Deceased-donor transplants: UNOS in the crosshairs

 There is unprecedented political will aiming towards reform of the system by which organs for transplant are recovered from deceased donors in the U.S. and allocated to patients in need of a transplant.  Here are two opposing views about current proposals to reform or replace the current government contractor in charge of this system, UNOS, the United Network for Organ Sharing..

From NPR:

The Government's Plan To Fix A Broken Organ Transplant System, March 28, 2023

You can listen here:

"For nearly 40 years, the United Network for Sharing Organs (UNOS) has controlled the organ transplant system.

"But that's about to change. Last week, the government announced plans to completely overhaul the system by breaking up the network's multi-decade monopoly.

"For those who need an organ transplant, the process is far from easy. On average, 17 people die each day awaiting transplants. More than 100,000 people are currently on the transplant waiting list according to the Health Resources and Services Administration.

"UNOS has been criticized for exacerbating the organ shortage. An investigation by the Senate Finance Committee released last year found that the organization lost, discarded, and failed to collect thousands of life-saving organs each year.

"Can the government reverse decades of damage by breaking up control? And what does this move mean for those whose lives are on the line?

"The Washington Post's Health and Medicine Reporter Lenny Bernstein, Federation of American Scientists Senior Fellow Jennifer Erickson, and Director at the Vanderbilt Transplant Center Dr. Seth Karp join us for the conversation. Dr. Karp was also a former board member for The United Network for Sharing Organs

*********

And here's an alternate view, by three professors of surgery at the University of California San Francisco Medical Center, saying that the system isn't badly broken at all, and that attempts to fix it may lead to coordination failures that, at least in the short term, will cause additional problems.

From MedPageToday:

Our Organ Transplant System Isn't the Failure It's Made Out to Be. — Upholding the system will save lives  by Peter G. Stock, MD, PhD, Nancy L. Ascher, MD, PhD, and John P. Roberts, MD, March 24, 2023

"Thanks to a robust network of hospitals, nonprofit organizations, and government support, the U.S. remains a leader in organ transplantation. This community, which is managed by United Network for Organ Sharing (UNOS), saves tens of thousands of lives every year. Despite this success, opponents of UNOS are advocating to dismantle the transplant system as we know it.

...

"As transplant surgeons with a long history of involvement with the system -- including one of us (Roberts) serving as a past Board President of UNOS/Organ Procurement and Transplantation Network (OPTN) -- we have intimate knowledge of both its successes and its shortcomings. While UNOS has room to improve operationally -- and is working to do so -- we clearly see the organization's life-changing results in our operating rooms and offices. More work lies ahead, however, such as addressing the fact that a rising number of organs are recovered but not transplanted.

"Neither UNOS nor organ procurement organizations (OPOs), which facilitate recovery and organ offers to hospitals, have control over whether medical centers ultimately accept and transplant organs into patients. Though the former two have taken all the blame to date, this remains an issue that concerns the entire system. Leaving our nation's transplant centers out of this critical discussion is a serious oversight. For our entire system to save more lives, transplant centers need to have clear organ acceptance criteria, the appropriate resources to process available organs, and the tools and flexibility to utilize organs from more medically complex donors.

...

"The recommendations for division of labor as suggested this week by Carole Johnson, administrator of the Health Resources and Services Administration (HRSA), may be well intentioned but present a significant risk of further fragmentation and negative consequences due to a lack of coordination between government agencies and contractors. This coordination is essential for a functional and successful system. UNOS specifically has been handicapped by a meager budget for years, and despite this has a well-developed system. We believe that given the recent 10-fold budget increase by the Biden administration, the current contractor has the potential to rectify the shortcomings that have been highlighted in the press."

*********

Earlier posts:

Sunday, August 14, 2022

More on UNOS in the hot seat and calls for reform of the U.S. deceased donor transplant system

Thursday, March 23, 2023

Health Resources and Services Administration (HRSA) Announces Organ Procurement and Transplantation Network Modernization Initiative.

Pay transparency, horizontally, vertically, and across firms, by Zoe Cullen

 Information architecture is an important part of market design. Here's a nuanced review of pay transparency by Zoe Cullen, dealing with the non-obvious effects of horizontal transparency (letting workers know what similar workers are paid), vertical transparency (finding out how pay proceeds up the career ladder), and cross-firm transparency (what other firms are paying).

Is Pay Transparency Good?  by Zoe B. Cullen, NBER working paper 31060, DOI 10.3386/w31060 March 2023

Abstract: Countries around the world are enacting pay transparency policies to combat pay discrimination. 71% of OECD countries have done so since 2000. Most are enacting transparency horizontally, revealing pay between co-workers of similar seniority within a firm. While these policies have narrowed co-worker wage gaps, they have also lead to counterproductive peer comparisons and caused employers to bargain more aggressively, lowering average wages. Other pay transparency policies, without directly targeting discrimination, have benefited workers by addressing broader information frictions in the labor market. Vertical pay transparency policies reveal to workers pay differences across different levels of seniority. Empirical evidence suggests these policies can lead to more accurate and more optimistic beliefs about earnings potential, increasing employee motivation and productivity. Cross-firm pay transparency policies reveal wage differences across employers. These policies have encouraged workers to seek jobs at higher paying firms, negotiate higher pay, and sharpened wage competition between employers. We discuss the evidence on pay transparency’s effects, and open questions.

And from the conclusions:

"We conclude that “horizontal” pay transparency policies that reveal pay gaps between co-workers at the same firm create unintended spillovers between worker negotiations that lower worker bargaining power and wages. This characterizes the strong majority of pay transparency policies that have been put in place over the past two decades. However, policies that focus on ameliorating information frictions in the labor market more broadly have achieved the objectives of raising wages and equity. “Cross-firm” and “vertical” pay transparency policies have proven potential to increase motivation, allocation of talent, and sharpen competition. These policies are not designed to draw attention to employers who pay similar workers different wages, but instead these policies educate workers about the full range of opportunities to earn higher wages when they make decisions about training, where to apply, and how hard to work. Our evidence on misperceptions suggests low earners have the most to gain from improved access to this information. Pay transparency policies can also have pro-competitive effects by educating employers about market wages, eroding information rents when employers have private knowledge about the value workers bring to the job.

"Cross-firm pay transparency policies have recently gained traction among policy makers. In January of 2023, California and Washington became the second and third states in the U.S. to mandate that employers include a salary range in the job postings external job candidates see, following on the heels of Colorado and New York City. This is a big step toward making pay information available at the time workers are choosing where to direct their applications, and employers expect that this will lead applicants to direct their applications toward higher paying firms, increasing wage competition."

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And here's a quick story about that paper in yesterday's WSJ.

Knowing Everyone’s Salaries Can Light a Fire Under Workers. Seeing a career path to advancement—and believing the process is fair—motivates employees, studies show. By Courtney Vinopal, March 28, 2023

Bride price in China

 The NY Times has the story:

In China, Marriage Rates Are Down and ‘Bride Prices’ Are Up. China’s one-child policy has led to too few women. Grooms are now paying more money for wives, in a tradition that has faced growing resistance.  By Nicole Hong and Zixu Wang

"As China faces a shrinking population, officials are cracking down on an ancient tradition of betrothal gifts to try to promote marriages, which have been on the decline. Known in Mandarin as caili, the payments have skyrocketed across the country in recent years — averaging $20,000 in some provinces — making marriage increasingly unaffordable. The payments are typically paid by the groom’s parents.

"To curb the practice, local governments have rolled out propaganda campaigns such as the Daijiapu event, instructing unmarried women not to compete with one another in demanding the highest prices. Some town officials have imposed caps on caili or even directly intervened in private negotiations between families.

...

"Officials have acknowledged their limited ability to eliminate a custom that many families see as a marker of social status. In rural areas, neighbors may gossip about women who command low prices, questioning whether something is wrong with them, according to researchers who study the custom.

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

Earlier:

Friday, September 28, 2018

Bride price in rural China

Alex Chan

 Congratulations, Alex.

Alex Chan

@alex8chan

·

Mar 24

I will join

@HarvardHBS

as an Assistant Professor next academic year! to the sacrifices my family made for me + their support… #HBS #FirstGen + my advisors who made this dream possible #AlRoth

@MurielNiederle

@LaurenceCBaker

@MichelleM_Mello

@I_am_NickBloom

@SIEPR

@Stanford

And earlier (in October)

Welcome to the club, Alex.

The economics and politics of compensating kidney donors, by McCormick and Held

Political feasibility is an unavoidable consideration in any discussion of compensating kidney donors.  McCormick and Held take the latest a stab at it. 

How to End the Kidney Shortage. Few if any of these news stories lamenting the kidney shortage or touting hightech breakthroughs mention that we already have a solution to the shortage: compensating kidney donors to induce more supply  By Frank McCormick and Philip J. Held, SPRING 2023 • REGULATION (CATO Institute).

"A crucial question remains: what level of compensation should the government offer to kidney donors? The answer is a political judgment call that involves the tradeoff between the number of patients saved from premature death and the probability of getting a particular law or regulation changed.

Junk Fees and Related Pricing Practices

 The White House is taking interest in hidden fees, both  because they interfere with competition on price (e.g. when Ticketmaster reveals fees only as someone tries to complete a purchase), and because they sometimes seem unconscionable.  Here's a White House statement.

The President’s Initiative on Junk Fees and Related Pricing Practices

"The Biden-Harris Administration is taking action on junk fees that hurt Americans’ pocketbooks and the economy."

"Exploitative or predatory fees. Excessive fees that target consumers who have limited alternative options – because they are locked into a product or service, or are otherwise economically vulnerable – can likewise impose a financial burden. As the CFPB explains, a sign of exploitative fees is that they “far exceed the marginal cost of the service they purport to cover.” Bank overdraft fees, which greatly exceed the bank’s cost of credit, and surprise “termination fees” are leading examples."

HT: Susan Athey

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Regarding bank overdraft fees, my sense is that these drive lots of people away from the formal banking system and into the hands of high-interest-rate check cashing and payday loan services. Since we already regulate some debit card fees, I wonder if banks can't be encouraged to have some kind of debit-card-only "checking" accounts. Those would be able to prevent overdrafts, so they should be very cheap to administer, and would allow people to avoid paying very high fees and interest rates to non-bank financial services.

Alcohol and race in Australia

 In the U.S. we certainly have a complicated history around both race and alcohol, but in Australia there may be even more complications, as a recent (limited) ban on alcohol and aborigines is reinstated.

The NY Times has the story

Authorities Reinstate Alcohol Ban for Aboriginal Australians. The reaction to a rise in crime has renewed hard questions about race and control, and about the open wounds of discrimination. By Yan Zhuang

"Mr. Shaw lives in what the government has deemed a “prescribed area,” an Aboriginal town camp where from 2007 until last year it was illegal to possess alcohol, part of a set of extraordinary raced-based interventions into the lives of Indigenous Australians.

"Last July, the Northern Territory let the alcohol ban expire for hundreds of Aboriginal communities, calling it racist. But little had been done in the intervening years to address the communities’ severe underlying disadvantage. Once alcohol flowed again, there was an explosion of crime in Alice Springs widely attributed to Aboriginal people. Local and federal politicians reinstated the ban late last month. 

...

"For those who believe that the country’s largely white leadership should not dictate the decisions of Aboriginal people, the alcohol ban’s return replicates the effects of colonialism and disempowers communities. Others argue that the benefits, like reducing domestic violence and other harms to the most vulnerable, can outweigh the discriminatory effects.

...

"According to the Northern Territory police, commercial breaks-ins, property damage, assaults related to domestic violence and alcohol-related assaults all rose by about or by more than 50 percent from 2021 to 2022. Australia does not break down crime data by race, but politicians and Aboriginal groups themselves have attributed the increase largely to Indigenous people.

"This was a preventable situation,” said Donna Ah Chee, the chief executive of one of these organizations, the Central Australian Aboriginal Congress. “It was Aboriginal women, families and children that were actually paying the price,” she added.

"The organization was among those that called for a resumption of the ban as an immediate step while long-term solutions were developed to address the underlying drivers of destructive drinking. Ms. Ah Chee said she considered the policy to be “positive discrimination” in protecting those most vulnerable."

**********

Of course bans in one jurisdiction can have spillovers into others. Here's a story from the Australian Broadcasting Corporation:

Katherine reports rise in transient visitors since return of Alice Springs alcohol restrictions  By Matt Garrick and Max Rowley

"An outback town struggling with crime and homelessness is seeing an influx of transient visitors, which some believe is a direct impact of new alcohol restrictions in Alice Springs."

Health Resources and Services Administration (HRSA) Announces Organ Procurement and Transplantation Network Modernization Initiative.

Here's a long awaited HRSA announcement, indicating their intent to modernize the deceased organ procurement and allocation system in the U.S.  It's still a bit short on details, but specifically mentions budget increases. In the future it will apparently issue Requests for Proposals from organizations willing to bid on parts of the transplantation allocation system, including software. (I hope HRSA is also thinking about how organ allocation policies will be revised and kept up to date in the future, including the possibility of experimenting with proposed improvements on a regular basis.)

The press release:

HRSA Announces Organ Procurement and Transplantation Network Modernization Initiative. Initiative includes the release of new organ donor and transplant data; prioritization of modernization of the OPTN IT system; and call for Congress to make specific reforms in the National Organ Transplant Act

"[March 22, 2023] Today, the Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services (HHS), announced a Modernization Initiative that includes several actions to strengthen accountability and transparency in the Organ Procurement and Transplantation Network (OPTN):

"Data dashboards detailing individual transplant center and organ procurement organization data on organ retrieval, waitlist outcomes, and transplants, and demographic data on organ donation and transplant;

"Modernization of the OPTN IT system in line with industry-leading standards, improving OPTN governance, and increasing transparency and accountability in the system to better serve the needs of patients and families;

"HRSA’s intent to issue contract solicitations for multiple awards to manage the OPTN in order to foster competition and ensure OPTN Board of Directors’ independence;

"The President’s Fiscal Year 2024 Budget proposal to more than double investment in organ procurement and transplantation with a $36 million increase over Fiscal Year 2023 for a total of $67 million; and,

"A request to Congress included in the Fiscal Year 2024 Budget to update the nearly 40-year-old National Organ Transplant Act to take actions such as:

"Removing the appropriations cap on the OPTN contract(s) to allow HRSA to better allocate resources and,

"Expanding the pool of eligible contract entities to enhance performance and innovation through increased competition.

“Every day, patients and families across the United States rely on the Organ Procurement and Transplantation Network to save the lives of their loved ones who experience organ failure,” said Carole Johnson, HRSA Administrator. “At HRSA, our stewardship and oversight of this vital work is a top priority. That is why we are taking action to both bring greater transparency to the system and to reform and modernize the OPTN. The individuals and families that depend on this life-saving work deserve no less.”

"Today, HRSA is posting on its web site at Organ Donation and Transplantation (hrsa.gov) a new data dashboard to share de-identified information on organ donors, organ procurement, transplant waitlists, and transplant recipients. Patients, families, clinicians, researchers, and others can use this data to inform decision-making as well as process improvements. Today’s launch is an initial data set, which HRSA intends to refine over time and update regularly.

"This announcement also includes a plan to strengthen accountability, equity, and performance in the organ donation and transplantation system. This iterative plan will specifically focus on five key areas: technology; data transparency; governance; operations; and quality improvement and innovation. In implementing this plan, HRSA intends to issue contract solicitations for multiple awards to manage and improve the OPTN. HRSA also intends to further the OPTN Board of Directors’ independence through the contracting process and the use of multiple contracts. Ensuring robust competition in every industry is a key priority of the Biden-Harris Administration and will help meet the OPTN Modernization Initiative’s goals of promoting innovation and the best quality of service for patients.

"Finally, the President’s Budget for Fiscal Year 2024 would more than double HRSA’s budget for organ-related work, including OPTN contracting and the implementation of the modernization initiative, to total $67 million. In addition, the Budget requests statutory changes to the National Organ Transplant Act to remove the decades old ceiling on the amount of appropriated funding that can be awarded to the statutorily required vendor(s) for the OPTN. It also requests that Congress expand the pool of eligible contract entities to enhance performance and innovation through increased competition, particularly with respect to information technology vendors.

"HRSA recognizes that while modernization work is complex, the integrity of the organ matching process is paramount and cannot be disrupted. That is why HRSA’s work will be guided by and centered around several key priorities, including the urgent needs of the more than 100,000 individuals and their families awaiting transplant; the 24/7 life-saving nature of the system; and patient safety and health. HRSA intends to engage with a wide and diverse group of stakeholders early and often to ensure a human-centered design approach that reflects pressing areas of need and ensuring experiences by system users like patients are addressed first. As a part of this commitment, HRSA has created an OPTN Modernization Website at OPTN Modernization (hrsa.gov) to keep stakeholders informed about the Modernization Initiative and provide regular progress updates."

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

Here's a related story in the NY Times:

U.S. Organ Transplant System, Troubled by Long Wait Times, Faces an Overhaul. The Biden administration announced a plan to modernize how patients are matched to organs, seeking to shorten wait times, address racial inequities and reduce deaths.  By Sheryl Gay Stolberg

"The Biden administration announced on Wednesday that it would seek to break up the network that has long run the nation’s organ transplant system, as part of a broader modernization effort intended to shorten wait times, address racial inequities and reduce the number of patients who die while waiting.

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

 Earlier, the Washington Post had a story about how the most recent (current) version of the system  for allocating deceased donors is indeed having some problems, the most serious of which (in my view) is the congestion  involved in placing an organ for transplant. (This congestion involves time in getting an organ accepted, and then transported...)

New liver transplant rules yield winners, losers as wasted organs reach record high. The number of lifesaving liver transplants has plummeted in some Southern and Midwestern states that struggle with higher death rates from liver disease  By Malena Carollo and Ben Tanen

"New rules requiring donated livers to be offered for transplant hundreds of miles away have benefited patients in New York, California and more than a dozen other states at the expense of patients in mostly poorer states with higher death rates from liver disease, a data analysis by The Washington Post and the Markup has found.

"The shift was implemented in 2020 to prioritize the sickest patients on waitlists no matter where they live. While it has succeeded in that goal, it also has borne out the fears of critics who warned the change would reduce the number of surgeries and increase deaths in areas that already lagged behind the nation overall in health-care access.

...

"The new system, called the “acuity circles” policy, has nearly doubled the median distance livers are transported, increased transport costs and coincided with the highest number of wasted livers in nearly a decade, 949 in 2021. That’s 1 in 10 donated livers. The analysis further shows a significant increase in the number of states sending donated livers beyond their own borders. In 2019, before the new policy took effect, 21 states and territories exported a majority of livers they collected. Two years later, 42 did."

IgNobel Prize celebration today: laugh and think

 I'll be joining an IgNoble event this afternoon at Stanford, everyone is invited.

Ig Nobel Prize face-to-face

Health Data Science Center, Wednesday, March 22, 2023, 1:00pm - 3:00pm PDT

Stanford University Rotunda E241 (Chem-H + Wu Tsai Building)

This event is open to the general public

REGISTER HERE to attend

"Our esteemed founder of the prize (and the journal the Annals of Improbable Research), Marc Abrahams, will take us through the fascinating history of the Ig Nobel Prize, from its inception in 1991 to the present day. We will learn about the inspiration behind the award, the selection process, and his most unforgettable moments along the way.

"We will be joined by Professor Alvin Roth (Nobel Economics Prize 2012) who will share his insights in research and active blogging, as well as Dr. Genie Scott (Public Welfare Medal 2010) on her journey with Ig Nobel and improbable research.

"We will hear from some of the brightest minds in research today as our panelists engage in discussions about the significance of improbable research. Our panelists include Alvin Roth (Economics) and Genie C. Scott (Anthropology), past (Ig) Nobel Prize laureates who have made groundbreaking discoveries in fields such as physics, medicine, economics, public policies, and more. 

"Audience members will also have the opportunity to ask questions and engage in the conversation with our panelists, as well as sign up for a meet-and-greet with Marc after the event. 

"Join us for an unforgettable afternoon of laughs, learning, and thought-provoking discussions at the Ig Nobel Prize face-to-face Event!"

The future cannabis market?

 The Washington Post has the story on a big bet on the future of the American cannabis market:

Giant California greenhouse signals a big bet on cannabis legalization. One enormous facility on the northern edge of metro Los Angeles reveals expectations of marijuana becoming legal nationally.  By Scott Wilson

"Graham Farrar has placed the bet here. He is the president and co-founder of Glass House Farms, and the company’s greenhouse offers 5 million square feet of indoor space for cannabis production. That comes to just over 114 acres, the equivalent of about 86 football fields.

...

"Far from the misty northern redoubts of the state’s historic cannabis culture, the crop here grows just a few miles from highway-side outlet malls, an expanding regional airport, and the broad blue-stretch and logo-smile of an Amazon warehouse and distribution center.

"Those neighborhood ambitions help reveal Farrar’s own restless intent — to create a national cannabis business, even though his product, while legal in the Republic of California, remains illegal in the United States of America.

“I have the capacity, when the time is right, to produce on a national scale the best cannabis in the world,” Farrar said during a recent tour.

“And when that happens,” Farrar added, speaking of national legalization, “this farm goes from feeling really big to really small.”

...

"Last year, the California legislature passed a bill to allow licensed California cannabis businesses to sell their products in other cannabis-legal states.

...

"In a recent interview, Lee said that allowing trade with Oregon, Washington, Nevada and Colorado — all cannabis-legal states — would pose a risk not “qualitatively” different than what the state or cannabis businesses are taking now by defying federal law.

...

"In this marketing view, California is to weed what Cuba is to cigars."

Victor Elias (1937-2023)

Victor Elias died last week, at 85.  He had a strong influence on academic economics in Argentina, not least through the many influential Argentine economists he helped inspire to study in the U.S., particularly at the University of Chicago, where he got his Ph.D. in 1969.

Here's the funeral notice published yesterday in La Nacion:

"Victor Elias, RIP. It is with deep regret that we bid farewell to a great talent and person, with countless  disciples, admirers and friends, economists scattered throughout the world. We accompany the entire community of Tucuman economists, the UNT and especially his children, grandchildren and great-grandson. Signed by: Fernando Alvarez, Hugo Hopenhayn, Rody Manuelli, Juan Pablo Nicolini, Alvin Roth, Silvana Tenreyro, Iván Werning."

Here's the obit from La Gaceta

Murió el economista tucumano Víctor Elías. Tuvo una reconocida trayectoria como académico en la UNT. Tenía 85 años.[Tucuman economist Víctor Elías died. He had a recognized career as an academic at UNT. He was 85 years old.]

"The renowned Tucuman economist and academic Víctor Elías passed away at the age of 85, leaving an enormous legacy that has marked several generations of Tucumans who studied Economics at the National University of Tucumán. 

"The son of Syrian immigrants, he was born in the capital of Tucumán on July 21, 1937 and due to his ancestry he received the nickname "Turk", as he was known inside and outside academic circles. "

Victor Elias and Al Roth, Tucuman, November 2016, photo by Ivan Werning

 

Kidney exchange in Turkey: a decade of experience at a hospital in Istanbul

 Here's a recent article, from Bahcesehir University Goztepe Medicalpark Hospital Transplant Center,  in Istanbul which has a decade of experience in kidney exchange. It's main point is that Turkey needs more kidney exchange, organized on a larger scale, because the deceased donor system there is very limited, so transplants primarily involve living donors. 

Long-Term Outcomes of Kidney Paired Donation Transplantation: A Single Center Retrospective Cohort Study, by Eda Altun and Melike Yavuz  In Transplantation Proceedings. Elsevier, 2023.

"In this single-center, retrospective, cohort study, we analyzed 141 KPD transplant patients from July 2011 to June 2020 at Bahcesehir University Goztepe Medicalpark Hospital Transplant Center, Istanbul, Turkey.

...

"Although the current study is based on a single-center's records, the findings suggest that the long-term outcomes of the KPD program were similar to conventional LDKT. These results demonstrate that KPD is practicable, thriving, and successful if performed to a more extensive donor list. Efforts should be made to expand the KPD program in countries such as Turkey, where cadaveric transplantation is insufficient. "

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Earlier:

Friday, July 24, 2015

Kidney exchange in Turkey, and the state of Turkish transplantation

Tuesday, February 3, 2015

Organ donation in Turkey

Wednesday, November 21, 2018

Kidney exchange in Turkey, some recent reports

Are embryos property?

 A Virginia judge has managed to make a repugnant legal argument about a repugnant transaction, since the relevant precedent he identifies has to do with the ownership of slaves.

Virginia judge rules human embryos are ‘chattel’ based on centuries-old slave laws  by Matthew Barakat, Associated Press

"Frozen human embryos can legally be considered property, or “chattel,” a Virginia judge has ruled, basing his decision in part on a 19th century law governing the treatment of slaves.

"The preliminary opinion by Fairfax County Circuit Court Judge Richard Gardiner – delivered in a long-running dispute between a divorced husband and wife – is being criticized by some for wrongly and unnecessarily delving into a time in Virginia history when it was legally permissible to own human beings.

“It’s repulsive and it’s morally repugnant,” said Susan Crockin, a lawyer and scholar at Georgetown University’s Kennedy Institute of Ethics and an expert in reproductive technology law.

...

"In a separate part of his opinion, Gardiner also said he erred when he initially concluded that human embryos cannot be sold.

“As there is no prohibition on the sale of human embryos, they may be valued and sold, and thus may be considered ‘goods or chattels,’” he wrote."

HT: Kim Krawiec

Talent management in the Marine Corps--lateral entry?

"Talent management" is making inroads in the armed forces.  One anomaly of military service is that almost all of its personnel enter the business at around age 18: there is almost no lateral entry.  But some skills, such as those related to cyber warfare, can also be cultivated in the private sector.  Think how hard it would be to run a tech company if you could only recruit your people right out of high school or college. 

Defense One has the story:

Marines See Early Successes in Retention Push—and Ways to Do Better. Meanwhile, the commandant wants to bring skilled people into the Corps at advanced ranks.

"Monday’s update highlights Berger’s dissatisfaction with the Corps’ progress toward what’s called “lateral entry”—enabling recruits with critical skills to come in at a rank that reflects their experience. The commandant wants the lateral-entry system to focus first on reservists and Marines who have left the service. This could help fill cyber jobs and others in which the Corps competes with the civilian sector, Glynn said.   

 ...

The service is still working on bringing to life its Talent Management Engagement Portal, which the update calls “a must-pay bill.” It is meant to improve career assignment selections with a transparent “marketplace” for Marines, units, and assignment managers, according to Glynn."

**********

Here's the Marine Corps' report Talent Management 2030 from November 2021

"CREATING A PATH TO LATERAL ENTRY

"Our current enlisted recruiting model is optimized for ecruiting teenagers, and for officers, those in their early twenties. (It was not always this way: During theInterwar Period, potential enlisted recruits had to be over 21 and required a character reference from an employer, teacher, coach, or religious leader). While we will always seek to attract young Americans to our ranks, we do not have an effective vehicle for finding, recruiting, and onboarding talented Americans who already possess critical skills. In other words, there is currently only one way to join the Marine Corps – at the bottom. 

...

"The rapid rise in importance of the cyber domain, for instance, has challenged us to find creative ways to quickly build critical skills at mid-career and senior levels. Unless we find a means to quickly infuse expertise into the force – at the right ranks – I am concerned that advances in artificial intelligence and robotics, among other fields where the speed of technological change is exponential, will force us into a reactive posture. We should have an open door for exceptionally talented Americans who wish to join the Marine Corps, allowing them to laterally enter at a rank appropriate to their education, experience, and ability."

And, somewhat separately

"CREATING A TALENT MARKETPLACE

"Taking advantage of the initial lessons learned by the Army, Navy, and Air Force, we are developing a web-based “talent marketplace,” where units post job information about available billets, Marines apply for those positions virtually, and monitors serve as overall managers and arbiters. While much in the way of mechanics remains to be determined, I am committed to creating a process that places increased responsibility in the hands of unit commanders and individual Marines, employs cutting edge technology, and preserves a vital role for headquarters. Initially, our talent marketplace will be for officers, and eventually senior enlisted, while we assess options for changes to the junior enlisted assignments process."

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Earlier:

Wednesday, November 10, 2021

The labor market that is the United States Marine Corps

Tuesday, December 1, 2020

The labor market that is the military: a report from the National Academies of Science, Engineering, and Medicine