New calls for decriminalizing drug use in Canada

Here's the story in the Washington Post:

Toronto medical official calls for decriminalizing drugs as opioid overdoses skyrocket in Canada

"With opioid-related overdoses and deaths reaching record levels in Canada, the top medical official in Toronto is calling for the decriminalization of all drugs as part of a strategy to treat illicit drug use as a public health and social issue, not a criminal one.

"In a report released Monday, Eileen de Villa, Toronto’s chief medical officer, urged the city’s board of health to pressure the federal government to eliminate legal penalties for the possession of drugs and to scale up “prevention, harm reduction and treatment services.”

"The report also recommended assembling a task force “to explore options for the legal regulation of all drugs in Canada,” which she hopes would destroy an illegal drug market contaminated with fentanyl — a synthetic opioid 100 times more potent than morphine — and other drugs like it.

“When we criminalize people who take drugs, we inadvertently contribute to the overdose emergency,” de Villa said. “It pushes people into unsafe drug use practices and creates barriers for people to seek help.”
********

Here's the Toronto report:
A Public Health Approach to Drug Policy
Date: June 28, 2018
To: Board of Health
From: Medical Officer of Health

*********
See also the Global Commission on Drug Policy's 2016 report:
ADVANCING DRUG POLICY REFORM: A NEW APPROACH TO DECRIMINALIZATION

Kidney exchange is fragmented in the U.S.

Market Failure in Kidney Exchange

Nikhil Agarwal, Itai Ashlagi, Eduardo Azevedo, Clayton R. Featherstone, Ömer Karaduman

NBER Working Paper No. 24775
Issued in June 2018

Abstract: "We show that kidney exchange markets suffer from traditional market failures that can be fixed to increase transplants by 25%-55%. First, we document that the market is fragmented and inefficient: most transplants are arranged by hospitals instead of national platforms. Second, we propose a model to show two sources of inefficiency: hospitals do not internalize their patients’ benefits from exchange, and current mechanisms sub-optimally reward hospitals for submitting patients and donors. Third, we estimate a production function and show that individual hospitals operate below efficient scale. Eliminating this inefficiency requires a combined approach using new mechanisms and solving agency problems."

Here's a key sentence:

"The three largest multi-hospital platforms together only account for a minority share of the kidney exchange market. 62% of kidney exchange transplants are within hospital transplants that are not facilitated by the NKR, APD or UNOS. Moreover, over 100 hospitals performed kidney exchanges outside these three platforms during this period."

Jason Furman buys books when they're on sale

Here's a recent book review of my (2015) book that caught my eye, posted by Ismail Ali Manik, which begins with this tweet:

I finally got around to reading Alvin Roth's "Who Gets What--and Why" (I confess because it was on sale for $1.99 on Kindle, but too late you missed it). It is an enjoyable, accessible, insightful guide to the economics of matchmaking. My review. https://t.co/zNCsim3ivP

— Jason Furman (@jasonfurman) June 14, 2018

 Random Book recommendation — Who Gets What and Why: The New Economics of Matchmaking and Market Design

You might want to read the book yourself, and in any event there is an interesting selection of quotes, and then links to a bunch of videos, at the link above.

One kidney donor's journey

I recently heard the following story, by email from a recent kidney donor, who has given me permission to share it. It's lightly edited to preserve her privacy and mine, but I can't resist noting that her first name is Hope.

"Dear Professor Roth,

"Seven weeks ago today, I donated a kidney to a stranger in Minnesota.  Mayo Clinic sent me his email address this afternoon, just in case I want to contact him.  I'm not sure yet if I want to initiate communication but I certainly can't stop thinking about it.  It made me think about the Freakonomics episode I heard three years ago that started everything.  You know the one...

"When I heard the episode, I knew right away I wanted to become a living kidney donor.  I was 49 at the time. I never had children and my life felt incomplete.  Moreover, I lost my mother to cancer after a long battle, when I was just 14 years old.  I daydreamed about helping a child who had a sick parent so she doesn't have to go through what I went through. 

"My wife's cousin needed a kidney shortly after the episode aired.  I asked her if it was ok if I stepped up.  I played her the Freakonomics episode and she approved.  I reached out to her cousin Rick.  It turns out a few people volunteered and he got a direct match.  I felt defeated, which sounds selfish after such good news.  Then I heard a follow up episode that united a donor with his recipient.  Stephen Dubner was crying... I was crying... I called Mayo Clinic the next morning and signed up for testing.

"The rest is a long story and I know you are a busy man so I'll skip most of it.  I ended up being part of a pair, instead of an altruistic donor.  There was a man who worked with my wife that needed a kidney.  He once saved her life with the Heimlich maneuver so it was pretty poetic that I could save his.  He received his kidney from a bridge donor and I gave mine to someone on the diseased donor list.  So I got to save two lives!  I'm doing great.  I went back to work a couple of weeks ago.  I have no regrets and I hope I can inspire others to do something selfless and extraordinary in their lifetime. 

"I hope others have written to you.  I'm sure you see the statistics and know the impact of what you created with paired kidney donation.  I just wanted to make sure you hear some personal stories.  Life changing stories..."

A subsequent email exchange clarified some details:

"Hi Al!  I did all of my testing in May of 2016 to be a non-directed donor. I tested positive for Valley Fever and had to wait 90 days to be retested. The 2nd test was negative and I was approved but I was getting married in October so we put a hold on the donation. Mark came into the picture after that. He didn’t know about paired donation. We got him to switch to Mayo and we became a pair. He had lots of complications so I had to wait a long time. When he was finally approved, so much time had passed that I had to do most of the testing all over again. It took awhile to find me a match because I’m AB+. 

So a false positive Valley Fever test got Mark a kidney. 

I met Mark the day of his surgery. My wife and I were the first faces he saw. He was there the day of mine. He brought me flowers and a card from his kids. 

My team at Mayo Clinic were there for me the whole time. There was never any pressure and changing from non-directed to paired was seamless. They never discussed Mark. He had his own team. I was allowed to chicken out at any time. But I’ve never been so sure of anything in my life."
***********

And here are my posts linking to the Freakonomics shows that gave people so much of Hope.

Thursday, June 18, 2015

Freakonomics podcast on Who Gets What and Why

Make Me a Match: A New Freakonomics Radio Episode

Friday, February 26, 2016

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

Ask Not What Your Podcast Can Do for You

and this one (from huffingtonpost.com):

Saturday, May 6, 2017

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

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

A television interview on kidney exchange in Mexico (video)

Here's a short video that ran on Mexican tv, with a one minute introduction in Spanish, and then 11 minutes in English with Spanish subtitles. Curiously, the recording ends abruptly just as I started to talk about the 1974 paper of Shapley and Scarf...:)





Here is an earlier post about my recent visit to Mexico:

Tuesday, May 22, 2018

Forbes Health Forum in Mexico City, May 23

Thursday, May 31, 2018

Kidney exchange takes another step forward in Mexico: Pro-Renal

The June issue of the newsletter of the ACM E-commerce group is devoted to market design. You can read them at the links below:

June, 2018

• News and Views
  • Editor's Introduction
    • HU FU
  • A Report on the Workshop on Mechanism Design for Social Good
    • REDIET ABEBE and KIRA GOLDNER
• Survey
  • Good Markets (Really Do) Make Good Neighbors
    • SCOTT DUKE KOMINERS
• Letters
  • First-Price Auctions with General Information Structures
    • DIRK BERGEMANN, BENJAMIN BROOKS, and STEPHEN MORRIS
  • Combinatorial Cost Sharing
    • SHAHAR DOBZINSKI and SHAHAR OVADIA
  • Correlation-Robust Mechanism Design
    • NICK GRAVIN and PINIAN LU
  • Game Dynamics as the Meaning of a Game
    • CHRISTOS PAPADIMITRIOU and GEORGIOS PILIOURAS

HT: Scott Kominers

Capitalisn't conversation on kidneys and repugnance with Luigi Zingales and Kate Waldock

Here's a podcast and transcript of a conversation I had recently  with Kate Waldock and Luigi Zingales on the Chicago Booth Capitalisn't show, about kidney exchange, repugnant transactions and more:  Capitalisn’t: Abdomenable Transactions





The closing interaction between Luigi and Kate seemed to me to capture something important about compensation for donors, and maybe about repugnance:

Luigi: Al is a great guy. His contribution is extremely important for economics but more importantly, is also very important for humankind. However, listening to his discussion and listening to how complicated it is to do these matches even with his algorithm and how many people are left out, the question arises: Why don’t we pay for people to donate an organ? Of course, not your heart because it means that you are killing yourself, but what about a kidney? People can very happily live without a kidney. If they’re willing to donate a kidney for money, why is it so wrong?

Kate: Luigi, how much money would you have to be paid to sell your kidney?

Luigi: Wow, that’s a good question because I would give a kidney to my wife and my kids, but I don’t think I would sell it for money.

Kate: All right. Fair enough. I’m not sure there’s a price that I would accept either. "

Explaining plasma donation

In recent posts I've commented on the repugnance (in Canada and elsewhere) to paid plasma donation, which is legal in the U.S.. (The U.S. consequently supplies much of the world's plasma needs.)  One question facing the plasma industry is how to defend against compensated plasma donation being seen as a repugnant transaction.

I think they are already very well equipped to communicate the need for plasma proteins, which provide treatments for a host of diseases, and which are used around the world.  But to the extent that (paid or unpaid) donation needs to be defended and encouraged, I would expect to see more stories like this one, from Australia.

This man's blood has saved 2.4 million babies
'I'd keep going if they let me,' says 81-year-old with magical plasma.

"The man with the golden arm

"Harrison's blood is valuable because he naturally produces Rh-negative blood, which contains Rh-positive antibodies. His blood has been used to create anti-D in Australia since 1967.

"Every ampule of Anti-D ever made in Australia has James in it," Robyn Barlow, the Rh program coordinator who recruited Harrison, told the Sydney Morning Herald. "Since the very first mother received her dose at Royal Prince Alfred Hospital in 1967."

Harrison was the program's first donor.

"It's an enormous thing ... He has saved millions of babies. I cry just thinking about it."

Since then, Harrison has donated between 500 and 800 milliliters of blood almost every week. He's made 1,162 donations from his right arm and 10 from his left.

...

Harrison's retirement is a blow to the Rh treatment program in Australia. Only 160 donors support the program, and finding new donors has proven to be difficult. Additionally, attempts to create a synthetic version of anti-D have failed."

Chen Yusun Memorial Lecture at Tsinghua. 陈岱孙纪念讲座

Monday, at Tsinghua University I'll have the honor of delivering the
Chen Daisun Memorial Lecture, 陈岱孙纪念讲座

From Google translate:
"In order to celebrate the centennial birthday of Tsinghua University and the 85th anniversary of the Department of Economics of Tsinghua University, the Tsinghua School of Economics and Management launched the "Chen Yisun Economics Memorial Lecture" in April 2011.

Professor Chen Yusun was born in 1900. He graduated from Tsinghua University in Beijing in 1920. After earning an undergraduate degree in economics from the University of Wisconsin in 1922, he went to Harvard University for further studies and received his Ph.D. in economics in 1926. Among his classmates studying at Harvard University's Department of Economics, Bertil Ohlin, one of the Hecksell-Ohlin international trade models, and Edward Chamberlain, known for his theory of oligopolistic competition. (Edward Chamberlin). In 1928, Professor Chen Yisun returned to China. In the same year, he served as professor and department head of the Department of Economics at Tsinghua University. Until 1952, the Department of Economics of China's higher education institutions was merged into other universities. Professor Chen Yisun died in 1997 at the age of 97. Professor Chen Yusun is recognized as the father of modern economics education in China. Under his leadership, the Department of Economics of Tsinghua University became one of the best economics departments in China at that time. During his tenure, Professor Chen Yisun was the most undergraduate student at Tsinghua University, accounting for about one-fifth of all undergraduate students in the university.

The lecture was titled Professor Chen Yusun and is the highest level academic lecture for teachers and students. Previous speakers include: 1997 Nobel Laureate in Economics, Myron Scholes, Professor of Finance, Stanford Business School, 2007 Nobel Laureate in Economics, Professor of Harvard University, USA Eric Maskin, winner of the 1997 Nobel Prize in Economics, Robert C. Merton, a professor at the Massachusetts Institute of Technology, and winner of the 2013 Nobel Prize in Economics, University of Chicago professor Lars Peter Hansen."

I'll speak on "Repugnant transactions and forbidden markets"

Tsinghua Conference on Behavioral, Experimental and Theoretical Economics (BEAT), July 9-10

Tsinghua Conference on Behavioral, Experimental and Theoretical Economics

(Tsinghua BEAT 2018)

July 9-10, 2018

Keynote speakers:

Jacob Goeree, University of New South Wales

Ed Hopkins, University of Edinburgh

Alvin Roth, Stanford University (2012 Nobel Laureate in Economics)

We are pleased to announce the 2018 Tsinghua Conference on Behavioral, Experimental and Theoretical Economics (shortened as Tsinghua BEAT). The conference will be held on the campus of Tsinghua University, at the School of Economics and Management, in Beijing on July 9-10, 2018. 

Program Overview:

Detailed paper schedule: Tsinghua BEAT 2018 (PDF)

Conference website: http://tinyurl.com/tsinghuabeat

Monday July 9th

Session Chair:  Tracy Xiao Liu

09:00 – 10:00    The Favored but Flawed Simultaneous Multiple Round Auction, Jacob Goeree*(joint with Nick Bedard, Philippos Louis, and Jingjing Zhang)

Information and Communication

10:15 – 10:45   Costly Miscalibration in Communication, Yingni Guo* (Northwestern) and Eran Shmaya

10:45 – 11:15   Robust Persuasion of a Privately Informed Receiver, Ju Hu and Xi Weng*

11:15 – 11:45   Ambiguous Persuasion, Dorian Beauchêne, Jian Li* (McGill) and Ming Li

Market Design

13:00 – 13:30   Core of Convex Matching Games, Xingye Wu* (Columbia/Tsinghua)

13:30 – 14:00   A Dynamic College Admission Mechanism in Inner Mongolia: Theory and Experiment, Binglin Gong and Yingzhi Liang* (Michigan)

14:00 – 14:30 Obvious Mistakes in a Strategically Simple College Admissions 

Environment: Causes and Consequences, Ran I. Shorrer and Sándor Sóvágó* (Groningen)

Search and Information Preference

14:45 – 15:15  Sequential Search with a Freeze Option - Theory and Experimental Evidence, Emanuel Marcu and Charles N. Noussair* (Arizona)

15:15 – 15:45  Information Avoidance and Medical Screening: A Field Experiment in China, Yufeng Li, Juanjuan Meng, Changcheng Song* (NUS) and Kai Zheng

Chen Daisun Lecture, Main Auditorium, Weilun Buiding, chaired by Yingyi Qian, Dean of School of Economics and Management, Tsinghua University

16:15 – 17:30  Repugnant Transactions and Forbidden Markets, Alvin Roth, Stanford University, 2012 Nobel Laureate in Economics

Tuesday July 10th

Session Chair:  Alexander White

09:00 – 10:00   Price Dispersion and Cycles: Theory and Experiment, Ed Hopkins* (joint with Tim Cason and Dan Friedman)

Development

10:15 – 10:45   Targeting High Ability Entrepreneurs Using Community Information: Mechanism Design In The Field, N. Rigol, R. Hussam and Benjamin Roth* (Harvard)

10:45 – 11:15   Prosocial Compliance in P2P Lending: A Natural Field Experiment, Ninghua Du, Lingfang Li* (Fudan), Tian Lu and Xianghua Lu

11:15 – 11:45   Does Haze Cloud Decision Making? A Natural Laboratory Experiment, Soo Hong Chew, Wei Huang and Xun Li* (Wuhan)

Reputation and Risk

13:00 – 13:30   Reputation Effects under Interdependent Values, Harry Di Pei* (MIT/Northwestern)

13:30 – 14:00   The Persistent Power of Promises, Florian Ederer* (Yale) and Frédéric Schneiderz

14:00 – 14:30   Intertemporal Consumption with Risk: A Revealed Preference Analysis, Joshua Lanier, Bin Miao* (SUFE)， John Quah and Songfa Zhong

Cognitive Biases

14:45 – 15:15   Motivated Framing Effects, Christine L. Exley and Judd B. Kessler* (Penn)

15:15 – 15:45   Are People Aware of Their Inattention: Evidence from Credit Card Repayment, Jiajun Jiang, Yi-Tsung Lee, Yu-Jane Liu and Juanjuan Meng* (Peking)

15:45 – 16:15   Competing by Default: A New Way to Break the Glass Ceiling, Nisvan Erkal, Lata Gangadharan and Erte Xiao* (Monash)

Organizing Committee:

Chong-En Bai

Yan Chen

Ming Gao

Audrey Hu

Tracy Xiao Liu

Alex White

Jie Zheng

Xiaohan Zhong  

Market design comes to Harvard Law School

Here's a piece from the Harvard Law Bulletin that caught my eye:
Holger Spamann brings new thinking to the structure of his class and casebook 

He's teaching "a corporate finance course divided into four different modules, any of which students can opt out of depending on their knowledge level.

"A student who comes in with a great deal of experience in the field will be able to skip the initial module on basic valuation. Subsequent modules cover diversification and market efficiency, capital structure, and then finally auctions and market design. Students who want to only dip their feet can opt out of later modules.

"Spamann, who also earned a master’s and Ph.D. in economics from Harvard and practiced briefly as an M&A attorney, says his background in economics informs his approach to corporate finance and how he teaches the subject."
********

Spamann and Guhan Subramanian also have a casebook for sale: here's the Amazon link.

Corporations: Casebook Paperback – September 2, 2017

by Holger Spamann (Author), Guhan Subramanian (Author)

Is altruism necessarily good?

That's basically the question asked, in the context of organ donation, by this paper in the BMJ:

Law, ethics and medicine
Paper
How altruistic organ donation may be (intrinsically) bad
Dr Ben Saunders, Social Sciences, University of Southampton, Southampton SO17 1BJ, UK; b.m.saunders@soton.ac.uk

Abstract: It has traditionally been assumed that organ donation must be altruistic, though the necessity of altruistic motivations has recently been questioned. Few, however, have questioned whether altruism is always a good motive. This paper considers the possibility that excessive altruism, or self-abnegation, may be intrinsically bad. How this may be so is illustrated with reference to Tom Hurka’s account of the value of attitudes, which suggests that disproportionate love of one’s own good—either excessive or deficient—is intrinsically bad. Whether or not we accept the details of this account, recognising that altruistic motivations may be intrinsically bad has important implications for organ procurement. One possible response is to say that we should take further measures to ensure that donors have good motives—that they are altruistic is no longer enough. An alternative is to say that, since altruistic donation need not be intrinsically good, we have less reason to object to other motivations. 

In a nutshell:

"we may think that the virtue of altruism lies between selfishness (excessive self-concern) and self-abnegation (deficient self-concern). While it is probably true that most people ought to be less selfish, if someone shows little or no concern for her own well-being, this too could be morally troublesome. This might explain worries about the motives of some altruistic donors; we may fear that they are ‘too altruistic’ or not sufficiently concerned with their own good."

Compensation for kidney donors debated in WSJ

Familiar positions, clearly stated, pro and con compensation for donors.
There are other reasons put forward for not rewarding organ donation, but the one espoused here (preserving "the ability for one to aspire to virtue") is perhaps the one I have the least sympathy with, as it seems to value the hope of heaven more than saving earthly lives...

How to Provide Better Incentives to Organ Donors
Three experts discuss strategies to address the shortage of organs available for people who need transplants

"We talked about options for increasing organ donation with Sally Satel, a doctor and fellow at the American Enterprise Institute and the beneficiary of two kidney donations; Alexandra Glazier, chief executive of New England Donor Services, which coordinates organ and tissue donation in six New England states and Bermuda; and Andrew Flescher, a professor of public health and English at the State University of New York at Stony Brook, and author of “The Organ Shortage Crisis in America.”
...
"WSJ: The gap between the number of people who need organs and the number of organs available continues to grow. Why is our current model failing to bridge that gap?

DR. SATEL: Having studied the issue for 12 years, since my first kidney transplant, I am convinced that the only solution—before technology makes donation from people obsolete, and it will—is to compensate potential organ donors.

PROF. FLESCHER: The way forward is living donation. Roughly 100,000 out of 120,000 folks who need an organ need a kidney, which can be procured from a living donor, as most of us are born with two kidneys. We need a way of getting everyone to care about the plight of folks on dialysis, not through any coercive measure, of course, but through simple exposure.

MS. GLAZIER: There is no question that need outpaces the supply significantly. That said, it’s important to recognize that the number of deceased organ donors in the U.S. has increased 26% in the past five years (2012-2017) and the number of organs transplanted has increased 28% over the same period. In the New England region, the increase was more than double this rate over the same time period.

...

"PROF. FLESCHER: I certainly do not think paying living donors is the way to go.

DR. SATEL: But what is left? I suppose the real question is what is so aversive about enrichment of some kind? Surely, we do it with plasma, egg, sperm, body, as in donations in medical schools, maternal surrogacy, breast milk, hair. We already pay for body products. And, of course, my colleagues and I do not recommend lump-sum cash, because we do not want to attract desperate, impulsive people who may regret acting. Instead, rewards could include things like tax credits, lifetime health insurance, a contribution to a 401(k) account or a tuition voucher.

PROF. FLESCHER: The introduction of money for a precious good comes at the cost of the ability for one to aspire to virtue, if not as hero, than as a civic-minded, socially conscious neighbor, free to act, and to be perceived as acting, out of the motive to offer help to one in need.

...

"WSJ: Sally, can you please sum up the central tenets of how compensation for living donors would work?

DR. SATEL: The principles of a system of compensation are these: 1. Informed consent. 2. Ensuring health protection, before and after. 3. An ample reward—something trivial amounts to exploitation. 4. Respect for autonomy of people who know what is in their best interest. 5. Expression of gratitude for the lifesaving act they performed.

I suggest a waiting period of six to 12 months to ensure that the would-be donor is sure he or she wants to proceed. And a noncash reward, because a cash reward will appeal to impulsive decision makers, and we need to avoid that.

Obstacles to kidney exchange in Germany

An op-ed in yesterday's Handelsblatt Global (in English) proposes that kidney exchange should be allowed in Germany:
Germany should allow donating organs to strangers
by Fabian Kurz and Fred Roeder, July 2, 2018

An earlier brief discussion/blog post (in German) with some interesting links describes some of the current obstacles to kidney exchange in Germany:

Nieren-Tausch kann Leben retten (Kidney exchange can save lives)
von Alexander Fink & Fabian Kurz, 20. Juni 2018

Here's the German Transplant Act.

Here's a ruling of the German Federal Social Court, confirming the effective ban on kidney exchange.

Here's a 2005 news story about two patient-donor pairs who were allowed to engage in a kidney exchange after arguing that they had established a sufficient relationship with each other, to fit the requirement of the law that transplants can only be received from close relations, i.e. immediate family, or a "special personal bond" .
Nieren-Tausch soll Leben retten (Kidney exchange is supposed to save lives)
***********

Some earlier discussions and links:

Thursday, March 17, 2016

Transplants in Germany, further discussion of changing the transplant law, in Der Tagesspiegel

Sunday, January 21, 2018

The number of organ donors in Germany has fallen to its lowest level in 20 years.

Wednesday, February 21, 2018

Organ donation in Germany

Organ donation in Germany is declining, from an already low rate.

Kidney exchange in all its aspects: a view from India

Here's a survey that sees kidney exchange, and all the advances that have been made in how to use it to facilitate more transplants, as a force for making medicine more inclusive around the world.

Kidney exchange transplantation current status, an update and future perspectives
Vivek B Kute, Narayan Prasad, Pankaj R Shah, Pranjal R Modi
World J Transplant. Jun 28, 2018; 8(3): 52-60
Published online Jun 28, 2018. doi: 10.5500/wjt.v8.i3.52

Abstract: "Kidney exchange transplantation is well established modality to increase living donor kidney transplantation. Reasons for joining kidney exchange programs are ABO blood group incompatibility, immunological incompatibility (positive cross match or donor specific antibody), human leukocyte antigen (HLA) incompatibility (poor HLA matching), chronological incompatibility and financial incompatibility. Kidney exchange transplantation has evolved from the traditional simultaneous anonymous 2-way kidney exchange to more complex ways such as 3-way exchange, 4-way exchange, n-way exchange,compatible pair, non-simultaneous kidney exchange,non-simultaneous extended altruistic donor, never ending altruistic donor, kidney exchange combined with desensitization, kidney exchange combined with ABO incompatible kidney transplantation, acceptable mismatch transplant, use of A2 donor to O patients, living donor-deceased donor list exchange, domino chain, non-anonymous kidney exchange, single center, multicenter, regional, National, International and Global kidney exchange. Here we discuss recent advances in kidney exchanges such as International kidney exchange transplantation in a global environment, three categories of advanced donation program, deceased donors as a source of chain initiating kidneys, donor renege myth or reality, pros and cons of anonymity in developed world and (non-) anonymity in developing world, pros and cons of donor travel vs kidney transport, algorithm for management of incompatible donor-recipient pairs and pros and cons of Global kidney exchange. The participating transplant teams and donor-recipient pairs should make the decision by consensus about kidney donor travel vs kidney transport and anonymity vs non-anonymity in allocation as per local resources and logistics. Future of organ transplantation in resource-limited setting will be liver vs kidney exchange, a legitimate hope or utopia?"

An interesting section of the paper discusses different practices regarding anonymity in kidney exchange centers in different countries:

"PROS AND CONS OF ANONYMITY IN DEVELOPED WORLD AND (NON-) ANONYMITY IN DEVELOPING WORLD

There is disparity on standard practice of kidney exchange in developed and developing World in term of (non-) anonymity. There is variable practice on anonymity before and after surgery in different countries.

Conditional approach[38]: When the donor-recipient pairs give consent for meeting after surgery, they are allowed to meet each other after surgery in some countries such as the United States of America[39] and the United Kingdom[40]. In other countries, such as the Netherlands and Sweden[41], anonymity is absolute. Anonymity protects patients, donors and transplant hospital/ administration against the risks of revoking anonymity and prevents further commercialization of organs, and breach of patient donor privacy. An Ethical, Legal and Psychosocial Aspects of Organ Transplantation (ELPAT), a subsection of the European Society for Organ Transplantation reported that a conditional approach to anonymity should be possible after surgery[42]. Pronk et al[38] showed that most donor-recipient pairs who participated in anonymous donation process are in favour of a conditional approach to anonymity. Guidelines on how to revoke anonymity if both parties agree are needed and should include education about pros and cons of (non-) anonymity and a logistical plan on how, when, where, and by whom anonymity should be revoked.

Non-anonymous allocation[11,12]: Donor-recipient pairs are allowed to meet each other before allocation of donor for surgery and even after surgery. They can share medical reports of exchange donors before surgery and kidney transplant and donor surgery outcome after surgery. Donor-recipient pairs do not choose their match but donor-recipient pairs may decline a match or can withdraw from participation in the kidney exchange program at any time, for any reason. Non-anonymous allocation has the potential of commercialization of organs in case of compatible donor-recipient pairs along with breach in privacy of donor-recipient pairs. Kute et al[11,12] reported that donor-recipient pairs are willing for non-anonymous allocation process in single center study of 300 kidney exchange transplants in India. They reported that non-anonymity is more helpful in manual allocation in absence of computer software allocation which also increases trust between patients, donors and transplant hospital/administration and legal team. More long term prospective studies are required to explore the donor and recipient perspective on anonymity in living kidney donation in different socio-economic regions and countries."

Regarding Global Kidney Exchange they conclude:

"Global kidney exchange appears to provide life-saving kidney transplantation to poor donor-recipient pairs from developing countries that otherwise could die due to economic constrain[50-53]."

And here's their conclusion:

CONCLUSION

"Kidney exchange transplantation has increased living donor kidney transplantation for end stage renal disease patients with chronological incompatibility and financial incompatibility. The participating transplant teams and donor-recipient pairs should make the decision by consensus about kidney donor travel vs kidney transport and anonymity vs non-anonymity in allocation as per local resources and logistics. There is need of uniform algorithm for management of incompatible donor-recipient pairs."