Fertility tourism to the U.S.

The Washington Post suggests that the U.S.A. might be a good place to come if your neighbors at home disapprove of what you hope to do...

From sex selection to surrogates, American IVF clinics provide services outlawed elsewhere

"While many countries have moved in recent years to impose boundaries on assisted reproduction, the U.S. fertility industry remains largely unregulated and routinely offers services outlawed elsewhere. As a result, the United States has emerged as a popular destination for IVF patients from around the world seeking controversial services — not just sex selection, but commercial surrogacy, anonymous sperm donation and screening for physical characteristics such as eye color.
...
"Numerous other countries also are tightening their regulation of the fertility industry. Last year, India banned commercial surrogacy. Next year, Ireland is set to join the Netherlands, Norway, Sweden, Switzerland, Finland, New Zealand and others in prohibiting anonymous sperm donation. And a large number of countries — including China, Canada and Australia — ban gender selection except in rare cases of medical need.
...
"A survey published in March in the Journal of Assisted Reproduction and Genetics found that nearly 73 percent of U.S. fertility clinics offer gender selection. Of those, nearly 84 percent offer it to couples who do not have fertility problems but are considering IVF solely to control the pregnancy’s outcome."

Economists as heroes (in new German book...)

Iconomix has a review of
Ökonomen sind Superhelden (Economists are superheroes)

"In his book, business journalist Malte Buhse shows how economists and economists hunt down criminals and save lives.
...
"Economists are modern superheroes and do outstanding things:

• Harvard economist Melissa Dell, for example, has used network research to simulate Mexican smuggling drug trafficking routes, giving investigators the most cost-effective transportation routes for drug trafficking. On the routes recommended by the model, the investigators were indeed successful.
• A similar problem was tackled by economists Eliana La Ferrara and Stefano Della Vigna with a completely different approach: to track down illegal arms transports, researchers tracked share price movements of smaller arms manufacturers and combined these data with the course of civil wars in countries such as Angola or Liberia. If the courses turned up after certain events, this aroused the suspicion of arms smuggling. Customs officials used this data to help enforce the arms embargo.
• An economist-superhero who won the Nobel Prize for his work is Alvin Roth. He has designed a market system that can help people with incurable kidney disease get a life-saving transplant. Often there is the problem that the patients find a donor-willing person in the immediate environment, but these are not considered as a donor due to the blood type. The market solution now is that such donor pairs are brought together and the relatives donate the kidney for the stranger - so to speak, crosswise. Thus, life can be saved with simple economic considerations."

The year in passings

Another year has passed, and I noted the passing in 2018 of several economists whose work has been important to market design.

Thursday, August 30, 2018 James Mirrlees 1936-2018

Thursday, August 23, 2018 Martin Shubik, 1926-2018

Wednesday, May 30, 2018 Martine Quinzii, RIP

 It appears that I didn't make such a post last year, and so let's remember also these distinguished economists:

Thursday, May 4, 2017 William J. Baumol (1922-2017)

Monday, April 3, 2017 Julio Rotemberg (1953-2017)

Tuesday, February 21, 2017 Ken Arrow (1921-2017)

Sunday, January 29, 2017 Yuji Ijiri (1935-2017)

Tuesday, January 3, 2017 Tony Atkinson (1944-2017)

I also noted the passing of a giant of transplantation,

Monday, March 6, 2017 Tom Starzl (1926-2017)

and of one of my great teachers when I was in college:

Wednesday, September 19, 2018 Masataka Mori, Sensei (1938-2018)

Rare whiskey: destructive testing

The Guardian breaks the news:
Rare whisky market flooded with fakes, says dealer
Lab tests found 21 out of 55 bottles of allegedly vintage scotch were counterfeit

"Simpson said it was not yet clear what systematic checks would work since the only accurate way of testing a whisky at present was to open the bottle and subject the liquid to chemical testing or the carbon testing techniques used by the Scottish centre.

"However, opening the bottle destroyed its value, making it impossible to prove its provenance while ensuring it could be sold on if it was found to be genuine. It would need the police or food safety authorities to tackle the problem, he said, by tracking a fraudulent bottle to its source."
***********

See earlier, related post. (I wonder if there is insurance against counterfeits?)

Tuesday, December 18, 2018

Insuring your whiskey collection

Notable economics papers from 2018

Quartz posts a list:

Twelve leading economists on the research that shaped our world in 2018

Computational and Experimental Economics in Barcelona: Call for papers

In Barcelona, in February:
Computational and Experimental Economics
Call for papers

"The workshop will run for 2 days and will take place on June 10-11, 2019 in Barcelona. In this two days’ workshop we want to bring together researchers working in two quite separate fields, computational economics and experimental economics"

Keynote Speakers

• Yan Chen (University of Michigan)
• Herbert Dawid (University of Bielefeld)

Workshop organizers

• Jasmina Arifovic (Simon Fraser University)
• Domenico Delli Gatti (Università Cattolica del Sacro Cuore)
• John Ledyard (Caltech)
• Rosemarie Nagel (ICREA-UPF and Barcelona GSE)

Compensate living donors for lost wages and other expenses?

It seems like an idea whose time should come, and for which there's growing support:

One simple change the government could make to encourage kidney donation
Donors often forgo wages for a couple weeks to save a life. That can be fixed.
By Dylan Matthews

"there’s a group that helps people with the travel costs associated with donating. It’s called the National Living Donor Assistance Center (NLDAC), and it’s funded by the federal Department of Health and Human Services (HHS), which administers Medicare. But the group helps a relatively small number of donors.
...
"NLDAC can pay for “travel, lodging, meals, and incidental expenses,” but barring regulation from the HHS, it can’t reimburse lost wages or pay for child care for donors. The group is currently running a randomized controlled trial, funded by the Laura and John Arnold Foundation, in a handful of transplant centers where it does reimburse for lost wages to see if offering that increases living donations.

"But NLDAC could adopt that policy nationally, right now, with a simple regulatory change. No action from Congress would be required, according to NLDAC’s own analysis. The HHS can, on its own, issue a rule permitting NLDAC to reimburse lost wages and child care expenses. And randomized trial aside, we already have strong reason to think that reimbursing lost wages would significantly increase donations.
...

"Waitlist Zero has been pushing this change, and Rep. Matt Cartwright (D-PA), a leader in Congress on kidney issues, is on board. Curiously, the National Kidney Foundation, perhaps the most high-profile nonprofit working on kidney issues, has declined to back this modest change. Troy Zimmerman, the group’s vice president of government relations, told me on the record that the group “supports the concept of paid leave for living donors but has not taken a position on this specific proposal.”

Their reluctance to vocally support this move is puzzling and frustrating. Letting NLDAC cover lost wages is a very modest change that would clearly help people, and move us closer to a world where there are finally enough donors to end the waitlist of people whose lives depend on a kidney transplant."

**********

Here are some earlier posts about NLDAC (I've been on their advisory board since 2016):

Saturday, July 21, 2018  Effects of removing some financial dis-incentives to kidney donation through the National Living Donor Assistance Center (NLDAC)

Tuesday, October 3, 2017  The effect of paying the travel expenses of living kidney donors: Schnier et al. on NLDAC

Thursday, December 22, 2016 NLDAC announces a trial of Lost Wages Reimbursement for Living Organ Donors (funded by the Arnold Foundation)

Tuesday, September 27, 2016 National Living Organ Donor Assistance Center (NLDAC)

Kim Krawiec on repugnance to monetary markets

Kim Krawiec has a forthcoming article in the Journal of Institutional and Theoretical Economics (JITE), focusing on repugnance, using global kidney exchange as a main example:

Kidneys without Money 

 Krawiec, Kimberly D.

Appeared or available online: November 27, 2018

Kidneys without Money
by Kimberly D. Krawiec

"Market design and matching have been especially important for markets in which the use of money is viewed as repugnant or distasteful. This article employs the example of kidney exchange, with a particular focus on a new form, global kidney exchange (GKE), to highlight the manner by which repugnance and the law limit exchange and create scarcity. Yet it also opens the door to innovation that, at each stage of market development, prompts new repugnance concerns and initiates a renegotiation of legal rules, social norms, and institutional barriers."


It is accompanied by commentaries, also focusing on repugnance:

Kimberly D. Krawiec
Kidneys without Money
DOI: 10.1628/jite-2019-0003

CommentsI. Glenn Cohen
On Repugnance, Distribution, and the Global Kidney Exchange
DOI: 10.1628/jite-2019-0004

Weyma Lübbe

Understanding (One's Own) Repugnances
DOI: 10.1628/jite-2019-0005

****************
Here's the updated reference
 Kidneys without Money
by Kimberly D. Krawiec
Journal of Institutional and Theoretical Economics (JITE)
Jahrgang 175 (2019) / Heft 1, S. 4-19 (16)

Gift-giving cycles: kidney exchange stories from Britain and Israel

The Guardian has a podcast about a British kidney exchange involving three patient-donor pairs. They call it a "chain" but they mean a cycle--it's a cycle of gift giving. You can listen at the link.

Would you give your kidney to a stranger?
The UK’s living donor scheme allows six people to enter a chain, and three of them will get a new kidney from a stranger. Rachel Williams speaks to six participants. 

"The UK’s living donor scheme allows six people to enter a chain, and three of them will get a new kidney from a stranger. Such chains are anonymous but, for the first time, the Guardian’s Rachel Williams has brought together six participants.

In today’s episode, we hear from those giving and receiving a kidney, and Williams explains how the matches are made possible. "

*************

And from YNet, a story of a non-directed donor who became a directed donor and part of a cycle with four patient-donor pairs:

The kidney club: Doctors at Beilinson Hospital performed an extraordinary 8-way kidney surgery involving 4 donors and 4 recipients brought together by Matnat Chaim, dedicated to encouraging altruistic kidney donations.

the 4 recipients

"The transplant chain was facilitated by Matnat Chaim, an Israeli non-profit dedicated to encouraging healthy volunteers to donate kidneys to patients requiring a transplant. The organization, which has already facilitated 626 transplants to date, was founded in 2007 by Rabbi Yeshayahu Heber after he found himself needing a kidney, finding a donor and then setting out to help others who were in the same predicament.

"This kidney donor chain began with altruistic donor Benjamin, who donated to a man named Lee. Yardena, Lee’s partner, in turn donated a kidney to a woman named Leah, whose son, Yonatan, donated a kidney to a man named Suheib. Suheib’s mother, Maison, then donated her kidney to a woman named Gil—who was meant to be the original recipient of the kidney donated by Benjamin.

""I approached Matnat Chaim Chairman Rabbi Heber and asked him to help me find a kidney donor," said Gil, 36, adding, "to my delight, Benjamin, a person I don’t even know, agreed to donate his kidney … unfortunately though he wasn’t a match.”

"After tests conducted by doctors at Beilinson ahead of the planned cross-transplant, a possibility arose for Gil to be at the receiving end of a new kidney.

"We have all become like family," Gil continued, “All of us are from a different background—religious, secular, right and left-wing, Jews and Arabs—there is now a special connection between us."
*********

See my previous posts on Matnat Chaim
******

Gift giving rings have for some reason reminded me today of the anthropological literature on gift giving in cycles through Kula rings in New Guinea, studied by the early anthropologist/ethnographer Bronisław Malinowski.

Merry Xmas to all of you for whom today (or yesterday) is a day of gift giving.

Birthright citizenship and birth tourism

Birthright citizenship (i.e. every child born within the country is a citizen) is (perhaps unsurprisingly) a new-world phenomenon: it occurs widely in the Americas, which were populated largely by immigrants.

The map comes from:
Birthright Citizenship in the United States--A Global Comparison

Prosperous countries that give citizenship to everyone born within their borders (regardless of their parents' citizenship) can be attractive places to give birth, particularly if they have good medical care and comfortable surroundings, and particularly for families whose home may be problematic for political or economic reasons.

Birthright citizenship has become a political issue in the U.S. under the Trump administration, as part of a larger repugnance towards immigration.
NY Times: President Wants to Use Executive Order to End Birthright Citizenship
“We’re the only country in the world where a person comes in and has a baby, and the baby is essentially a citizen of the United States for 85 years, with all of those benefits,” Mr. Trump told Axios during an interview that was released in part on Tuesday, making a false claim. “It’s ridiculous. It’s ridiculous. And it has to end.”

While some of that repugnance focuses on countries in Central and South America, there is also an expensive birth tourism market, catering e.g. to families from Russia and China.

Here's a recent story from Bloomberg:
There’s No Stopping the Russian Baby Boom in Miami
But it’s not, the new mothers insist, about the U.S. passport. “Why does Trump think everyone is dying to have one?”

"Being a birth tourist in Sunny Isles Beach isn’t cheap, with agencies charging as much as $50,000 to set up housing, hire interpreters, find doctors and deal with paperwork. Those who can’t afford that level of service buy smaller packages and rent apartments in far-flung suburbs, sometimes teaming up to share lodgings and expenses.
...
"The focus of Trump’s criticism hasn’t been the abuse of the system but the fact that it exists. One of his arguments against birthright citizenship is that when the babies born on U.S. soil become adults, they can petition for their parents to live permanently in the country.

But to many of the Russians in Sunny Isles, at least, this idea sounded unappealing. The biggest deterrent: They’d have to start paying personal income taxes that are more than double what they are in Russia."
********
And a story of a different sort from Newsweek:
FEDS RAID 'MATERNITY HOTELS' WHERE TOURISTS PAID UP TO $80K TO GIVE BIRTH IN U.S.
"Though it’s not illegal to have their babies in the United States, birth tourists usually lie to immigration officials about their reasons for travel, according to an official cited by NBC. The bigger focus, however, are the organizers of websites that targeted women in China and sold the "maternity hotel" stays to them.

"For that reason, authorities did not arrest the women staying in the buildings on Wednesday, but instead will use them as witnesses in an attempt to prosecute the "handlers."
************

And here's a headline that looks like it could come from the U.S., but comes instead from Canada:

Feds studying 'birth tourism' as new data shows higher non-resident birth rates
BY THE CANADIAN PRESS
"OTTAWA — The federal government is studying the issue of “birth tourism” with a view to better understand the scope of this practice within Canada and its impacts.

"This comes as new research published by Policy Options today shows the number of non-Canadian residents giving birth in Canadian hospitals is much higher than in figures reported by Statistics Canada.
...
"Immigration Minister Ahmed Hussen ... says Canada does not collect information on whether a woman is pregnant when entering Canada, nor can a woman be denied entry solely because she is pregnant or might give birth in Canada."

High expectations for legalized marijuana in NY State next year

The NY Times has the story:

Cuomo Moves to Legalize Recreational Marijuana in New York Within Months

"Gov. Andrew M. Cuomo announced that he would push to legalize recreational marijuana next year, a move that could generate more than $1.7 billion in sales annually and put New York in line with several neighboring states.
....
"Ten other states and Washington, D.C., have legalized recreational marijuana, spending the new tax revenue on a range of initiatives, including schools and transportation."

Medical care as a U.S. export

Travel for medical care is sometimes viewed with some repugnance, as the names "transplant tourism" and "fertility tourism" suggest.  (In the case of transplants, particularly from deceased donors, there is sometimes the suggestion that scarce national resources shouldn't be squandered on foreign patients.)  But of course a lot of travel for medical care has to do with going where care is available, and the U.S. hosts many foreign patients. (The availability of pain medicine for palliative end of life care is apparently an issue for some.)  Here's a story from the NY Times that reflects that even travel for ordinary medical care is complex, and can be viewed with some suspicion:

International Patients, Seeking Cures in the States
Are they taking up beds that could be used for vulnerable domestic patients or are they bringing money that could be used toward other programs?


"Each year, tens of thousands of seriously ill people come to the United States hoping to access our acclaimed care. While we do not have exact figures, an economist from the United States International Trade Commission estimated in a 2015 report that between 100,000 and 200,000 international patients per year make this journey. They come with cancer, heart disease and a host of other medical conditions. Most are incredibly sick and see us as their last beacon of hope.

But these patients are not just showing up. Many of our largest and most elite health care institutions seek them out. This is a multimillion-dollar industry, and it is growing. With millions of uninsured and underinsured patients and uncertainty in the domestic health care markets, hospitals are increasingly reliant on patients from abroad to stabilize their bottom line.

...

"Is an international patient “taking up a bed” that could otherwise be used for a vulnerable domestic patient? Or is the international patient providing funds that can be used toward other clinical and research programs?

"While many international patients are wealthy, they too are a vulnerable population. They enter a foreign medical culture, which may have different standards and expectations for doctor-patient communication, especially around sensitive issues like serious illness and death.

"Furthermore, international patients, particularly those from the Middle East, are frequently members of cultural, ethnic and religious minorities. In an age of rising American xenophobia and cultural protectionism, patients and families expose themselves to considerable risk coming to the United States. On a more practical level, recent travel bans have limited families from visiting sick or dying relatives who are already here.

...

"in American hospitals, patients and their families have access to advanced palliative and end-of-life care, which may not be the case in their home countries. For instance, opioids, which can be critical to alleviating suffering in the dying process, are not widely available in some countries.

Surrogacy, same sex marriage, and other Singapore repugnancies

Yesterday I blogged about a court ruling in Britain that, although commercial surrogacy is illegal in Britain, it is legal for a British subject to have a child by legal surrogacy in California.  Today we turn to Singapore, where a court had ruled that a child born by surrogacy to a gay couple could not be regarded as the biological father's child (even by adoption).  A higher court this week modified the decision.  It turns out that in Singapore surrogacy is not legal for unmarried couples, and there is no same sex marriage. In fact, homosexual sex remains a crime in Singapore...

NBC has the story:
Singapore court allows gay man to adopt son in landmark ruling
The ruling comes amid a renewed public push to review Singapore's colonial-era law under which gay sex carries a maximum penalty of two years in jail.

"Singapore's high court on Monday allowed a gay doctor to adopt his biological son, a landmark ruling in the socially conservative city-state that comes almost a year after his initial bid was rejected.

"The decision overturns a 2017 ruling in which a court said the man could not adopt the boy because he was born by a surrogate in the United States through in-vitro fertilization — a procedure not available to unmarried couples in Singapore.

"The ruling also comes amid a renewed public push to review Singapore's colonial-era law under which sex between consenting males carries a maximum penalty of two years in jail, after a repeal of a similar law in India this year.
...
"The man, in a relationship with a same-sex partner, paid $200,000 for a woman to carry his child through in-vitro fertilization in the United States after he had learned he was unlikely to be able to adopt a child in Singapore as a gay man."
*********

It appears that the judge's ruling acknowledged Singaporean law against same sex marriage and same sex relations generally, but felt that the welfare of the child (who otherwise would not have had a legal parent) needed to be given priority.

An English court awards a woman the costs of surrogacy in California (although commercial surrogacy is illegal in the UK)

Here's an unusual story about surrogacy, from the UK, with a legal opinion confirming that paying a surrogate is illegal in Britain, but that British citizens can legally pay a surrogate in California:

Woman left infertile after NHS failed to detect cancer for four years awarded £580k to cover surrogacy costs  by  Telegraph Reporters, 19 DECEMBER 2018

"A young woman left infertile because her cervical cancer was not spotted for more than four years has been awarded the costs of having surrogate children in America by the Court of Appeal.
...
"The High Court awarded XX a total of £580,000 in damages last year, including the costs of fertility treatment, cryopreserving her eggs and having children by surrogacy in the UK.

"However, XX's claim for the costs of four surrogacies in California, where commercial surrogacy is legal and binding, was dismissed as the court found that commercial surrogacy was still illegal in the UK and therefore contrary to public policy.

"But, giving judgment in London on Wednesday, senior judges allowed her appeal, meaning XX will now receive as much as an additional £560,000 to cover the cost of having children with commercial surrogates in the US.

"Her solicitors Irwin Mitchell say the ruling is the first time the costs of surrogacy in the USA have been awarded in a claim for clinical negligence.
...
"Finding that the ban on commercial surrogacy was "expressly limited to acts done in the UK", the judge said that "there seems to me to be an incoherence in depriving her of her claim at the outset when she personally proposes no wrongdoing, either under Californian law or under our own law".
***************
Update: here's an article from The Conversation that attempts to shed some light on the finer points of British surrogacy law.

"Under the Surrogacy Arrangements Act (1985), it is not illegal for a couple to pay a surrogate to carry a baby for them and it is not illegal for the mother to accept payment. However, it is illegal for any other person to take or offer money in relation to surrogate motherhood.

Commercial surrogacy agencies are therefore illegal, as are the activities of individual commercial surrogacy agents. And such commercial deals will not be upheld by the courts. By the terms of the Surrogacy Arrangements Act and section 36(1) of the Human Fertilisation and Embryology Act (1990), no surrogacy arrangement of any sort is enforceable in law."

Regulation of human and animal milk, in the U.S. and France

Here's an article full of interesting observations:

Mathilde Cohen, Regulating Milk: Women and Cows in France and the United States, 65 American Journal of Comparative Law, 469 (2017)


"Much like nineteenth-century milk reformers lobbied for a safe cow's milk supply in the cities, twenty-first-century public health officials are calling for the regulation of human milk.
...
"Milk is peculiar, however, in that, unlike other embodied forms of labor, it is also a food, cutting across species in two ways.15 Humans do not typically eat other humans' body parts or bodily fluids, yet human milk is their primal food.' 6 Humans do not typically turn to animals for sex cells, wombs, or sex, yet they commonly consume animal milk.
...
"The analogy between human and animal milk is sure to offend some. Much of human life and thinking, especially in Western cultures such as France and the United States, is concerned with distinguishing humans from other animals.
...
"I argue that some of the social and legal norms that have shaped the relationship
of the French and Americans to animal milk equally apply to human milk.
Why compare the United States to France? These are two of the biggest dairy consuming and producing countries in the world, 26which regulate animal milk production with little concern for animal welfare. Yet, the French and Americans entertain different cultural and regulatory approaches to human and animal milk, presenting us with a puzzling chiasm. The American sanitary regulation for animal milk is stricter than the French, resulting in a federal ban on raw milk.27 France, the birthplace of pasteurization, 28 is laxer, in part because raw milk is a necessary ingredient in its prized cheeses. With respect to human milk, the picture is reversed. The United States is the more permissive country, a land of no law, where American women can freely trade their milk. In France, human milk is so stringently governed that French women are prohibited from giving their milk to others, even for free, unless they turn to state-controlled milk banks."
...
p486. "In France, at the peak of the wet-nursing profession in the 1880s, close to 100,000 infants were placed in the care of wet nurses-about 10% of the children born in the country at the time."
...
p494. "Under French law the sale of human milk is illegal because milk is considered a bodily part similar to an organ.153 Article 16-1 of the French Civil Code states, "The human body, its elements and its products may not form the subject of a patrimonial right."54 Lactariums possess the exclusive right to process and distribute human milk.1 55 They are prohibited from paying donors for their milk 156-which, incidentally, has resulted in a state of near-constant shortage. Before the HIV/AIDS crisis, lactariums did compensate donors "for the time spent for the milk donation." 157 Since 1992, donors can no longer be indemnified. 158 The official explanation for this shift is that compensation would be contrary to the principle of gratuity of contracts pertaining to bodily parts."
...
p506. "The milk-sharing website, OnlyTheBreast.com, hosts wet-nursing classified ads. A recent example read:
'I am a Surrogate who is due to deliver any time in the next 2-3 weeks. I am an over producer and will not have a child to feed so I am looking for a local family who is in need and would like to provide their baby with liquid gold. I am looking to nurse a baby during work hours (M-F) and can provide pumped milk for over nights and weekends. Occasional weekend feeds can be .'
**************

See my other posts on breast milk.

Insuring your whiskey collection

A word to the financially prudent: don't forget to insure your whiskey collection.
Bloomberg has the story, about American International Group Inc.’s private client group.

What the Rise in Whisky Insurance Tells Us About the Super Rich
AIG’s head of global collections sees younger generations eschewing the collectibles of their forebears.

“Whisky collectors now number in the many hundreds, closing in on 1,000 individual collectors of all stripes and values,” says Fiamma of AIG customers highlighting whisky within their insured collection. “When auction houses are holding two or three whisky auctions a year, with some whisky going for a million or half a million dollars, clearly it warranted attention.”

Australia's parliament reports on organ trafficking

Australia's parliament has published a report on organ trafficking in Australia. They didn't find much trafficking there, but recommend that data be more vigorously collected. They report that only one case of (attempted) paid organ donation has come to the attention of the authorities, but that it was successfully prevented, and the intended recipient died. The report ends with a case study of an anatomical exhibit using human cadavers.

Compassion, Not Commerce:An Inquiry into Human Organ Trafficking and Organ Transplant Tourism

Human Rights Sub-Committee, House of Representatives, Joint Standing Committee on Foreign Affairs, Defence and Trade, November 2018, Canberra

(The above link is the the 178 page pdf version, and here's a link to the table of contents and each chapter separately).

"This report examines the global prevalence of human organ trafficking and the scope of Australian participation within this illicit trade.

...

"2.5...The commercial trade in human organs is near-universally prohibited. Despite these prohibitions and restrictions, the illicit commercial trade in human organs has been estimated by the research advisory organisation Global Financial Integrity to be worth between US$840 million and $1.7 billion globally each year.4 Up to 10 per cent of kidney transplants worldwide may now involve commercially traded organs.
...
"3.15 There has been only one reported case to date of alleged organ trafficking within Australian jurisdiction,
 Alleged case of organ trafficking in Australia
"In 2011, an Australian couple were alleged to have brought a woman from the Philippines to Australia, promising her monetary compensation and a working visa in exchange for a kidney donation.
The woman changed her mind upon arriving in Australia. Medical transplant integrity procedures – a pre-operative counselling session at a Sydney hospital –ensured that the situation was discovered before the removal of the organ.
The potential donor was identified as an alleged victim of organ trafficking, resulting in referral to the Australian Federal Police. Due to the death of the prospective recipient, and limitations of the legislation as then in force, the matter did not progress to prosecution."
...
"3.20 International studies have observed the tendency of patients born in a country where organ trafficking may occur, but living outside of that country, to be at a substantially higher risk of participation in transplant tourism.31 This would appear to be equally true in Australia, as Dr Campbell Fraser observed: "...less than five per cent of Australians who are waiting on organs are likely to even consider going overseas. ...most of the Australians who have purchased an organ overseas have ethnic family connections to the countries or regions where they buy their organs—Pakistani Australians tended to go to Pakistan, Egyptian Australians travel to Egypt, and so on."
...
"Mandatory reporting by medical practitioners
3.41 A large number of submissions and witnesses argued in favour of the establishment of a nationwide mandatory reporting scheme for commercial transplants. A Bill before the Parliament of New South Wales, Human Tissue Amendment (Trafficking in Human Organs) Bill 2016, introduced by Mr David Shoebridge MP, seeks to amend the Human Tissue Act 1983 (NSW). The amendment would, inter alia, require medical professionals to report to the NSW Secretary of Health any reasonable belief that a patient has received a commercial transplant or one sourced from a non-consenting donor.
...
"Case study on alleged human tissue trafficking 
‘Real Bodies’
6.1 The Real Bodies commercial anatomical exhibition, on display in Australia during the course of this inquiry, was brought to the attention of the  Sub-Committee by a number of witnesses and is illustrative of an apparent gap in the current legislation. The Real Bodies exhibition involves the commercial display of 20 plastinated human cadavers, and ‘over 200’ plastinated organs, embryos and foetuses.1
Allegations of the trafficking of organs and other human tissue
6.2Mr David Shoebridge MP of the New South Wales Parliament informed the Sub-Committee as to the nature of the exhibition:...
"[they] are real bodies ... they are displayed in quite grotesque circumstances—some of them literally sawn down the middle and presented as a human standing and divided in two so that you can look into the internal parts of them. There are pregnant women. There are multiple fetuses ... put on display for commercial gain ... it is a grossly exploitative process. The proprietors ... have been asked about the circumstances in which these bodies came into their possession, and they have been unable and unwilling to prove that any of the persons on display ever gave their consent."
**********

Here's an earlier post on repugnance to anatomical exhibits using cadavers:

Saturday, March 28, 2009, Markets for (viewing) bodies

Simons Institute program in Online and Matching-based market design, Fall 2019

Programs

Fall 2019

Online and Matching-Based Market Design

Aug. 21 – Oct. 4, 2019

Economists have developed a deep and rich theory for understanding the evolution and operation of markets, as well as a bounty of empirical methodologies and practical solutions pertaining to particular settings. Computer scientists have developed the powerful "algorithmic way of thinking," which has become a key enabler of the sciences in this century, just as mathematics was in the last. Sophisticated algorithms, such as the stable matching algorithm, maximum matching algorithms, and algorithms for budgeted auctions, have been applied to centralized labor markets, auctions, financial exchanges, the allocation of public goods, etc. However, in the past, this progress proceeded with limited direct interaction between economists and computer scientists.

In recent years, a vibrant IT ecosystem together with the en-masse relocation of our most important activities to online platforms has given birth to enormously influential and innovative online market structures, including online retail markets, ad auctions, short-term housing markets such as AirBnB, online labor markets such as Uber and Upwork, markets for virtual currencies such as Bitcoin and Ethereum, and markets for online dating such as OK Cupid and Match.com. These new applications require a truly interdisciplinary approach to market design. New algorithms include the specification of information available to consumers and feedback across time in dynamic mechanisms, in addition to the rules governing the aggregation of users’ responses. These new components suggest a new strategic environment, where fairness, transparency, and welfare are clear objectives.

As these markets occupy a rapidly increasing fraction of our economy, the time is ripe for bringing together market-design scholars from economics and computer science under the same roof for an extended period of time to address these challenges. This six-week long program has been designed to accomplish precisely that. 

Click here to subscribe to our announcements email list for this program.

Organizers: Vijay Vazirani (UC Irvine; chair), Itai Ashlagi (Stanford), Federico Echenique (Caltech), Nicole Immorlica(MSR, NE), Aranyak Mehta (Google, Mountain View), Leeat Yariv (Princeton and Caltech)

Workshops

Matching and Objectives

Sep. 5 – Sep. 6, 2019

Platform Markets

Sep. 17 – Sep. 18, 2019

Information Design and Data Science

Oct. 1 – Oct. 2, 2019

Those interested in participating in this program should send email to the organizers at this address.

Are uterus transplants repugnant? And to whom? And why? (in the Irish Times)

Here's an article in the Irish Times on uterus transplants , that makes clear the view that the views of those not directly involved should play a large  and perhaps decisive role in public discussions of transactions that some may find repugnant. The author indicates that among his concerns is that the parentage of the baby might be in doubt (i.e. that a child conceived from the eggs and sperm of his genetic parents and carried to birth by his pregnant genetic mother might have to be regarded as the child of the donor of the uterus...). I wonder if even the author thinks this is a serious reason to ban uterus transplants; rather, I get the sense that he is throwing his net widely in the hope that different objections might resonate with different parts of his audience. Maybe his goal is simply to be controversial. [Just to be clear, I am not disagreeing that child welfare is an important concern when evaluating issues related to reproduction and childbirth...but this concern strikes me as particularly far-fetched.]

Are uterus transplants ethically acceptable?
Several infertile women worldwide have given birth with wombs received from either living or dead donors   by George Winter

"In September 2014, the first live birth following UTx was reported from Sweden by Prof Mats Brännström and colleagues. The recipient had Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome – she was born without a viable womb – and the donor was a 61-year-old friend. Since then, there have been at least 12 successful births worldwide following UTx.

"Recently, it was revealed that the first baby had been born following a womb transplant from a deceased donor. Ten previous attempts had been made in different countries to deliver a live baby following a uterus or womb transplant from a deceased donor, but this – performed by surgeons in Brazil – was the first with a successful outcome.

...

"The UTx procedure begins with in-vitro fertilisation, using the recipient’s egg and her partner’s sperm; the subsequent embryo is frozen; a uterus – from a living or dead donor – is transplanted; the embryo is thawed and implanted; and following pregnancy and delivery by Caesarean section, a hysterectomy is performed, obviating the need for lifelong immunosuppressive therapy."

...

"The “Ethical Considerations” section of the Womb Transplant UK website implies that any societal misgivings on the acceptability of UTx will be ignored: “Ultimately, the decision to go forward will depend on the judgment of the researchers, the participating institution, and most importantly, the patient to whom the transplant will be offered.”

"Hardly an unbiased trio.

"What ethical dilemmas might arise?

"If a transplanted uterus were to jeopardise a recipient’s life, it could be removed; but what if it contains a viable foetus? And there is debate over living versus deceased donation, with Spanish and Japanese teams favouring the Swedish “live” model, and French, Belgian and UK researchers preferring deceased donors. Writing in the journal Bioethics, Dr Nicola Williams cites the view of the International Federation of Gynaecology and Obstetrics that “the retrieval of a uterus from a living donor necessitates a relatively major surgery with its own risk of complications [and] constitutes reason enough to deem the procedure ethically inappropriate”.

"Also, how much would a child be entitled to know about the donor from whose uterus he or she issued, and – irrespective of whether the donor had been dead or alive – would the infant be the child of the donor or the recipient?"

***********

George Winter, the author of the piece, apparently writes often on ethical issues in medicine (although the above is the first article I had read by him). See e.g.  his recent related articles on The ethical considerations of face transplants and 
The brave new world of wombless gestation--Artificial womb technology poses many ethical questions – we need to debate them
(that article is about experimental technology about lamb embryos brought to term "in a plastic “biobag” – literally, a womb with a view ..."  I was relieved to note that, in considering the implications for humans, the author didn't raise the question above about the parentage--or in this case perhaps the humanity--of the baby (so maybe he was just kidding.)

**********

And see my related post from yesterday:
Friday, December 14, 2018  Successful birth in Brazil to a woman who received a uterus transplanted from a deceased donor

Successful birth in Brazil to a woman who received a uterus transplanted from a deceased donor

The Lancet reports the first known case of a live birth to a woman born without a uterus who received a transplanted uterus from a deceased donor.

Livebirth after uterus transplantation from a deceased donor in a recipient with uterine infertility

December 04, 2018 DOI:https://doi.org/10.1016/S0140-6736(18)31766-5

Background

Uterus transplantation from live donors became a reality to treat infertility following a successful Swedish 2014 series, inspiring uterus transplantation centres and programmes worldwide. However, no case of livebirth via deceased donor uterus has, to our knowledge, been successfully achieved, raising doubts about its feasibility and viability, including whether the womb remains viable after prolonged ischaemia.

Methods

In September, 2016, a 32-year-old woman with congenital uterine absence (Mayer-Rokitansky-Küster-Hauser [MRKH] syndrome) underwent uterine transplantation in Hospital das Clínicas, University of São Paulo, Brazil, from a donor who died of subarachnoid haemorrhage. The donor was 45 years old and had three previous vaginal deliveries. The recipient had one in-vitro fertilisation cycle 4 months before transplant, which yielded eight cryopreserved blastocysts.

Findings

The recipient showed satisfactory postoperative recovery and was discharged after 8 days' observation in hospital. 

...

The female baby weighed 2550 g at birth, appropriate for gestational age, with Apgar scores of 9 at 1 min, 10 at 5 min, and 10 at 10 min, and along with the mother remains healthy and developing normally 7 months post partum. The uterus was removed in the same surgical procedure as the livebirth and immunosuppressive therapy was suspended.

*************

In Brazil (where commercial surrogacy is apparently illegal, and legal surrogates must be family members of the intended mother), the urge to have one's own baby is nevertheless strong. 

See earlier post:

Wednesday, January 15, 2014

Womb transplants in Sweden (where surrogacy is illegal)