Removing disincentives from kidney donation: pro and con in the American Journal of Kidney Diseases

 Two dueling papers in the American Journal of Kidney Diseases consider the effects of compensating kidney donors to remove disincentives from kidney donation.  The first (by McCormick et al.) suggests that including payments to compensate for risk would increase donation. The second paper (by Danovitch et al.) agrees, but says that this is what would make  compensation unethical, since it is unethical to pay for risk, as that might convince some to donate who otherwise would not.

Reducing the Shortage of Transplant Kidneys: A Lost Opportunity for the US Health Resources and Services Administration (HRSA)

Frank McCormick, Philip J. Held, Glenn M. Chertow, Thomas G. Peters, John P. Roberts   DOI:https://doi.org/10.1053/j.ajkd.2020.10.007 

"If the government removes all of these disincentives, it would not only be a major step toward economic fairness, but it would also significantly increase the number of living donors. "

The True Meaning of Financial Neutrality in Organ Donation

Gabriel M. Danovitch, Alexander M. Capron, Francis L. Delmonico, DOI:https://doi.org/10.1053/j.ajkd.2020.11.006

"Although McCormick et al discuss this principle  in the accompanying Policy Forum Editorial,4 it is our opinion that they distort the meaning of financial neutrality.5 The authors expand the legitimate costs of donation, including travel, lodging, lost work, and other verifiable expenses, to reach a $38,000 fixed payment to donors by including a dollar value for wholly subjective factors such as pain, fear, risk, and quality of life. For example, “risk” is assigned a value of $6,500. These factors are intrinsic to the process of organ donation, and it is disingenuous to include them under the rubric of financial neutrality.

...

"Critically, HRSA explicitly rejects the suggestion that payment be made for “undertaking a ‘risk,’ whether it be a long-term health risk or surgical risk.”

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

I have to assume that people who reject payments for risk live in rural parts of America where we have volunteer fire departments, rather than in cities, where we pay fire fighters, partly for the risk they take.

In a different context, here's a recent post about a paper in the Journal of Medical Ethics that considers payments for risk in vaccine trials:

Thursday, October 29, 2020

Paying participants in challenge trials of Covid-19 vaccines, by Ambuehl, Ockenfels, and Roth

"we note that increasing hourly pay by a risk-compensation percentage ... provides compensation proportional to risk only if the risk increases proportionally with the number of hours worked. (Some risky tasks take little time; imagine challenge trials to test bulletproof vests.) To ensure that equal consequences are compensated with equal amounts across a wide variety of studies, we instead recommend a three-part contract consisting of: (1) salary for time involvement that is adjusted to account for the amount of discomfort experienced during participation, (2) insurance against ex post adverse outcomes and (3) ex ante compensation for risks that cannot be compensated ex post (such as death). Such a scheme also increases transparency about what is requested from participants and thus contributes to high-quality participation decisions."

Congestion in vaccine delivery, and shortage of overall supply: latest news, and a call for increased production

Covid vaccines in many parts of the U.S. are being distributed only slowly, while other places are experiencing shortages.

 The NY Times brings us up to date:

New Pandemic Plight: Hospitals Are Running Out of Vaccines.  Health officials are frustrated that available doses are going unused while the virus is killing thousands of people each day. Many vaccine appointments have been canceled.   By Simon Romero and Giulia McDonnell Nieto del Rio

"In the midst of one of the deadliest phases of the pandemic in the United States, health officials in Texas and around the country are growing desperate, unable to get clear answers as to why the long-anticipated vaccines are suddenly in short supply. Inoculation sites are canceling thousands of appointments in one state after another as the nation’s vaccines roll out through a bewildering patchwork of distribution networks, with local officials uncertain about what supplies they will have in hand.

...

"Health officials trying to piece together why this is happening are puzzled by reports that millions of available doses are going unused. As of Friday morning, nearly 39.9 million doses of the Pfizer-BioNTech and Moderna vaccines had been distributed to state and local governments, but only about 19.1 million doses had been administered to patients, according to the Centers for Disease Control and Prevention....

...

"“Right now, in many cities and counties when an announcement of available vaccinations is made, website sign-up pages crash and phone calls go unanswered"

...

"The public health department in San Francisco and hospitals in the city were “caught by surprise” by the lack of doses, Dr. Rutherford said, and by the eligibility expansion to those 65 and older, which likely strained the system. Varying vaccine distribution channels — such as Kaiser Permanente and the University of California, San Francisco — receive the doses on their own, he said, further complicating an already convoluted distribution system.

“So it’s a little hard for the city to understand exactly what’s left over, what they need to do, where the holes are to fill,” Dr. Rutherford said. Still, new vaccination sites are opening in San Francisco, which Dr. Rutherford said would help speed the process along once more doses become available. “There’s this tension between efficiency and equity,” he said. “It’s never easy.”

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

Here's a paper that points out that getting people vaccinated fast would have enormous benefits in terms of saving lives and reopening the economy, and that once we get the kinks out of vaccine distribution, it makes sense to invest in production facilities much faster than the pharma companies might feel it was necessary to do on their own.

Preparing for a Pandemic: Accelerating Vaccine Availability  By AMRITA AHUJA, SUSAN ATHEY, ARTHUR BAKER, ERIC BUDISH, JUAN CAMILO CASTILLO, RACHEL GLENNERSTER, SCOTT DUKE KOMINERS, MICHAEL KREMER, JEAN LEE, CANICE PRENDERGAST, CHRISTOPHER M. SNYDER, ALEX TABARROK, BRANDON JOEL TAN, WITOLD WIECEK

Abstract: Vaccinating the world’s population quickly in a pandemic has enormous health and economic benefits. We analyze the problem faced by governments in determining the scale and structure of procurement for vaccines. We analyze alternative approaches to procurement, arguing that buyers should directly fund manufacturing capacity and shoulder most of the risk of failure, while maintaining some direct incentives for speed. We analyzed the optimal portfolio of vaccine investments for countries with different characteristics as well as the implications for international cooperation. Our analysis, considered in light of the experience of 2020, suggests lessons for future pandemics.

Mike Rees wins transplant surgeon excellence award for innovations in kidney exchange

Mike Rees, who founded the Alliance for Paired Kidney Donation (APKD), received The American Association of Kidney Patients (AAKP)  2021 MEDAL OF EXCELLENCE AWARD at the American Society of Transplant Surgeons Winter Symposium (January 16),  during the ASTS Awards Ceremony.  In the two-minute video below, he accepts the award for his introduction of Nonsimultaneous Extended Altruistic Donor Chains, Standard Acquisition Charges, and Global Kidney Exchange (GKE).

Forbes interviews Jennifer Erickson on organ donation

 I met Jennifer Erickson when she was at the White House Office of Science and Technology Policy during the Obama administration, and helped organize the White House Organ Summit in 2016.

Here's a story about her in Forbes:

Why Ending The Organ Donation Waitlist Can Save Countless Lives And Billions Of Dollars  by Rob Dube

“You have no budget,” Jennifer’s boss told her. “What you do have is your desk, a phone, and a period of time where people will take your call. You’re here to hustle. You’re here to make something happen for people around the country.

...

"After speaking with experts, Jennifer chose to focus on ending the waitlist for organ transplants. She was drawn in by the enormous problems within the United States’ current organ donation system. The U.S. has the research, resources, and expertise. Yet, “tens of thousands of organs go unrecovered every year!” says Jennifer. “That’s nuts!”

...

"Once the research was compiled, Jennifer found startling information. She uncovered “really troubling issues with inequality,” Jennifer says. Too often, low-income citizens and people of color were left out-of-loop both as donors and recipients. “Research shows that Black families are less likely to be approached about organ donation, and talked to less about it when they actually are.” 

"And although saving lives is always at the forefront of her mind, Jennifer learned how much money the U.S. could save by ending the organ transplant waitlist. “For every patient who gets a kidney transplant,” Jennifer says, “We save a quarter of a million dollars. 

"Most people care more about saving lives—but what an opportunity to save tens of billions a year while helping Americans at the same time. It’s huge, exciting, and we have every reason to get it right.”

"The conversation with Jennifer Erickson continues on the Leading with Genuine Care podcast. "

HT: Frank McCormick

**********

Related post:

Monday, January 13, 2020

The organization of organ donation: Jennifer Erikson and Abe Sutton call for an Office of Organ Policy

Mike Luca on social media bans

 Mike Luca writes, in Wired, about social media bans as part of their design.

Social Media Bans Are Really, Actually, Shockingly Common--Booting Trump didn’t set a precedent. From Yelp to Uber to Airbnb, platforms regularly ban users and content, but too often behind the scenes.

"DONALD TRUMP’S ACCOUNTS have been banned on Twitter, Facebook, and a host of other platforms. Every last one of @realdonaldtrump’s 47,000 tweets vanished from the site in an instant, from the birther lies and election conspiracy theories to the 2016 taco bowl tweet. In an explanatory blog post, the company cited the attack on the Capitol and “the risk of further incitement of violence” that might occur by permitting further Trump tweets. His multiplatform removal has drawn cheers from many, as well as the ire of more than a few Trump supporters. The bans have also raised concerns that the companies had gone too far in exercising their power to shape what users see.

...

"To combat review fraud, Yelp and other platforms flag reviews they deem spammy or objectionable and remove them from the main listings of the page. Yelp puts these into a section labeled “not currently recommended,” where they are not factored into the ratings you see on a business’s page. The goal of approaches like this is to make sure people can trust the content they do see.

...

"Ultimately, removing content can be valuable for users. People need to feel safe in order to participate in markets. And, it can be hard to trust review websites riddled with fake reviews, housing rental websites rife with racial discrimination, and social media platforms that are megaphones of misinformation. Removing bad content can create healthier platforms in the long run. There is a moral case for banning the president. There is also a business case."

SAT eliminates subject tests

 The portfolio of standardized tests available to college admissions offices is shrinking (or at least changing)...

The WSJ has the story:

College Board Eliminates SAT Subject Tests--Decision takes effect immediately, while many colleges already made the exams optional   By Melissa Korn and Douglas Belkin

"The College Board is eliminating SAT subject tests, as the pandemic accelerates a push for changes in college admissions.

"The 20 subject tests have been offered for decades in areas including math, English literature, world history and physics, but have fallen out of favor as a requirement for college applications. Between 2016 and 2019, registrations for the test fell by 8%—and dropped sharply last year, as test sites were closed due to the coronavirus pandemic.

...

"Robyn Lady, director of student services at Chantilly High School in Virginia, applauded the latest move. ...

“Anything that moves us closer to simplifying the process for students and removing barriers is a move in the right direction,” she said, adding that she’d like to see all standardized tests eliminated from college admissions. “This is all about equity and access.”

Vaccine congestion: short planning horizons

 ProPublica has the story:

How Operation Warp Speed Created Vaccination Chaos--States are struggling to plan their vaccination programs with just one week’s notice for how many doses they’ll receive from the federal government. The incoming Biden administration is deciding what to do with this dysfunctional system.       by Caroline Chen, Isaac Arnsdorf and Ryan Gabrielson

"Hospitals and clinics across the country are canceling vaccine appointments because the Trump administration tells states how many doses they’ll receive only one week at a time, making it all but impossible to plan a comprehensive vaccination campaign.

"The decision to go week by week was made by Operation Warp Speed’s chief operating officer, Gen. Gustave Perna, because he didn’t want to count on supplies before they were ready. Overly optimistic production forecasts turned out to be a major disappointment in the rollout of the H1N1 vaccine more than a decade ago, also leading to canceled appointments and widespread frustrations with the government’s messaging.

"This time, however, the most pressing problem isn’t the overpromising of supply. For each of the past three weeks, the federal government got about 4.3 million shots. But the amount that each state is sent has fluctuated as Operation Warp Speed changes the quantities available week by week.

State health officials say the unpredictable shipments have led to chaos on the ground, including the inability to quickly use up all of the doses sent to them. The week-by-week system also makes it hard to plan for the second doses that everyone needs because they come three or four weeks after the initial dose.

...

"The makers of the two authorized vaccines, Pfizer and Moderna, are each contracted to supply 100 million doses by the end of March. But with just 31.2 million delivered as of Jan. 15, according to data from the Centers for Disease Control and Prevention, the companies will need to ramp up their pace to hit their targets."

*********

HT: Peter Cramton

School choice under discussion in Vienna (video, in English and German)

 On Wednesday I spoke about school choice in Vienna.  (Here's the prospectus.)The video is below. (I start speaking around minute 9:30, in English, for 30 minutes, and the subsequent talk and discussion are in German.)

 

(https://www.youtube.com/watch?v=eZgOM6-xdH8&feature=youtu.be)

My understanding is that there will now be some opportunity for the scholars in Vienna to study the current (local) school assignment system used in Vienna, in conjunction with the schools administration.

Congestion in decentralized vaccination

 The news is full of stories of people obsessively refreshing web pages, hoping to get an appointment for a Covid vaccine.

The Washington Post has this story:

Tipsters, tech-savvy kids, pharmacy hopping: How Americans are landing coronavirus vaccines.  ‘It feels like I’m trying to get a Beyoncé ticket,’ said a woman trying to get her mother an appointment  By Fenit Nirappil, Karin Brulliard and Sarah Fowler

"Those searching for a shot face a decentralized system of vaccine distribution operated by cash-strapped public health departments and a disparate network of clinics and medical providers, all crushed by unprecedented demand for a shield against the virus decimating American life.

"While many Americans have had no problem getting shots, others like Cohen have spent hours trying to get vaccinated, to no avail. The challenges in vaccinating people mirror the botched rollout of coronavirus testing as a mix of government and private providers navigate unfamiliar terrain while communicating with the public in different ways.

"Some vaccine appointment websites crashed almost as soon as they launched. Older Americans are enlisting their kids and grandchildren to stay on the phone and keep refreshing websites until they land an appointment. Tiny intelligence networks are forming around the country to scour for morsels of information on how to get a leg up on the vaccine search.

"Claire Hannan, executive director of the Association of Immunization Managers, said these struggles are unavoidable as the federal government defers distribution to localities without the resources to create a centralized sign-up for vaccines or to hold mass inoculation drives.

...

"The Centers for Disease Control and Prevention plans to encourage people to use VaccineFinder as a national resource for finding shots, but a public search function has not launched while supplies are still limited."

A proposed match for English professors, in the Chronicle of Higher Ed

 Here's a proposal for a centralized clearinghouse for new Ph.D.s in English.  It's a thought experiment, unconstrained by considerations of stability.

The Chronicle of Higher Ed 

Medical Residencies Use Automatic Matching. Professorships Should, Too.--A thought experiment in improving a dismal situation.  By Kim Adams

"What would a computerized match look like in faculty hiring? Let’s say that I am applying for a tenure-track assistant professor position in English. I would read job ads from universities and submit the requested application materials, just as I do now. The main difference would be timing. In order for a match to work, all the job ads would need to be posted by a given date, for example, September 1. It would work best if they were all posted in the same place, perhaps the website of the new Faculty Match Program. The application materials would likewise be due at a uniform time, let us say November 1.

...

"The algorithm would be designed to ensure a maximum distribution of candidates across openings. While the number of first round interview requests a candidate could receive would be unlimited, the number of campus visits would be limited to three. The process would prefer to provide each candidate with one campus visit before providing any candidates with a second. This would benefit both parties. A greater number of candidates would receive campus visits than in the current system. And the department conducting the search could rest assured that the candidates matched to their campus were actually interested in taking the job.

...

Colleges would then conduct campus visits and complete the hiring process as usual. Because of the imbalance of candidates and positions, the risk of unmatched candidates would be high (but that’s nothing new). The risk of unmatched positions is small, perhaps smaller than in the current system, under which searches not infrequently fail despite the superabundance of job candidates. Stable matches would mean fewer faculty members who go on the market after one or two years in a position, thereby decreasing the quantity of applications that search committees need to wade through in future cycles.

...

"The failure of the academic-job market is evident to all those involved. The madness of the market is subsuming the process of doctoral education. Without substantial changes, the doctoral degree will lose its value and the market will collapse. Collective action among graduate students and contingent faculty members can draw attention to these issues, but only the unified, cooperative action of deans and presidents can solve them.

Covid vaccine causes outbreak of smoking in New Jersey

 Strategy-proofness is an idea that shouldn't be appreciated only by game theorists.

The NY Times has the story:

Smokers in N.J. Are Eligible for Vaccine. No Proof Needed. New Jersey is one of only two states that has included smoking among the high-risk medical conditions that make people eligible for the Covid-19 vaccine.

More on convalescent plasma for treating Covid-19

Early results concerning the effectiveness of convalescent plasma have been mixed.  Here's a new study, in the NEJM, and reported in the NY Times. (see my earlier posts here.)

Here's the Times story:

Blood Plasma Reduces Risk of Severe Covid-19 if Given Early  By Katherine J. Wu

"A small but rigorous clinical trial in Argentina has found that blood plasma from recovered Covid-19 patients can keep older adults from getting seriously sick with the coronavirus — if they get the therapy within days of the onset of the illness.

"The results, published Wednesday in the New England Journal of Medicine, are some of the first to conclusively point toward the oft-discussed treatment’s beneficial effects."

And here's the NEJM article:

Early High-Titer Plasma Therapy to Prevent Severe Covid-19 in Older Adults

List of authors.

Romina Libster, M.D., Gonzalo Pérez Marc, M.D., Diego Wappner, M.D., Silvina Coviello, M.S., Alejandra Bianchi, Virginia Braem, Ignacio Esteban, M.D., Mauricio T. Caballero, M.D., Cristian Wood, M.D., Mabel Berrueta, M.D., Aníbal Rondan, M.D., Gabriela Lescano, M.D., et al., for the Fundación INFANT–COVID-19 Group*

"BACKGROUND: Therapies to interrupt the progression of early coronavirus disease 2019 (Covid-19) remain elusive. Among them, convalescent plasma administered to hospitalized patients has been unsuccessful, perhaps because antibodies should be administered earlier in the course of illness.

METHODS: We conducted a randomized, double-blind, placebo-controlled trial of convalescent plasma with high IgG titers against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in older adult patients within 72 hours after the onset of mild Covid-19 symptoms. The primary end point was severe respiratory disease, defined as a respiratory rate of 30 breaths per minute or more, an oxygen saturation of less than 93% while the patient was breathing ambient air, or both. The trial was stopped early at 76% of its projected sample size because cases of Covid-19 in the trial region decreased considerably and steady enrollment of trial patients became virtually impossible.

RESULTS: A total of 160 patients underwent randomization. In the intention-to-treat population, severe respiratory disease developed in 13 of 80 patients (16%) who received convalescent plasma and 25 of 80 patients (31%) who received placebo (relative risk, 0.52; 95% confidence interval [CI], 0.29 to 0.94; P=0.03), with a relative risk reduction of 48%. A modified intention-to-treat analysis that excluded 6 patients who had a primary end-point event before infusion of convalescent plasma or placebo showed a larger effect size (relative risk, 0.40; 95% CI, 0.20 to 0.81). No solicited adverse events were observed.

CONCLUSIONS: Early administration of high-titer convalescent plasma against SARS-CoV-2 to mildly ill infected older adults reduced the progression of Covid-19. "

Another pandemic shortage: donor sperm

 Sperm from conventional sperm banks is now in short supply. But there are "known donor" peer to peer websites and Facebook groups for direct donation, without a sperm bank:

The NY Times has the story:

The Sperm Kings Have a Problem: Too Much Demand  By Nellie Bowles

"Many people want a pandemic baby, but some sperm banks are running low. So women are joining unregulated Facebook groups to find willing donors, no middleman required.

...

"“We’ve been breaking records for sales since June worldwide not just in the U.S. — we’ve broken our records for England, Australia and Canada,” said Angelo Allard, the compliance supervisor of Seattle Sperm Bank, one of the country’s biggest sperm banks. He said his company was selling 20 percent more sperm now than a year earlier, even as supplies dwindled.

...

"Michelle Ottey, director of operations at Fairfax Cryobank, another large sperm bank, said demand was up for access to its catalog for online sperm shopping because “people are seeing that there is the possibility of more flexibility in their lives and work.”

...

"About 20 percent of sperm bank clients are heterosexual couples, 60 percent are gay women, and 20 percent are single moms by choice, the banks said.

...

"Each vial from a premium bank can cost up to $1,100. The bank guarantees a vial will have 10 million or 15 million total motile sperm. Each month, during ovulation, a prospective mother (or her doctor) unthaws a vial and injects the sperm.

"The recommendation is to buy four or five vials per desired child, since it can easily take a few months of trying to get pregnant. And since donors sell out fast, if a woman wants two children with the same donor, she needs to be ready with about $10,000.

...

"Apps for finding donors, like Modamily and Just a Baby, popped up. So did Known Donor Registry, where some 50,000 members arrange the giving and receiving of sperm. Facebook groups with tens of thousands of members — where men will post pictures of themselves, often with their own children — began advertising themselves to interested parties.

...

"The legal risk for both parties — risk that a mother will ask the donor for child support, and risk that a donor will want custody — is high, and the laws around this are not consistent in every state. The women who turn to Facebook groups for sperm tend to be unable to afford traditional sperm banks.

Regulating the timing of job search: evidence from the labor market for new college graduates, by Hiroko Okudaira

 

Regulating the timing of job search: evidence from the labor market for new college graduates

Hiroko Okudaira, Doshisha University, Labour Economics, Volume 67, December 2020, 101941

Abstract: In entry-level labor markets, students search for post-graduation positions well in advance of their actual start dates, prompting debates over regulating job search timing. This study examines a unique case concerning the new college graduate labor market in Japan, where a guideline revision successfully delayed the timing of job searches and forced market participants to search under a shorter horizon. Based on differential exposures to the guideline revision across regions, I find that the revision significantly increased the employment rate at graduation. No positive effect was observed on students’ human capital investment. Additional analyses offers one plausible interpretation, that the positive employment effect was driven by thick market externality.

"This paper provides the first evidence on the consequences of regulating job search timing by exploiting the unique case of the new college graduate job market in Japan, where a guideline revision successfully delayed search timing and forced market participants to search under a shorter horizon. 

...

"By 2009, the job search timing advanced to the middle of the junior year, nearly 18 months prior to graduation. In 2010, the biggest business association announced it would revise the guideline and establish a job search start date for the first time since its introduction. 

...

"Unlike previous cases, however, the revision successfully delayed the overall timing due to the closure of a popular online platform until the first date specified in the revision. Because college students start communicating with firms’ personnel via these online platforms by registering for first-step seminars and because these online platforms were so dominant, the market was diluted substantially in that much fewer firms and students were available in the market prior to the first date.

***********

Xiaolin Xing and I included some of the unsuccessful attempts to control the timing of the college graduate market in Japan in 

Roth, A.E. and X. Xing, "Jumping the Gun: Imperfections and Institutions Related to the Timing of Market Transactions," American Economic Review, 84, September, 1994, 992-1044

School choice in Vienna (public talk on January 13)

 I'll give a (Zoom) talk tomorrow in Vienna (talk in English, discussion in German...)  

13JAN

livestream13.01.2021, 18:00WU matters. WU talks.

Type Lecture / discussion 

LanguageLecture in English, Discussion in German 

Organizer WU (Vienna University of Economics and Business) Marketing & Communications

The status quo and the need for reform

This event is organized by the Department of Strategy and Innovation.

When it comes to choosing the right elementary school, a number of factors besides the school’s location can play a role, including how likely it is to even get a place in the chosen school. For this reason, many parents plan their registration strategically. What are the current system’s weaknesses, and what possible approaches could be taken to fix them? Nobel laureate Alvin E. Roth gives us an insight into the design of the computer algorithms used to distribute kids to schools fairly in many cities around the world.

Lecture:

Alvin E. Roth, Winner of the Nobel Prize 2012, Professor of Economics, Stanford University

Anita Zednik, Assistant Professor, Institute for Markets and Strategy, WU

Discussion:

Christiane Spiel, University of Vienna

Christoph Wiederkehr, Executive City Councillor for Education, Youth, Integration and Transparency

Anita Zednik, Assistant Professor, Institute for Markets and Strategy, WU

Moderation:

Ben Greiner, Professor of Empirical Business Research, WU

LIVESTREAM

Remembering the 116th Congress (it fixed Medicare coverage of immunosuppressive drugs for transplant patients)

 This won't be the most memorable thing about the Congress that adjourned in 2020, but it's something positive: up through the end of 2020, inexplicably, Medicare covered only 3 years of immunosuppressive drugs for kidney transplant recipients. This meant that a few hundred patients a year who had no other medical insurance would lose their drugs, and their kidneys, after which Medicare (having refused to pay for the drugs that would have kept the transplanted kidneys working), cheerfully resumes paying for dialysis, which is vastly more expensive (and far less good for the patients).  It looks like Medicare is now going to be the insurer of last resort for such patients, and so they will be both healthier and less expensive.

H.R.5534 - Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020   116th Congress (2019-2020)

"To amend title XVIII of the Social Security Act to provide for extended months of Medicare coverage of immunosuppressive drugs for kidney transplant patients, and for other purposes."

**********

Here's an earlier post, about the previous situation:

Tuesday, September 15, 2009

Penny wise and pound foolish on kidneys and antirejection drugs

Partial strategyproofness: Relaxing strategyproofness for the random assignment problem by Mennle and Seuken in JET

 Most market mechanisms that we encounter in practice aren't strategy proof, and many markets don't admit any strategyproof mechanisms, so we need to have a language to talk about how strategyproof a mechanism is or isn't.  There are a number of approaches to that, and here's a new one.

Partial strategyproofness: Relaxing strategyproofness for the random assignment problem

Timo Mennle  and Sven Seuken, Journal of Economic Theory, Volume 191, January 2021

Abstract: We present partial strategyproofness, a new, relaxed notion of strategyproofness for studying the incentive properties of non-strategyproof assignment mechanisms. Informally, a mechanism is partially strategyproof if it makes truthful reporting a dominant strategy for those agents whose preference intensities differ sufficiently between any two objects. We demonstrate that partial strategyproofness is axiomatically motivated and yields a parametric measure for “how strategyproof” an assignment mechanism is. We apply this new concept to derive novel insights about the incentive properties of the probabilistic serial mechanism and different variants of the Boston mechanism.

Prices and Decentralization Without Convexity: Milgrom's Arrow Lecture at Columbia (video)

 Columbia University Press posts a "video of Paul Milgrom's 2014 Kenneth J. Arrow Lecture that inspired Discovering Prices: Auction Design in Markets with Complex Constraints. Paul Milgrom discusses how prices can guide decentralized resource allocations in environments with non-convexities. His work on auctions led the Royal Swedish Academy of Sciences to award him and Robert Wilson the Nobel Memorial Prize in Economic Sciences for improvement to auction theory and invention of new auction formats."

Prices and Decentralization Without Convexity

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

Related post:

Saturday, May 20, 2017

Discovering Prices, by Paul Milgrom

History and pre-history of kidney transplantation

 From the Hektoen International Journal (starting with an Egyptian papyrus from 1550 BCE):

A brief history of kidney transplantation by Laura Carreras-Planella, Marcella Franquesa, Ricardo Lauzurica, Francesc E. Borràs.  Barcelona, Spain

"The history of kidney transplantation as we know it today began in the 1950s, but other key attempts were made earlier in the twentieth century. The first successful organ transplant was performed by Emerich Ullmann from the Vienna Medical School in 1902 when he auto-transplanted a kidney in a dog from its normal location to the vessels of the neck, where it produced some urine.44,45 In the same year, dog-to-dog and dog-to-goat kidney transplants were performed by Ullmann and Alfred von Decastello, ... In 1906 Mathieu Jaboulay, with Carrel as assistant surgeon (both of them Nobel laureates), performed the first kidney transplantations from goats and pigs to the arms and thighs of humans. Each kidney worked for one hour only ... The first transplantation from a human cadaver was attempted in the USSR by Yurii Voronoy in 1939, although the organ was rejected because of blood group incompatibility and the patient died after two days.

...

"Investigations resumed after World War II with other attempts at human kidney transplantation, especially by two groups in Europe and the United States. In 1946 a human kidney allograft was transplanted to blood vessels in the arm under local anesthesia by a team in Boston.50 The graft only functioned for a short time, but it was long enough to help the patient recover from acute renal failure. This achievement attracted major interest, as did the first transplantation from a live donor performed by Jean Hamburger (who defined the term “nephrology”) in Paris from a mother to her sixteen-year-old son. The transplanted kidney functioned for twenty-two days.51 In 1950, Lawler in Chicago was the first to attempt intra-abdominal kidney transplantation.

"In 1954 at Peter Bent Brigham Hospital (later Brigham and Women’s Hospital) in Boston, Joseph Murray performed the first truly successful living donor kidney transplantation. He received the Nobel prize for this achievement in 1990. The transplant was performed from one monozygotic twin to the other, so there was no histo-incompatibility. This was the first time that a transplanted patient, who had been dying from renal failure, survived for years after the transplant.52 The procedure was met with growing success—one kidney recipient even had a successful pregnancy and delivery—and expanded to other hospitals. 53 The first kidney transplantation in Spain was performed in 1965 at the Hospital Clínic de Barcelona by Antoni Caralps, Pedro Pons, Gil-Vernet, and Magriñá, followed by eight additional transplantations at the same hospital that year.

"However, even though transplantation surgical techniques had greatly improved, good immunosuppressive regimens were still lacking. The use of the newly available azathioprine, prednisolone, or total body irradiation helped during the initial crucial rejection period between identical twins or siblings.54 In the mid-1960s, great improvements were made in the pre-treatment of patients with hemodialysis to enhance health before surgery; organ transportation between hospitals; identification of HLA antigens, discovered by Jean Dausset; development of tissue-typing and lymphocytotoxicity testing; and an increase in kidney transplants, which provided valuable data for improvement.55–57 Methodologies and management were consolidated in the 1970s, and saw the beginning of transplantations from cadaveric donors.

"But the most remarkable breakthrough of this period was the introduction of the calcineurin inhibitors cyclosporine A and tacrolimus. Cyclosporine A was first isolated in 1971 from a soil fungus (Hypocladium inflatum gams) in Norway and studied by Jean-Francois Borel and Hartmann F. Stähelin at Sandoz (now Novartis).58,59 The importance of this drug was reflected in the speed at which it was approved and released to the market in 1983. This small cyclic polypeptide made it possible to reduce the percentage of rejection in the first year after transplantation from 80% to 10%.60 Tacrolimus, somewhat better than cyclosporine A in reducing acute rejection and improving graft survival,61 was isolated from Streptomyces tsukubaensis in the soil of Tsukuba, Japan in 1987. The name tacrolimus derives from “Tsukuba macrolide immunosuppressant,” although it was initially called FK506 because of its target FK506 binding protein (FKBP).62,63,57 Mycophenolic acid, which was first isolated in 1893 from Penicillium glaucum in spoiled corn, was found to possess antibiotic activity but carried many adverse effects.64 A century later, its ester derivate mycophenolate mofetil was synthesized as a safer drug with immunosuppressant action.65,66 Rapamycin, also known as sirolimus and a current first-line immunosuppressant, was first found to be an antifungal metabolite of Streptomyces hygroscopicus. Discovered in Rapa Nui (formerly named Easter Island) in 1964, the name rapamycin comes from the site of its discovery.67–69 It is also abbreviated as mTOR because tor in German means door, and this protein serves as a gateway to cell growth and proliferation.70 Other analogs such as everolimus were synthesized later and are also routinely used in kidney transplantation.71 Although many immunosuppressive drugs are now in use, cyclosporine A and tacrolimus are still key in preventing organ rejection, even fifty years after their discovery."

Vouchers for organ donation, by Kim, Li, and Xu in JET

There are now a number of ways in which an organ donation (or registration as an organ donor) can turn into a future priority for receiving an organ.  Here's a paper from the January JET that looks at an overlapping generation model in which priority vouchers can be inherited by family members. The paper considers how, while this increases the incentive for the patriarch (or matriarch) of a family to register as a deceased donor, inheriting the voucher might reduce the incentive for descendants to donate, since they already have some priority on the deceased donor waiting list.  The paper models how this can be avoided by giving inherited vouchers increased priority when the current recipient registers.

Organ donation with vouchers by Jaehong Kim, Mengling Li, and Menghan Xu,  Journal of Economic Theory, Volume 191, January 2021, https://doi.org/10.1016/j.jet.2020.105159 

Abstract: The ever-increasing shortage of organs for transplantation has motivated many innovative policies to promote the supply of organs. This paper proposes and analyzes a general class of deceased organ allocation policies that assign priority on organ waiting lists to voucher holders to promote deceased donor registration. Priority vouchers can be obtained by self-registering for donation or through family inheritance. In an overlapping generations framework, we find that extending the donor priority benefits to future generations can improve the aggregate donation rate and social welfare. In particular, giving higher priority to voucher inheritors who register for donation is always beneficial regardless of the levels of population growth and care for future generations. By contrast, the efficacy of granting priority to nondonors with inherited vouchers depends on these two sociodemographic factors because of potential free-riding incentives.

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Related post:

Monday, September 26, 2016

The effects of Israel's new organ transplantation law on family consent for deceased donation