when the contact is costly to make. We also use a numerical example to explore policies to reduce the inequity associated with the use of demonstrated interest in admission decisions, examining in particular the subsidization of costly demonstrated interest by low-income students.

Here's an article about the paper in Inside Higher Ed...
Another Edge for the Wealthy
"Many colleges favor applicants who show "demonstrated interest" -- and the way they measure it puts those without money at a disadvantage, study finds."

More on compensation for donors

It's hard for anyone to say anything new in the long (and long-running) debate about whether we should try to increase the supply of kidneys by crafting some form of ethical, non-coercive compensation for donors, or whether this should remain illegal.
Frank McCormick points me to this recent article, which ends with what I hope is a fairly noncontroversial link to the deceased donor registries:

It May Sound Awful, but We Really Do Need to Pay for Human Organs
by Mark Joffe

It concludes:
"While there is little support for an Iranian-style organ market in the United States, there is an increasing realization that finding more live donors will involve offering them incentives to give up a kidney. A reform that compensates donors without allowing recipients to pay for organs is a viable middle ground. The government could fund such a program with cost savings on dialysis. One estimate puts the potential savings at as much as $12 billion a year.

Last year, Rep. Matt Cartwright (D-Penn.) introduced the Organ Donation Clarification Act, which would have allowed state and local governments to implement pilot programs offering non-cash benefits to live organ donors. These in-kind benefits might include a tuition voucher, loan forgiveness or a contribution to the organ donor’s designated charity. In addition, Cartwright’s legislation would have clarified language in NOTA to establish that cash reimbursement for donor travel expenses, medical costs and lost wages is permissible. The bill attracted 11 bipartisan cosponsors but did not move out of committee.

Cartwright’s office told me that he plans to reintroduce the legislation in the current Congress. Once he does, he will have the support of a group of D.C. policy wonks who have created the Organ Reform Group and Network. One of the group’s members, economist Kurt Schuler, donated a kidney to a stranger in 2014 under the current system, but believes that incentives are needed to end the nation’s kidney shortage.

Whether or not you agree that live donors should be compensated for their kidneys, I hope we can all agree that donating our organs at death is no sacrifice. While this issue is on your mind, consider signing up for the organ registry at https://organdonor.gov/register.html."

Trump Administration Withdraws Proposed Ban on Compensation for Bone Marrow

After the Ninth Circuit ruled that compensation for blood stem cells (sometimes simply referred to as bone marrow) could be compensated in some cases, the department of Health and Human Services moved to reinstate the ban.  (I coauthored one of many of the public comments they received "in opposition to the proposed rule changes by the Health Resources and Services Administration (HRSA) that would ban compensation for bone marrow donations.")

On August 1 the new administration (which hasn't done much else that I approve of)  withdrew the proposed rule change (which I gather should leave the Ninth Circuit decision as the law of the land).

Here's a news story and an editorial (the only reports I've seen so far).

First the story (which seems to incorrectly attribute the administrative agency behind the move to the Office of Management and the Budget instead of to the Department of Health and Human Services (HHS):

Trump Administration Withdraws Proposed Obama Ban on Compensation for Bone Marrow

"The Office of Management and Budget has withdrawn a proposed rule banning compensation for hematopoietic stem cells. In other words, you can get paid when someone harvests stem cells from your bone marrow.

Bone marrow transplantation is used to treat a variety of ailments, including aplastic anemia, sickle cell anemia, bone marrow damage during chemotherapy, and blood cancers such as leukemia, lymphoma, and multiple myeloma. In 1984, Congress passed the National Organ and Transplant Act, which outlawed compensation to the donors of solid organs like kidneys and livers. Oddly, the act also defined renewable bone marrow as a solid organ.

Originally, hematopoietic stem cells were obtained from bone marrow obtained by inserting a needle into donors' hip bones. Researchers later developed a technique in which donors are treated with substance that overstimulates the production of hematopoietic stem cells, which then circulate in their bloodstreams. In a process similar to blood donation, the hematopoietic stem cells are then filtered from the donors' blood. The red blood cells and plasma are returned to the donors.

More Marrow Donors, a California-based nonprofit, wanted to set up a system to encourage hematopoietic stem cell donations with $3,000 awards, in the form of scholarships, housing allowances, or gifts to charity. The Institute for Justice, a libertarian law firm, brought suit on their behalf, and in 2012 a federal appeals court sensibly ruled that the law's ban on compensation for solid organ donations did not apply to stem cells obtained from donors' bloodstreams. The Obama administration reacted by proposing a regulation defining stem cells obtained from blood as the equivalent of a solid organ.

Now the new administration has withdrawn the proposal."

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Here's the editorial, from yesterday's WSJ:
Money for Marrow, Finally

"last week the Department of Health and Human Services withdrew a proposed Obama -era regulation that would have prohibited compensation for bone-marrow donation. About 11,000 ailing Americans are currently searching the national marrow registry, hoping to find a compatible donor. This year at least 3,000 people will die waiting for a transplant."

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Here are my previous posts on bone marrow donation and the compensation controversy.


HT: Philip Held and Frank McCormick

Child marriage in California

The San Francisco Chronicle has the story:

Effort to bar child marriage in California runs into opposition
By Jill Tucker

"A Bay Area legislator was shocked when he learned from a young constituent that while Californians cannot legally consent to sex until they are 18, they can — with the permission of a parent and a judge’s order — get married at any age, even if their spouse is many years older.

“I thought, that can’t be true in California,” said state Sen. Jerry Hill, a Democrat from San Mateo. “We found that it is true in California and true in many states throughout the country.”

But Hill’s resulting proposal to bar juveniles from getting hitched has been watered down after it prompted strong objections from civil rights groups, including the American Civil Liberties Union.

As the emotional fight unfolds in Sacramento, there’s no agreement even about a basic piece of information — how many minors get married each year in California. People who want to limit such marriages say the total is in the thousands, while those who oppose the bill say that’s vastly inflated.

The state doesn’t keep such numbers, and even efforts to change that are running into resistance."
...
"Activists aiming to stop such marriages say they occur across demographic groups, spurred by religious reasons, cultural norms, pregnancy, financial incentives or, in some cases, to protect someone from statutory-rape accusations because marriage circumvents the age-of-consent requirement.

Nationally, about 5 of every 1,000 children ages 15 to 17 were married as of 2014, according to U.S. census data analyzed by the Pew Research Center — figures that don’t specify where the marriages occurred. Activists for age restrictions estimate that California sees about 3,000 marriages per year that include a minor.

The ACLU and other opponents say that estimate is inflated, noting that just 44 petitions for juvenile marriage were filed in Los Angeles County — which has a population just above 10 million — over the past five years.

The focus of efforts should be on abusive and coerced relationships, regardless of marital status, said Phyllida Burlingame of the ACLU’s Northern California chapter.

Referring to current regulations, including the requirement of a court order allowing a juvenile to marry, she said California had “a strong package of both programs and laws that prevent coerced marriage among youth, and a lack of data showing this is a widespread problem.” Hill’s original proposal, she said, “was a solution that wasn’t necessarily going to have the impact on improving young people's health and relationships that we want.”
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HT: Jen Stack

Polygamy convictions in Canada

The CBC has the story:

Winston Blackmore and James Oler found guilty of polygamy by B.C. judge
Former bishops of Bountiful both have numerous wives and children
CBC

"Two former religious leaders in B.C. have been found guilty of polygamy after marrying more than two dozen women over the course of 25 years.

"Winston Blackmore and James Oler were convicted of practising plural or "celestial" marriage in the fundamentalist community of Bountiful, B.C.

"In B.C. Supreme Court on Monday, Justice Sheri Ann Donegan said Blackmore "subscribed to beliefs and practices of the Fundamentalist Church of Jesus Christ of Latter-Day Saints," a Mormon sect that believes in plural marriages.

"James Oler, another former leader from the same community, was accused of having five wives and Blackmore 24 wives.

"Both men are former bishops of the sect in the province's southeast. Neither denied having multiple marriages and Blackmore has fathered more than 145 children from his marriages.
...
"Blackmore's lawyer, Blair Suffredine, previously said he'd launch a constitutional challenge to the validity of the polygamy laws if his client were to be found guilty.
...
"The legal fight began in the early '90s when police first investigated allegations that residents of an isolated religious community were practising multiple marriages.

"A lack of clarity around Canada's polygamy laws initially led to failed attempts at prosecuting Blackmore, followed by several efforts to clarify the legislation, including a reference question to the B.C. Supreme Court.

"The court ruled in 2011 that laws banning polygamy were constitutional and did not violate religious freedoms guaranteed in the Charter of Rights and Freedoms.

"The mainstream Church of Jesus Christ of Latter-Day Saints, based in Utah, officially renounced polygamy in the late 1800s and disputes any connection to the fundamentalist group's form of Mormonism."
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Prosecution of polygamy in the U.S. has focused not on polygamy itself, but on the fact that some of the brides are underage.  Here's an AP report of the present case via ABC news, which includes the following:
"Oler was chosen to lead the Canadian community just north of the U.S. state of Idaho following Blackmore's excommunication from the sect in 2002 by Warren Jeffs, considered the prophet and leader of the group.

"Authorities have said Jeffs still leads the sect from a Texas prison, where he is serving a life sentence for sexually assaulting underage girls he considered brides."
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See my earlier posts on polygamy

Interview on market design in Mundo Empresarial (in Spanish)

Recent mail brought a copy of the Summer issue (Segudo Trimestre 2017) of Mundo Empresarial to my desk, and it contains a multi-page interview with me that I only dimly remember giving. It may have been a while ago: the link below lists both Saturday, July 22, 2017 and May 14, 2015 as the date of publication. (I'm guessing the web version may have come out long ago, but I missed it.)

Entrevista a Alvin E. Roth, Premio Nobel de Economía 2012

 The last question and answer (with the help of Google Translate):

Por último, además de por haber ganado el Nobel, ¿por qué querría ser recordado Alvin E. Roth?
Me haría muy feliz ser recordado como un buen maestro que ha aprendido mucho de sus alumnos.

Finally, in addition to winning the Nobel Prize, why would Alvin E. Roth want to be remembered? 
It would make me very happy to be remembered as a good teacher who has learned a lot from his students.