A non-simultaneous liver exchange chain at UCSF, and a brief history of liver exchange

 Living donor liver transplants are relatively uncommon in North America compared to Asia.  Liver exchange might help change that. Here are some reports of recent and not so recent liver exchanges, including a non-simultaneous exchange chain  at UCSF, and a simultaneous chain in Canada.  Expect more in the near future.

 (Non-simultaneous chains have become the backbone of kidney exchange in the U.S., so we may start to see longer chains of liver exchange as well.)

Here's the most recent report of a short non-directed donor chain:

Expanding living donor liver transplantation: Report of first US living donor liver transplant chain  by Hillary J. Braun  Ana M. Torres  Finesse Louie  Sandra D. Weinberg  Sang‐Mo Kang  Nancy L. Ascher  John P. Roberts, American Journal of Transplantation, First published: 10 November 2020 https://doi.org/10.1111/ajt.16396

Abstract: "Living donor liver transplantation (LDLT) enjoys widespread use in Asia, but remains limited to a handful of centers in North America and comprises only 5% of liver transplants performed in the United States. In contrast, living donor kidney transplantation is used frequently in the United States, and has evolved to commonly include paired exchanges, particularly for ABO‐incompatible pairs. Liver paired exchange (LPE) has been utilized in Asia, and was recently reported in Canada; here we report the first LPE performed in the United States, and the first LPE to be performed on consecutive days. The LPE performed at our institution was initiated by a nondirected donor who enabled the exchange for an ABO‐incompatible pair, and the final recipient was selected from our deceased donor waitlist. The exchange was performed over the course of 2 consecutive days, and relied on the use and compliance of a bridge donor. Here, we show that LPE is feasible at centers with significant LDLT experience and affords an opportunity to expand LDLT in cases of ABO incompatibility or when nondirected donors arise. To our knowledge, this represents the first exchange of its kind in the United States."

The paper says this about the timing of the surgeries:

"Other centers reporting LPE have performed the donor and recipient operations in four operating rooms simultaneously4, 5 which can be logistically challenging, but addresses concerns regarding simultaneity and equalizing risk. In our case, we performed the operations on sequential days. In doing so, we accepted the risk that, given a good outcome in Recipient 1 on the first day, Donor 2 (the “bridge” donor) might opt out of living donation at the last moment. Reappropriating terminology from the kidney paired exchange (KPE) literature, a bridge donor is defined as someone who donates more than 1 day after their intended recipient received a transplant.12 A recent paper discussing the feasibility of LPE in the United States emphasized that, in the early days of KPE, there was concern that the bridge donor might back out at the last minute and break the chain.13 As a result, kidney donor operations were initially attempted simultaneously. However, a 2018 review of 344 KPE chains between 2008 and 2016 revealed that only 5.6% of bridge donors broke the chain and the majority of these donors developed a medical issue during their time as a bridge donor that prohibited them from completing donation.12 Ultimately, because this occurrence was so infrequent, the authors concluded that simultaneous donor operating rooms for chains are unnecessary and may actually deter potential donors based on logistical issues. "

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And here's a report from Canada of a non-directed donor chain of liver exchange with all surgeries conducted simultaneously (also with the NDD donating to an incompatible patient-donor pair whose donor donated to a patient on the deceased donor waiting list).

Living donor liver paired exchange: A North American first  by Madhukar S. Patel  Zubaida Mohamed  Anand Ghanekar  Gonzalo Sapisochin  Ian McGilvray  Blayne A. Sayed  Trevor Reichman  Markus Selzner  Jed A. Gross  Zita Galvin  Mamatha Bhat  Les Lilly  Mark Cattral  Nazia Selzner, American Journal of Transplantation, First published: 10 June 2020 https://doi.org/10.1111/ajt.16137 

Abstract: Paired organ exchange can be used to circumvent living donor‐recipient ABO incompatibilities. Herein, we present the first case of successful liver paired exchange in North America. This 2‐way swap required 4 simultaneous operations: 2 living donor hepatectomies and 2 living donor liver transplants. A nondirected anonymous living donor gift initiated this domino exchange, alleviating an ABO incompatibility in the other donor‐recipient pair. With careful attention to ethical and logistical issues, paired liver exchange is a feasible option to expand the donor pool for incompatible living liver donor‐recipient pairs.

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Here's a 2014 report from S. Korea:

Section 16. Update on Experience in Paired-Exchange Donors in Living Donor Liver Transplantation For Adult Patients at ASAN Medical Center by  Jung, Dong-Hwan1; Hwang, Shin1; Ahn, Chul-Soo1; Kim, Ki-Hun1; Moon, Deok-Bog1; Ha, Tae-Yong1; Song, Gi-Won1; Park, Gil-Chun1; Lee, Sung-Gyu, Transplantation: April 27, 2014 - Volume 97 - Issue - p S66-S69, doi: 10.1097/01.tp.0000446280.81922.bb

"Between January 2003 and December 2011, approximately 2,182 adult LDLT cases were included in this study. During this period, 26 paired-exchange donor LDLT cases were performed (1.2%).

"Results: Of the 26 paired-exchange donor LDLT cases, 22 pairs were matched due to ABO-incompatibility, and 4 pairs were matched because of cascade allocation of unrelated donors or relatively small graft volume to the recipients. A total of 28 living donors were included in the 26 paired-exchange donor LDLT cases because of inclusion of two dual-graft transplants. Elective surgery was performed in 22 cases, and urgent operation was performed in 4 cases. The overall 1-year and 5-year patient and graft survivals were both 96.2% and 90.1%, respectively.

"Conclusions : Our experience suggests that the paired-exchange donor program for adult LDLT seems to be a feasible modality to overcome donor ABO incompatibility."

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Here's a story of a liver exchange in Texas, between an incompatible pair and a compatible pair.

Saturday, December 28, 2019 A liver exchange in San Antonio, Texas

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Here's a liver exchange in Hong Kong between an incompatible pair and a compatible pair.

Friday, April 4, 2014 An unusual liver exchange in Hong Kong

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Here's a report from two major liver transplant centers in Hong Kong and S. Korea. The Korean team reported 16 donor exchanges conducted over a 6-year period.

Friday, April 9, 2010 Liver exchange

Ethical Payment in Human Infection Challenge Studies in the American Journal of Bioethics

 There are likely more vaccine trials ahead of us, of new vaccines and modifications of old ones to defend against new variants of covid. Here's a just-published paper, written when vaccine trials were still in the future. It's still relevant, because challenge trials (in which volunteers are exposed to a particular virus) can be much more focused than ordinary vaccine trials (particularly as the prevalence of disease begins to decline...see yesterday's post).

Promoting Ethical Payment in Human Infection Challenge Studies

Holly Fernandez Lynch, Thomas C. Darton, Jae Levy, Frank McCormick, Ubaka Ogbogu, Ruth O. Payne, Alvin E. Roth, Akilah Jefferson Shah, Thomas Smiley and Emily A. Largent            

Published online: 04 Feb 2021, The American Journal of Bioethics,  https://doi.org/10.1080/15265161.2020.1854368

Abstract: To prepare for potential human infection challenge studies (HICS) involving SARS-CoV-2, we convened a multidisciplinary working group to address ethical questions regarding whether and how much SARS-CoV-2 HICS participants should be paid. Because the goals of paying HICS participants, as well as the relevant ethical concerns, are the same as those arising for other types of clinical research, the same basic framework for ethical payment can apply. This framework divides payment into reimbursement, compensation, and incentives, focusing on fairness and promoting adequate recruitment and retention as counterweights to concerns about undue inducement. Within the basic framework, several factors are especially salient for HICS, and for SARS-CoV-2 HICS in particular, including the nature of participant confinement, anticipated discomfort, risks and uncertainty, participant motivations, and trust. These factors are reflected in a payment worksheet created to help sponsors, researchers, and ethics reviewers systematically develop and assess ethically justifiable payment amounts.

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Here's a link to the original (long) working paper:

Wednesday, August 19, 2020

The ethics (and some economics) of paying participants in Human Infection Challenge Studies, for a coronavirus vaccine

Human infection challenge trials for Covid vaccine to move forward in UK

 The BBC has this story:

Covid-19: World's first human trials given green light in UK

"Healthy, young volunteers will be infected with coronavirus to test vaccines and treatments in the world's first Covid-19 "human challenge" study, which will take place in the UK.

"The study, which has received ethics approval, will start in the next few weeks and recruit 90 people aged 18-30.

"They will be exposed to the virus in a safe and controlled environment while medics monitor their health.

...

"The Human Challenge study is being delivered by a partnership between the UK government's Vaccines Taskforce, Imperial College London, the Royal Free London NHS Foundation Trust and the company hVIVO, which has pioneered viral human challenge models.Clive Dix, interim chair of the Vaccines Taskforce, said: "We have secured a number of safe and effective vaccines for the UK, but it is essential that we continue to develop new vaccines and treatments for Covid-19.

"We expect these studies to offer unique insights into how the virus works and help us understand which promising vaccines offer the best chance of preventing the infection."

...

"Initially, the study will use the virus that has been circulating in the UK since the pandemic began in March, which is of low risk to healthy adults, to deliberately infect volunteers.

"In time, a small numbers of volunteers are likely to be given an approved vaccine and then exposed to the new variants, helping scientists to find out the most effective jabs - but this phase of the study has not yet been given the go-ahead."

HT: Tom Darton

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And here's a story from the NY Times, which touches on the issue of compensation for participants (and the associated debate about whether that is repugnant):

U.K. Approves Study That Will Deliberately Infect Volunteers With Coronavirus. Researchers hope to learn things about how the immune system responds to the coronavirus that would be impossible outside a lab.  By Benjamin Mueller

"After being exposed to the virus, the participants will be isolated for two weeks in the hospital. For that and the year’s worth of follow-up appointments that are planned, they will be paid 4,500 pounds, or about $6,200. The researchers said that would compensate people for time away from jobs or families without creating too large an economic incentive for people to participate."

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Related posts on challenge trials:   https://marketdesigner.blogspot.com/search/label/challenge

Canadian organ donations down sharply during pandemic

 During the pandemic, Canadian kidney exchange was suspended, and organ donation was sharply reduced.

The ChronicleHerald has the story:

Organ donations down sharply during pandemic  by Andrew Duffy

"Organ donations in Canada have dropped significantly during the pandemic even though COVID-19 has raised the country’s annual death toll.

"Medical officials say organ donations are down 20 to 30 per cent from pre-pandemic levels.

...

"Living donations, including kidney and liver donations, are down 30 per cent, Shemie said, while organ donations from deceased patients have dropped 21 per cent.

"There are a variety of reasons for those declines, he said, starting with the impact of the pandemic on intensive care units (ICUs). Organ donors are identified and managed in ICUs, but those units have been swamped with COVID-19 cases at various times during the past 10 months, he said. Transplant recipients also need to spend time in ICUs recovering from their surgeries.

...

"What’s more, he said, the pandemic has reduced the pool of potential organ donors because the number of people suffering devastating brain injuries has gone down. Lockdown restrictions mean fewer people are driving cars or playing sports with a resultant drop in serious injuries.

...

"More than 20,000 Canadians have died from COVID-19 during the past year, but the disease makes them unsuitable as organ donors. “There are a substantial number of people who are dying, tragically, of COVID, but because they have COVID, they can’t become donors,” Shemie said.

...

"In Italy, transplant doctors have made limited use of donated organs from COVID-19 patients. In that country, people on the transplant wait list who have survived COVID-19 are eligible to receive organs donated by people who have died with the disease, Shemie said.

...

"Canadian Blood Services recently announced that its Kidney Paired Donation program, an inter-provincial organ sharing effort, is back up and running after a temporary pause. "

The 1% Steps for Health Care Reform Project (including kidney exchange)

 The goal of the 1% Steps for Health Care Reform Project is to shift the way we think about health care spending in the US and offer a roadmap to policy makers of tangible steps we as a country can take to lower the cost of health care in the US. We want to leverage leading scholars’ work to identify discrete problems in the US health system and offer evidence-based steps for reform. We will continually update the project with new proposals that are based on the latest academic research.

Here is their full list of Policy Briefs.

Here's one on kidney exchange:

Expanding Kidney Exchange

Authors: Nikhil Agarwal, Massachusetts Institute of Technology; Itai Ashlagi, Stanford University; Michael Rees, The University of Toledo Medical Center; Alvin Roth, Stanford University

Here's one paragraph:

"Policy Proposal: This brief discusses three specific proposals for expanding kidney exchange. First, policy makers should eliminate financial disincentives for participating in kidney exchange platforms by including medical and administrative costs specific to kidney exchange in reimbursements from the Medicare program. Second, policy makers should direct the federal contractor UNOS (United Network for Organ Sharing) to allow kidney exchange chains to be initiated by deceased donors. Third, Medicare should pay for the costs of a global kidney exchange that allows exchanges involving patients in different nations."

And here's some discussion by Nikhil Agarwal with Zack Cooper:

Economics envy: signalling proposals for the radiation oncology match (to reduce congestion and coordination failure)

 Here's a call to introduce signaling into the resident match for radiation oncologists, explicitly modeled after the signaling used in the job market for economists.

I Need a Sign: The Growing Need for a Signaling Mechanism to Improve the Residency Match

Wesley J. Talcott, MD, MBA , Suzanne B. Evans, MD, MPH, 

Int J Radiation Oncol Biol Phys, Vol. 109, No. 2, pp. 329-331, FEBRUARY 01, 2021, DOI:https://doi.org/10.1016/j.ijrobp.2020.09.008

"Increased attention has been directed toward the radiation oncology interview application process, as the COVID19 crisis threatens to exacerbate its many longstanding inefficiencies.1,  2,  3 A signaling mechanism, by which applicants can send a signal indicating strong interest to a strictly limited number of programs, has been discussed in other specialties to remedy similar inefficiencies4,  5,  6 and will be implemented this application cycle by otolaryngology residency programs. We strongly believe our field should similarly take a leading role on this initiative this application cycle.

Such a system is not novel. A signaling mechanism was introduced in the Economics postdoctoral job market match, which has resembled the Radiation Oncology market in terms of applications submitted per applicant and interview invitations per application. Candidates submitting applications have the option to signal to employers with up to 2 “signals of interest.” These signals are sent through a secure portal associated with the American Economic Association,7 rather than through an extrinsic third party. The instructions for the portal encourage applicants not to send signals to their top 2 programs, but instead to programs who would be likely to factor the signal into their interview invitation decision. 

...

"To improve the interview application process, we recommend granting applicants a strictly limited supply of free virtual “signals of interest” that can be submitted via a monitored online portal. An applicant would be allowed to submit up to 2 signals from this portal to programs of interest. Signals must be limited, as value of these virtual signals comes from their scarcity; strict enforcement of a 2-signal limit means received signals convey credible interest, whereas the absence of an accompanying signal (the case with the vast majority of submitted applications) conveys essentially no information. This system should be free for applicants, to not introduce more financial inequities in this process. The cost to set up the online portal would be minimal given its simplicity, with little overhead once established, and could be shouldered by programs or radiation oncology organizations."

International adoptions temporarily halted in the Netherlands

 The decision by the Netherlands to indefinitely ban international adoptions has generated some controversy.  

The NY Times has the story:

Netherlands Halts Adoptions From Abroad After Exposing Past Abuses.  An inquiry found systemic abuses like child trafficking, lack of record-keeping and government complicity until 1998. Practices have since improved, the government said, but not enough.   by  Claire Moses

"The Netherlands has temporarily halted all adoptions from abroad after an investigation found that the government had failed to act on known abuses, including child theft and trafficking, between 1967 and 1998.

“Adoptees deserve recognition for mistakes that were made in the past,” Sander Dekker, the minister for legal protection, said on Monday, as the results of the investigative report were made public

...

"The government formed an independent commission in 2018 to look into international abuses after a lawsuit showed that the Dutch government had been involved in an illegal adoption from Brazil in 1980, and pointed to the possibility of more such cases. Experts said they knew of no other Western country that had stopped international adoptions.

"In its report, the commission said it had found systematic wrongdoing, including pressuring poor women to give up their babies, falsifying documents, engaging in fraud and corruption, and, in effect, buying and selling children. In some cases, the Dutch government was aware of misdeeds in adoptions from Bangladesh, Brazil, Colombia, Indonesia and Sri Lanka, but did nothing about them and allowed them to continue, the report said.

"“The intercountry adoption system itself served as a kind of ‘child-laundering’ mechanism, as children who were put up for adoption under suspect circumstances could be transformed into legitimately adopted children,” the commission reported. It described the creation of an adoption market and the conversion of children into “tradable goods,” a system that could be “categorized as an abuse.”

"The government froze new applications for international adoptions, though pending adoptions can be completed, Mr. Dekker said.

...

“We need a permanent stop,” to adoptions from abroad, Mr. Westra said.

"Many others disagreed.

"Sander Vlek, the chairman of the National Organization for Adoptive Parents and the father of two adopted children from South Africa, said the decision to suspend international adoptions was made hastily, without input from Parliament or scientific research about contemporary adoptions.

“This severely disadvantages children for whom parents will no longer be available,” he said.

...

"Another group, the Dutch Adoption Foundation, said in a statement that the years of misdeeds were “painful and sad,” but warned that a ban could push adoptions into a black market. The foundation urged Parliament not to agree to the suspension in international adoptions.

"The foundation said it was “unpleasantly surprised” about the “draconian” decision. “This affects the children who gain most from adoption,” it said."

HT: Stephanie Wang

New York State's new surrogacy law takes effect

NBC has the story:

No Longer an Outlier: New York Ends Commercial Surrogacy Ban.  New York's longstanding ban on commercial surrogate pregnancy is about to end nine years after a bill to rescind it was first introduced.    By David Crary

"Instead of being a national outlier, New York will become a leader, according to experts on surrogacy . They say the new law, passed in April and taking effect on Monday, has a surrogates’ bill of rights providing the nation’s strongest protections for women serving as surrogates.

"Among the provisions: the right to independent legal representation, a guarantee of comprehensive medical coverage, and the right to make their own health care decisions, including whether to terminate or continue a pregnancy.

“We went to California because it had the best laws,” Hoylman said. “Now New York has the best law. We think it’s a model for other states.”

"The new law allows gestational surrogacy on a commercial basis, involving a surrogate who is not genetically related to the embryo. An egg is removed from the intended mother, fertilized with sperm and then transferred to a surrogate — in contrast to so-called traditional surrogacy that involves an egg from the surrogate. The gestational option is welcomed by many LGBTQ people who want to be parents, as well as by couples struggling with infertility.

"With the change in New York, surrogacy advocates say only Louisiana and Michigan have laws explicitly prohibiting paid gestational surrogacy. Nebraska has no explicit ban, but a statute there says paid surrogacy contracts are unenforceable.

...

"Gestational surrogacy routinely costs between $100,000 and $150,000. Hoylman declined to estimate the total costs incurred by him and Sigal but said, “It was worth every penny.”

"Among the standard costs are fees for lawyers and the surrogacy agency, the cost of in vitro fertilization, plus compensation and health insurance for the surrogate. Compensation rates vary widely — generally $25,000 to $50,000.

"The first bill seeking to repeal the New York ban was introduced by Assemblywoman Amy Paulin in 2012, the year Hoylman was elected to the Senate. It floundered for years in the face of staunch opposition by the Roman Catholic Church and some feminists, who argued that paid surrogacy led to the exploitation of women.

“Under this bill, women in economic need become commercialized vessels for rent, and the fetuses they carry become the property of others,” renowned feminist Gloria Steinem wrote to lawmakers in 2019.

"New York Gov. Andrew Cuomo, who earlier in his tenure pushed hard to legalize same-sex marriage, argued in response that the surrogacy ban was “based in fear, not love” and was especially harmful to same-sex couples."

HT: Nick Arnosti.

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Here's a related story from the NY Times:

Meet the Women Who Become Surrogates. New York State will now allow gestational surrogates to carry babies for other parents. Here’s why they do it.   By David Dodge

"In 1995, Lisa Wippler, having recently retired from the Marines, moved with her husband and two young sons to Oceanside, Calif., and was contemplating her next chapter in life. The answer came while lying in bed one night, reading an article about infertility.

...

"Last year, Ms. Wippler — by this point a three-time surrogate herself — was part of a delegation of surrogacy advocates who traveled to Albany, where she had the opportunity to share her story with lawmakers considering whether to legalize the practice in New York State.

...

"In her advocacy work, Ms. Wippler said, she has been befuddled to hear the arguments put forward by opponents — some of whom contend the surrogacy industry preys on poor and vulnerable women.

“I’m a retired Marine,” she said. “I can guarantee you no one coerced me.”

...

"A surrogate’s compensation varies by a number of factors, including geographic location and whether she is a first time or experienced carrier. At the Los Angeles-based agency where Ms. Wippler now works as the director of surrogate admission, the range falls between $30,000 and $60,000, which is typical across the industry in the United States, she said."

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Earlier post: 

Wednesday, April 22, 2020

Surrogacy finally becomes legal in New York

Multiple queues for Covid vaccines, as pharmacies join the supply chain

 It is good news that pharmacies are now being included among the places that can dispense Covid vaccinations, because not everyone is connected to another kind of health care provider.  But it will not end the congestion in getting appointments and delivering vaccines.

Having multiple waiting lists for appointments--i.e. for appointments at different pharmacy chains, health care providers, county vaccination centers--will add to congestion. People will have incentives to make appointments with more than one provider, because supplies at each provider are uncertain, so that some appointments may be cancelled due to shortages of vaccine on the appointed date.  After getting vaccinated, at least some people will neglect to cancel their other appointments, and so some doses of vaccine will not be delivered when scheduled. (Hopefully they won't be wasted).  So vaccinations will still be slower than we might hope.

Here's a CBS report:

Pharmacies now offering COVID-19 vaccines: Here's what you need to know BY KATE GIBSON

"The federal government this week started sending supplies of COVID-19 vaccines to 21 national drugstore chains and to independent pharmacies in a move to accelerate distribution. The program will be implemented in stages, based on available vaccine supplies, according to the U.S. Centers for Disease Control and Prevention.

...

"National drugstore chains CVS Health and Walgreens are among those getting supplies of COVID-19 vaccines from the federal government. But getting a shot isn't as easy as walking through the pharmacy door. Consumers are instead being discouraged from flocking to the stores, but rather get in line by making an appointment online or the phone. "

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Here's the CDC site:

Pharmacies Participating in the Federal Retail Pharmacy Program

Margo St. James, (1937-2021) fought to make sex work safer, and legal

 The NY Times has the story

Margo St. James, Advocate for Sex Workers, Dies at 83.  She founded a group called COYOTE (Call Off Your Old Tired Ethics) and devoted her life to the cause of decriminalizing prostitution.

"Ms. St. James sought to reframe prostitution as a profession with legitimate workplace and human rights issues rather than as something sinful. (An ally, Carol Leigh, coined the term “sex worker” in the early 1980s, and Ms. St. James helped popularize it.)

"“There is no immorality in prostitution,” she would often say. “The immorality is the arrest of women as a class for a service that’s demanded of them by society.”

"A media-savvy activist, Ms. St. James invested her crusade with showmanship. She organized an annual Hooker’s Ball, a fund-raising event that celebrated sex workers and drew politicians, police officers and movie stars. The balls reached their zenith in 1978 with 20,000 attendees filling the Cow Palace in San Francisco.

...

"She also established a free health clinic, the St. James Infirmary, which was run by and for sex workers in the Bay Area — one of the first of its kind in the world."

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Here is the St. James Infirmary, "a peer-based occupational health and safety clinic for sex workers of all genders.

"It is our mission to meet the needs of people engaged in the sex trade through advocacy, direct services, and social justice."

Along with providing medical care, they host a "Bad Date List" on their website: "The Bad Date List is a community-based violence intervention tool utilized by sex workers to share information regarding “bad dates.” A Bad Date may be any person who threatens, behaves violently towards, robs, extorts, or engages in any behavior that violates the agreed upon terms and boundaries of the exchange. This list may also be used to report bad encounters with law enforcement."

Surrogacy still repugnant (and illegal) in Michigan

Michigan is now one of only a handful of U.S. states that criminalize commercial surrogacy and/or don't recognize (or severely restrict) parental rights in gestational surrogacy. The NY Times has the story about Michigan resident surrogate parents of twins, from their own eggs and sperm, who have to jump through hoops to adopt them.

Couple Forced to Adopt Their Own Children After a Surrogate Pregnancy. Tammy and Jordan Myers will have to adopt their twins after two Michigan judges denied them parental rights because the children had been carried by a surrogate.  By Maria Cramer

"Twice, judges have denied their requests to be declared the legal parents of the twins, even though a fertility doctor said in an affidavit that the babies are the couple’s biological children. In separate affidavits, the surrogate and her husband have agreed that the Myerses are the parents of the twins.

"The Myerses have started the adoption process, which will entail home visits from a social worker, personal questions about their upbringing and their approach to parenting, and criminal background checks. They said they have already submitted their fingerprints.

...

In 2020, New York passed a law that lifted its ban against compensating women who act as surrogates. Louisiana prohibits compensating surrogates but recognizes agreements or contracts in which a woman has volunteered to be a surrogate, Mr. Vaughn said. The state allows such agreements only for married heterosexual couples.

"But Michigan has a far-reaching law that does not recognize any agreement with a woman who agrees to be inseminated or implanted with an embryo, he said. The law also does not recognize the parental rights of the intended parents.

...

"Under Michigan’s law, paying a woman to act as a surrogate is a felony punishable by up to five years in prison and a $50,000 fine, said Melissa Neckers, the lawyer for the couple.

...

"In 2015, the Myerses were trying to have a second child when Ms. Myers, 39, learned she had breast cancer. She immediately had her eggs harvested before undergoing multiple surgeries, including a partial hysterectomy and a bilateral mastectomy.

...

"In a post on Facebook, the couple described their story and need to find an unpaid volunteer who would be willing to help them have a baby. Ms. Vermilye, 35, who also lives in Grand Rapids, read the post and sent them a note saying she was interested.

“My husband and I had talked about how I had a gift of carrying and delivering very easily,” said Ms. Vermilye, who has a girl and a boy who are 6 and 9. “We felt like it was kind of unfair that we had it so easy and have friends and family that don’t."

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The United States Surrogacy Law Map.  State-by-State Gestational Surrogacy Law & Statutes

European Network for Collaboration on Kidney Exchange Conference next Friday

 David Manlove writes to announce a conference on kidney exchange next Friday, via Zoom, on Central European Time:

"Day of talks on kidney exchange (ENCKEP Final Action Conference) - Friday 19 February

The Final Conference of the ENCKEP COST Action (European Network for Collaboration on Kidney Exchange Programmes) will take place on Friday 19 February 2021, showcasing results from the Action and featuring external speakers.  See https://www.enckep-cost.eu/ and https://www.cost.eu/actions/CA15210 for more information about ENCKEP.  Some talks may be of interest to a wider audience, hence we are advertising this event beyond ENCKEP.

Please register via https://www.eventbrite.co.uk/e/enckep-action-conference-and-training-school-tickets-138925575135 to obtain the Zoom link.

Schedule: all timings are Central European Time (CET), GMT+1 

Friday 19 February, Morning

0930-1000: Fairness models for multi-agent kidney exchange programmes, Xenia Klimentova, Ana Viana, João Pedro Pedroso, Nicolau Santos

1000-1030: Novel Integer Programming models for the stable kidney exchange problem, Xenia Klimentova, Péter Biró, Ana Viana, Virginia Costa, João Pedro Pedroso

1030-1100: New algorithms for hierarchical optimisation in kidney exchange programmes, Maxence Delorme, Sergio García, Jacek Gondzio, Joerg Kalcsics, David Manlove and William Pettersson

1100-1130: break

1130-1200: Measuring the gains of the participation of compatible pairs to  kidney exchange programs at a local level, Péter Biró, Radu Mincu, Lucrezia Furian, Antonio Nicolò

1200-1230: Long term simulation analysis of deceased donor initiated chains in kidney exchange programs, Utkarsh Verma, Narayan Rangaraj

Friday 19 February, Afternoon

1400-1430: Demonstration of the ENCKEP simulator, Xenia Klimentova / Péter Biró

1430-1500: Presentation of ENCKEP simulator results, Christian Jacquelinet

1500-1515: Transnational collaboration: the Scandiatransplant Exchange Programme, Tommy Andersson

1515-1530: Transnational collaboration involving the Czech Republic, Austria and Israel, Jiří Froněk

1530-1600: break

1600-1615: Transnational collaboration: the Australian and New Zealand Paired Kidney Exchange (ANZKX) Programme, Paolo Ferrari

1615-1645: Maintaining KPD while building LPE during a pandemic: the U.S. Experience, Ruthanne Leishman

Best regards,

David Manlove (ENCKEP Chair)"

Economics at the extremes (of gender and salary): UC Berkeley report

 This report includes two figures in which the discipline of Economics is near one of the extremes.  The regression models on gender and salaries are interesting too.

UC BERKELEY FACULTY SALARY EQUITY STUDY, ANNUAL UPDATE, 2020  OFFICE OF THE VICE PROVOST FOR THE FACULTY, DECEMBER 2020

Equity v. efficiency in vaccination

Here's a sad story from the NY Times, as we struggle with getting people vaccinated, while making sure that everything is fair and square:

The Vaccine Had to Be Used. He Used It. He Was Fired.  By Dan Barry

"The Texas doctor had six hours. Now that a vial of Covid-19 vaccine had been opened on this late December night, he had to find 10 eligible people for its remaining doses before the precious medicine expired. In six hours.

...

"The doctor figured that if he returned the open vial to his department’s almost certainly empty office at this late hour, it would go to waste. So as he started the drive to his home in a neighboring county, he said, he called people in his cellphone’s contact list to ask whether they had older relatives or neighbors needing to be immunized.

...

"The next morning, he said, he submitted the paperwork for the 10 people he had vaccinated the previous night, including his wife. He said he also informed his supervisor and colleagues of what he had done, and why.

"Several days later, the doctor said, that supervisor and the human resources director summoned him to ask whether he had administered 10 doses outside of the scheduled event on Dec. 29. He said he had, in keeping with guidelines not to waste the vaccine — and was promptly fired.

"The officials maintained that he had violated protocol and should have returned the remaining doses to the office or thrown them away, the doctor recalled."

London Metals Exchange proposes to end in-person trading

 Another colorful market mechanism looks set to bite the dust, replaced by electronic/computerized trading.

The WSJ has the story:

After 144 Years, London Metal Exchange Proposes Closing Trading Ring  By Joe Wallace

"The London Metal Exchange is proposing closing its open-outcry ring, where traders have swapped metals like copper and lead using shouts and hand signals for 144 years, in a bid to attract more financial players.

"The LME temporarily closed the ring when Covid-19 ripped through the U.K. in March, judging the tight circle of red couches that dozens of traders crowd around to be a health risk. The exchange, owned by Hong Kong Exchanges & Clearing Ltd. 388 3.94% , is now proposing shutting it for good.

"The ring began life when the LME was founded above a London hat shop in 1877, though its origins date to sawdust circles around which merchants bought and sold metals in the early 1800s,

...

"If the change goes through, the LME would join CME Group’s New York Mercantile Exchange, which closed its open-outcry trading floor in lower Manhattan in 2016. The LME said it planned to lay out its next steps by the end of June after feedback from market participant

...

"Trading in the ring takes place in frenetic five-minute sessions. To avoid miscommunication amid the hubbub, dealers use hand signals to convey orders. Three fingers facing down, for example, indicates that they would like to sell metal for a price ending in three. It is assumed that every dealer knows the previous digits.

"Though much trading had migrated to the LME’s electronic platform before the pandemic, many market participants still routed orders through ring members. Some thought that open-outcry remained the best way to set closing prices that are used as reference points in metal contracts globally"

Understanding Big Data:Data Calculus In The Digital Era : report from the Luohan Academy

 Here's a new report from the Luohan Academy

Understanding Big Data:Data Calculus In The Digital Era   Feb 05, 2021 

Authors

Luohan Community: Patrick Bolton, Bengt Holmström, Eric Maskin, Sir Christopher Pissarides, Michael Spence, Tao Sun, Tianshu Sun,Wei Xiong, Liyan Yang

In-house: Long Chen, Yadong Huang, Yong Li, Xuan Luo, Yingju Ma, Shumiao Ouyang, Feng Zhu

From the foreword: "The pervasive use of digitized information has reached a new height that we call the era of "big data." While this has led to unprecedented societal cooperation, it has also intensified three major concerns: How can we properly protect personal privacy in the age of big data? How do we understand and manage the ownership and distribution of benefits and risks arising from the use of data? Will the use of big data lead to "winner-take-all" markets that undermine competition to the detriment of consumers and society? "

From the conclusion: "While acknowledging the challenges of privacy and data security risks, we have explored how such risks can be effectively and efficiently managed through a middle ground of government and industry self-regulation. With the right design of mechanisms and technologies, it has become increasingly possible to maintain anonymity, collect and share data while avoiding the sharing of personally identifiable information and reducing privacy and security risks, while still allowing data to freely flow. With the right technologies, the benefits of data sharing do not have to conflict with unacceptable risks to privacy. There is a way forward to capture the enormous benefits of big data while mitigating its risks, the goal of efficient and effective privacy protection. 

"One major issue is data ownership. Giving ownership of data to users who are the subjects of the data may seem like a natural safeguard of privacy. But exclusive ownership would run up against the efficient use of data as a non-rivalry good. In practice, individuals are seldom willing to make the effort of producing and recording data. In the language of economists, the private provision of a public good is generally inefficient. In addition, most people on the street do not have the capacity to mine and create big data for innovation. Data producers -- engineers at information technology firms -- do.

...

"We conclude by recommending the following three principles for governing the market for digital data:

Principle 1: Data ownership by data producers (including data subjects as producers) should be predicated on data integrity, anonymity, and especially the protection of personal and societal privacy.

Principle 2: Privacy protection and data security can to a large extent be achieved by combining state-of-the-art technologies and innovative mechanism designs.

Principle 3: Competition and consumer protection analyses of and policy prescriptions for data-driven markets should take into account the documented pro-competitive and pro-consumer benefits of big data along with any potential for anti-competitive and anti-consumer effects in specific markets."

Repugnant speech: the NYT and the "N word"

 NPR has the story:

Two Prominent 'New York Times' Journalists Depart Over Past Behavior  by David Folkenflik   February 6

"Two widely heralded journalists for The New York Times departed the paper Friday after unrelated episodes of their past behavior received sharp new scrutiny from other media outlets, readers and colleagues.

"Donald McNeil Jr., recognized as one of the nation's leading reporters on COVID-19, left after fallout from the disclosure in The Daily Beast that he had used a racial slur during a New York Times-sponsored trip for high school students. The revelation of his use of the N-word, which he said came in response to a student's query about the appropriateness of the word in a young friend's video, stirred a formal protest among more than 100 of his peers in the newsroom.

...

"In his parting letter to colleagues, McNeil said he had used a racial slur in a context that he had thought defensible at the time, but now realizes was not.

"I was asked at dinner by a student whether I thought a classmate of hers should have been suspended for a video she had made as a 12-year-old in which she used a racial slur. To understand what was in the video, I asked if she had called someone else the slur or whether she was rapping or quoting a book title. In asking the question, I used the slur itself.

...

"In a joint letter to the newsroom, Baquet and Kahn said, "We do not tolerate racist language regardless of intent." They pledged to better define and enforce guidelines on workplace behavior, including "red-line issues on racist language."

Financing drug discovery

 Bloomberg has a nice story about financial innovation in funding drug discovery startups:

Out of Grief, MIT’s Andrew Lo Invented a Better Way to Finance Biomedical Innovation.  A company he inspired, BridgeBio Pharma, is worth $9 billion and is creating cures for orphan diseases   by Peter Coy

"The main factor in the dearth of financing, Lo realized, was the lack of diversification. Let’s say a drug costs $200 million to develop and has only a 5% chance of success. If it does succeed after 10 years of development, it could earn $2 billion a year annually for 10 years. Intriguing, but too much of a lottery ticket for most investors. 

"But what if you could raise $30 billion to fund 150 startups at once? If the success of each was independent—that is, uncorrelated with the success of any other drug in the portfolio—then the chance of at least three becoming blockbusters was 98% and the chance of at least five becoming blockbusters was 87%. Those odds were so attractive, Lo realized, that even conservative fixed-income investors who like single-A-rated bonds would be willing to finance such a fund.

"Lo had been lecturing and publishing papers along these lines for several years when a former student, Neil Kumar, told him he wanted to put Lo’s ideas into practice in a company that would focus on treatments for orphan diseases caused by single-gene defects and cancers with clear genetic drivers. It was a perfect test of the concept because each rare disease was unique; their causes were uncorrelated, as in Lo’s thought experiment.

"Lo made a small investment and was listed as a co-founder of what became BridgeBio Pharma Inc. in Palo Alto, Calif. According to Bloomberg data, the company had a market value of $9.3 billion as of Feb. 4, making Kumar’s 5.6% stake worth more than $500 million. In the webinar, Lo said, “I’m most proud of the fact that they have 20 projects of which four are in Phase 3 trials.” The company anticipates approval of one by the end of 2021 and another by the end of 2022, he said, adding, “These are therapies that would not have been developed” if not for BridgeBio."

Kidney black market at an Afghan hospital

 The NY Times reports today on an Afghan hospital at which people in need of a transplant can buy a kidney.  The report focuses on apparently poor after-care for donors, who are interviewed recovering in nearby apartments.  It would be interesting to know more about how that compares to the situation in neighboring Iran, where there is a legal monetary market for kidneys for transplant.

In Afghanistan, a Booming Kidney Trade Preys on the Poor. Widespread poverty and an ambitious private hospital are helping to fuel an illegal market — a portal to new misery for the country’s most vulnerable.  By Adam Nossiter and Najim Rahim

"The illegal kidney business is booming in the western city of Herat, fueled by sprawling slums, the surrounding land’s poverty and unending war, an entrepreneurial hospital that advertises itself as the country’s first kidney transplantation center, and officials and doctors who turn a blind eye to organ trafficking.

...

"For the impoverished kidney sellers who recover in frigid, unlit Herat apartments of peeling paint and concrete floors, temporarily delivered from crushing debt but too weak to work, in pain and unable to afford medication, the deal is a portal to new misery. In one such dwelling, a half-sack of flour and a modest container of rice was the only food last week for a family with eight children.

"For Loqman Hakim Hospital, transplants are big business. Officials boast it has performed more than 1,000 kidney transplants in five years, drawing in patients from all over Afghanistan and the global Afghan diaspora. It offers them bargain-basement operations at one-twentieth the cost of such procedures in the United States, in a city with a seemingly unending supply of fresh organs.

...

"On the fourth floor of the hospital, three out of four patients in recovery said they had bought their kidneys.

“I feel fine now,” said Gulabuddin, a 36-year-old imam and kidney recipient from Kabul. “No pain at all.” He said he had paid about $3,500 for his kidney, bought from a “complete stranger,” with an $80 commission to the broker."

...

"“My father would have died if we had not sold,” said Jamila Jamshidi, 25, sitting on the floor across from her brother, Omid, 18, in a frigid apartment near the city’s edge. Both had sold their kidneys — she, five years ago, and he, one year ago — and both were weak and in pain."

Senate Finance Committee subpoenas UNOS

 There's a new sheriff in town in Washington, and Congress is taking note by investigating UNOS, the United Network for Organ Sharing, which is in charge of administering the allocation of deceased organs for transplant.

The United States Senate Committee on Finance yesterday issued the following announcement:

Grassley, Wyden Subpoena the United Network for Organ Sharing as part of Continued Investigation into U.S. Organ Transplant System

Washington – Senate Finance Committee leaders Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.) yesterday issued a subpoena to the United Network for Organ Sharing (UNOS), compelling production of documents related to the committee’s investigation of organ procurement organizations (OPOs), and potential false claims submitted to government benefit programs. The Committee determined that issuing a subpoena was necessary in order to receive full and complete production from UNOS.

 

Senators Grassley and Wyden issued the following joint statement:

 “We have serious concerns related to UNOS’ role in overseeing our nation’s OPOs, which have been severely underperforming for decades. Our review has shed light on the improper use of Medicare funds, conflicts of interest and gaps in oversight. UNOS has served as the federal government’s contractor, without competition, since 1986, and is responsible for overseeing the Organ Procurement and Transplantation Network established by Congress. UNOS has indicated they will comply with the subpoena and we look forward to continuing our inquiry.”

 "Senate Finance Committee members began inquiries into organ procurement organizations and UNOS, nearly a year ago. Reports have also detailed various gaps and conflicts in UNOS management of the organ donation system, resulting in a failure to properly ensure an effective system operating on behalf of patients across the country.

 "In November 2020, the Department of Health and Human Services (HHS) issued a Final Rule to impose new transparency guidelines on OPOs. Racial equity experts have lauded these OPO reforms, highlighting that OPOs often provide substandard care to patients of color. And given expert projections that COVID-19 may severely increase the demand for kidney transplants in the coming years, it is more important than ever to ensure the OPO system is functioning effectively and in patients’ interests.