Many preference signals as a soft cap on number of applications in medical residency matching

 Here's a review article on matching for medical residents,  with particular attention to neurosurgery, in the Cureus Journal of Medical Science.  In specialties that (like neurosurgery) allow applicants to send many signals, many applicants signal to and match with programs with which they have some prior connection.

Ozair, Ahmad, Jacob T. Hanson, Donald K. Detchou, Matthew P. Blackwell, Abigail Jenkins, Marianne I. Tissot, Umaru Barrie et al. "Program Signaling and Geographic Preferences in the United States Residency Match for Neurosurgery." Cureus 16, no. 9 (2024).

Abstract: Postgraduate residency training has long been the cornerstone of academic medicine in the United States. The Electronic Residency Application Service (ERAS), managed by the Association of American Medical Colleges (AAMC), is the central residency application platform in the United States for most clinical specialties, with the National Residency Matching Program (NRMP) being the algorithm for matching residency programs with applicants. However, the determination of the best fit between ERAS applicants and programs has been increasingly challenged by the rising number of applicants per residency spot. This application overburdening across competitive specialties led to several adverse downstream effects, which affected all stakeholders. While several changes and proposals were made to rectify the issue of application overburdening, the 2020-2021 ERAS Match Cycle finally saw several competitive specialties, including otolaryngology and urology, utilize a new system of supplemental residency application based on preference signals/tokens. These tokens permit applicants to electronically signal a select number of programs in a specialty of choice, with the program reviewing the application now cognizant that they have been signaled, i.e., the applicant has chosen to use up a limited set of signals for their program. Initial results from otolaryngology and urology, as described in this article, indicated the value of this new system to both applicants and educators. Given the favorable outcomes and broader uptake of the system among other specialties, the field of neurosurgery adopted the utilization of the ERAS-based program signaling and geographic preference for the first time for the 2022-2023 Residency Application Cycle and later opted to continue them for the 2023-2024 and 2024-2025 cycles. For the 2024-2025 Match Cycle, neurosurgery applicants have 25 signals, i.e., a "high-signal" approach, where non-signaled programs have a low interview conversion rate. This literature review discusses the rationale behind the change, the outcomes of other competitive specialties from prior cycles, the evolving nature of the change, and the potential impact on applicants and programs. As we describe in this review, signaling may potentially represent a surrogate form of an application cap. Other considerations relate to cost savings for both applicants and programs from a high-signal approach in neurosurgery. These modifications represent a foundational attempt to alleviate the application overburdening and non-holistic review in the residency application process, including for neurosurgery. While these changes have been a welcomed addition for all stakeholders in residency match cycles so far, further prospectively directed surveys along with qualitative research studies are warranted to better delineate the downstream impact of these changes and guide further optimization of the application system.

Mohammad Akbarpour, interviewed by Scott Cunningham

Here's an interview of Mohammad Akbarpour, as part of Scott Cunningham's growing series of interviews of interesting economists. (Even the picture of the two of them looks interesting, and it gets better:)

   

Scott writes:

"Welcome to the Mixtape with Scott! Sometimes the shortest distance between point A and point B is a straight line, but other times the shortest distance is a winding path. This week’s guest, Mohammad Akbarpour from Stanford University, is perhaps an example of the latter. Mohammad is a micro theorist at Stanford who specializes in networks, mechanism and design and two sided matching. Mohammad is an emerging young theorist at Stanford, student of such luminaries as Matt Jackson and Al Roth, whose background in engineering, mathematics and computer science has given him a fresh approach to topics that I associate with Stanford’s theory people as a whole — policy oriented, applied work, mechanism design, networks and matching. He got into economics “the long way” — growing up in Iran, majoring in engineering, and then moving into Stanford’s operations research PhD program. In this interview, he generously shares a snippet of the arc of his life, and it’s a remarkable story, and one I really enjoyed hearing. I think you will too."

Abundant: a moving documentary about living organ donors

This past weekend I streamed a preview of a new movie about  living organ donors, kidneys (mostly) and some livers. It's called Abundant, and early in the project it described itself as "a documentary about the human experience of giving."

The movie consists mostly of the stories of donors, the experiences they had, and how they felt and feel about the lives they saved, and their connection to other donors, who are able to share the profound satisfaction that donation has given them. The stories are interspersed with commentary from various kinds of experts. (I was on the preview list since I get a good 60 seconds of commentary:)

The movie is also about chains, starting with kidney exchange chains, since many of the donors are nondirected donors who started chains.

At a more metaphorical level, the movie talks about chains of connections. One of the people they interview is Stephen Dubner, the host of the podcast Freakonomics.  He interviewed me on Freakonomics about kidney exchange, that podcast was heard by Ned Brooks, who was moved to donate a kidney (which started a chain) and then to start the National Kidney Donor Organization (NKDO).  Dubner interviewed him on Freakonomics too, and those Freakonomics interviews contributed more links to the chain.

This movie is destined to be a link in that chain too.

With more than half a million people on dialysis in the U.S., almost everyone knows or knows of someone who needs a kidney transplant.  This is the movie for all of them, with stories that may help them find a donor.  And who knows how many people will create new links in that chain.

It's a movie about how generosity creates abundance.

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earlier:

Wednesday, February 21, 2024

Nondirected living kidney donors--Abundant (the movie, in progress)

Friday, February 26, 2016

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

A 40 year old proof about top trading cycles is corrected (by two Berkeley grad students)

 Science (and math) can be self-correcting, sometimes slowly.  Here's an article that corrects the first proof that the top trading cycles algorithm is group strategy proof.  That's a true result, with multiple subsequent proofs.  But apparently the first proof presented wasn't the best one.  That's good to know.

One reason this may have taken a long time to spot is that the result is correct, and that there are subsequent proofs that connect the result to properties of other mechanisms.  

Will Sandholtz and Andrew Tai, the authors, did this work as Ph.D. students at UC Berkeley. (good for them!)

Group incentive compatibility in a market with indivisible goods: A comment  by Will Sandholtz and Andrew Tai

"Highlights

• Bird (1984), first to show top trading cycles is group strategy-proof, has errors.

•We present corrected results and proofs.

•We present a novel proof of strong group strategy-proofness without non-bossiness.

"Abstract: We note that the proofs of Bird (1984), the first to show group strategy-proofness of top trading cycles (TTC), require correction. We provide a counterexample to a critical claim and present corrected proofs in the spirit of the originals. We also present a novel proof of strong group strategy-proofness using the corrected results."

Opt-out organ donation in Britain

 Opt-out is not a panacea for deceased organ donation in countries in which family consent is required for donation.

More families refusing to donate relatives' organs  by Lucy Parry, BBC 

"An "opt-out" law was introduced in Wales in 2015, followed by England in 2020, Scotland in 2021 and Northern Ireland in 2023.

"It means all adults are considered to have agreed to be potential organ donors when they die, unless they have recorded a decision not to donate or are in an excluded group.

"The change in law was designed to increase the number of organs available for donation.

"But ultimately families have the final say and the consent rate fell to 61% in the 12 months to April, from 69% four years ago."

#############

HT: Frank McCormick

Related:

Monday, July 22, 2024

Don't take "No" for an answer in deceased organ donor registration (a paper forthcoming after ten+ years)

Should fox hunters be a protected minority?

 The NYT reports on the question:

Fox Hunters in the U.K. Want Protected Status Under Discrimination Law. A lobbying group is preparing a bid to define hunting with animals as a protected belief. Many experts have questions.  By Amelia Nierenberg

"English fox hunters have tried, for years, to push back against a nearly 20-year-old ban on their beloved sport.

"The centuries-old tradition of using packs of dogs to chase and kill foxes — or any wild mammals — became illegal in England in 2005, after a long parliamentary struggle driven by campaigners and lawmakers who opposed it on animal welfare grounds.

"So far, the law has stood, and fox hunting remains hugely unpopular among the general public: 80 percent of people in Britain think it should remain illegal, according to YouGov, a polling company.

"Now, a pro-hunting activist has a new plan of attack.

"Ed Swales, the activist, founded Hunting Kind, a lobby group that aims to protect hunting with dogs and other forms of hunting, in early 2022. He wants to use Britain’s Equality Act — which protects people from discrimination because of their age, race, sexuality or religion, among other things — to classify a pro-hunting stance as a protected belief.

...

“We’ve been doing this for millennia,” he said. Hunting is “literally part of our cultural heritage.”

"Hunting itself is not illegal in England. Shooting deer, rabbits, duck and some other animals is allowed during hunting seasons, with permission from the landowner and a gun license.

...

"Last year, Chief Superintendent Matt Longman, England’s police lead on fox hunting, said that illegal hunting was “still common practice,” with trail hunts frequently taking place in natural fox habitats.

...

"In 2007, a belief in fox hunting was explicitly denied protection in Scotland’s courts, where a judge found that “a person’s belief in his right to engage in an activity which he carries on for pleasure or recreation, however fervent or passionate,” did not compare to protected beliefs or religion, and therefore would not be covered under human rights law.

"And in 2009, the European Court of Human Rights unanimously ruled that the ban on fox hunting with dogs did not violate human rights."

HRSA has accepted bids to reform deceased donor organ allocation

 Here's yesterday's HRSA press release. (Item 2, Supporting OPTN IT Modernization, might be of most interest to most readers of this blog.)

In Historic Step, HRSA Makes First Ever Multi-Vendor Awards to Modernize the Nation’s Organ Transplant System and End the Current Contract Monopoly

U.S. Department of Health and Human Services
Health Resources and Services Administration

FOR IMMEDIATE RELEASE

September 19, 2024

HRSA NEWS ROOM

newsroom.hrsa.gov

Contact: HRSA PRESS OFFICE

Phone: 301-443-3376

Email: Press@hrsa.gov

As part of the Administration’s efforts, for the first time in the program’s nearly 40-year history, HRSA has awarded separate contracts to reform the organ procurement and transplant network. Multiple vendors will support improving quality and patient safety, modernizing IT, bolstering communications with patients, and more

Today, the Health Resources and Services Administration (HRSA) at the Department of Health and Hunan Services (HHS) announced the first ever multi-vendor contract awards to modernize the nation’s organ transplant system to improve transparency, performance, governance, and efficiency of the organ donation and transplantation system for the more than 100,000 people on the organ transplant waitlist.

The Organ Procurement and Transplantation Network (OPTN) has long faced critiques about lack of transparency, potential for conflicts of interest, IT reliability issues and other structural challenges. As part of the Administration’s transformation of the OPTN, for the first time in 40 years, multiple contractors will provide their expertise and proven experience to improve the national organ transplant system. This transition from a single vendor to multiple vendors to support OPTN operations is a critical step in advancing innovation in the transplant system to better serve patients and their families and implements the bipartisan Securing the U.S. Organ Procurement and Transplantation Network Act signed by the President in September 2023.

“With the life of more than 100,000 Americans at stake, no organ donated for transplantation should go to waste,” said HHS Secretary Xavier Becerra. “For too long, our organ transplant system has fallen short, mired in monopoly. The Biden-Harris Administration has reformed OPTN to require accountability in the operation of organ procurement that our transplant patients and their families demand.”

“One person is added to the waitlist every 10 minutes. Each one relies on and deserves the best care possible,” said HRSA Administrator Carole Johnson. “Today’s action marks a significant advancement in the Biden-Harris Administration’s commitment to doing what it takes to make sure the nation’s organ matching system works for patients, donors, and the families who depend on the OPTN for that life-saving call.”

HRSA is announcing multiple OPTN modernization awards to support critical actions, including:

1. Improving Patient Safety - Arbor Research Collaborative for Health will provide support on patient safety and the policy compliance systems and processes overseen by the OPTN Board of Directors and the Membership and Professional Standards Committee to improve oversight of the multiple entities in the OPTN.
2. Supporting OPTN IT Modernization - General Dynamic Information Technology (GDIT) will focus on the opportunities to improve the OPTN organ matching IT system and inform HRSA’s Next Generation IT procurement and development work.
3. Increasing Transparency and Public Engagement in OPTN Policy Development - Maximus Federal will advance opportunities to improve public visibility and engagement in the OPTN policy making process, including improving transparency around OPTN policy making committees’ deliberations and actions.
4. Strengthening Patient-Centered Communications - Deloitte will focus on improvements in communications from the OPTN, within the OPTN and, importantly, with patients and families.
5. Improving OPTN Financial Management - Guidehouse Digital will address improvements for OPTN’s budget development and management systems and processes.

In August 2024, HRSA announced that the OPTN Board of Directors—the governing board that develops national organ allocation policy—is now separately incorporated and independent from the Board of longtime OPTN contractor, the United Network for Organ Sharing (UNOS). HRSA awarded an OPTN Board Support contract to a new vendor, American Institutes for Research, to support the newly incorporated OPTN Board of Directors.

HRSA launched the OPTN Modernization Initiative in March 2023, including making proposals to reform the decades old OPTN statute and increase funding for the program to better serve patients and families. Within a year, HRSA worked closely with bipartisan leaders in Congress to secure passage of the Securing the U.S. OPTN Act and substantially boost funding to support modernization efforts. Today’s awards represent a key step forward in this work.

###########

Here's the full list (from OrangeSlices AI):

14 Prime awardees named for $440M in HHS HRSA OPTN Operations Transition IDIQs

The total ceiling for Domain 1 is $30M, Domain 2 is $145M, Domain 3 is $235M, and Domain 4 is $40M. The following awardee information is provided for the HRSA procurement:

1. ABT GLOBAL

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 1 – $30M

2. ARBOR RESEARCH COLLABORATIVE FOR HEALTH

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 1 – $30M

3. GUIDEHOUSE DIGITAL LLC

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 1, 2, 4 – $215M

4. MAXIMUS FEDERAL SERVICES

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 1, 2 – $175M

5. RAND CORPORATION

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 1 – $30M

6. CUSTOMER VALUE PARTNERS

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 2, 4 – $185M

7. GENERAL DYNAMICS INFORMATION TECHNOLOGY INC

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 2, 3 – $380M

8. KPMG LLP

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 2 – $145M

9. UNITED NETWORK FOR ORGAN SHARING

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 2 – $145M

10. ACCENTURE FEDERAL SERVICES LLC

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 3 – $235M

11. LEIDOS INC

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 3 – $235M

12. SAPIENT GOVERNMENT SERVICES INC

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 3 – $235M

13. DELOITTE CONSULTING LLP

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 4 – $40M

14. HIGHLIGHT TECHNOLOGIES INC

Total IDIQ Maximum Not to Exceed/Ceiling: Domain 4 – $40M

The IDIQs include a base ordering period of one year staring on 9/25/2024 and 4 option periods.

Solicitation: 75R60224R0008, OPTN Operations Transition Indefinite-Delivery-Indefinite-Quantity (IDIQ)

Agency: HEALTH AND HUMAN SERVICES HEALTH RESOURCES AND SERVICES ADMINISTRATION

Getting more transplants,, two recent articles

 Frank McCormick, and Martha Gershon point me to two articles about increasing kidney transplants.

The first one is by Dylan Matthews in Vox Future Perfect. Here are its first paragraphs and last sentence (the middle is well worth reading too if you're new to this debate..)

The moral case for paying kidney donors.
Kidney donors save lives. Why aren’t we compensated for it?

"A few months ago, I wrote about a proposal called the End Kidney Deaths Act, which seeks to make sure that every one of the more than 135,000 Americans who get diagnosed with kidney failure every year has access to a kidney transplant.

"Its method is simple: a federal tax credit worth $10,000 a year for five years, paid to anyone who donates a kidney to a stranger. It’s the kind of thing that would’ve helped a lot when I donated a kidney back in 2016. Elaine Perlman, a fellow kidney donor who leads the Coalition to Modify NOTA, which is advocating for the act, estimates the measure will save 100,000 lives over the first decade it’s enacted, based on conversations with transplant centers on how many surgeries they can perform with their current resources. Polling has shown this kind of measure has overwhelming public support, with at least 64 percent of Americans supporting a system where a government agency compensates donors.

...

"Not enough nurses? Pay nurses more. Not enough waiters? Pay your waiters more. Not enough kidney donors? Here’s a crazy idea: Pay us."

##########

And here's an article in Healthcare Brew, by Caroline Catherman:

From pigs to payouts, weighing solutions for the US kidney shortage.  About one out of every 20 people waiting for a kidney transplant die each year, according to the United Network for Organ Sharing. Scientists, policymakers, and other experts are scrambling to find a solution.

It also talks about the End Kidney Deaths Act, and pig kidneys and more effective deceased donation as well.

More on non-anonymous kidney exchange in India

 Here's some further description of how kidney exchange is conducted in India without authorization* to use nondirected donors (so that all exchanges are conducted in cycles, i.e. in the absence of chains of exchange).

Vivek B. Kute, Himanshu V Patel, Subho Banerjee,Divyesh P Engineer, Ruchir B Dave, Nauka Shah, Sanshriti Chauhan ,Harishankar Meshram , Priyash Tambi  , Akash Shah, Khushboo Saxena,Manish Balwani , Vishal Parmar, Shivam Shah, Ved Prakash ,Sudeep Patel, Dev Patel, Sudeep Desai, Jamal Rizvi , Harsh Patel, Beena Parikh, Kamal Kanodia, Shruti Gandhi, Michael A Rees,  Alvin E Roth,  Pranjal Modi “Impact of single centre kidney-exchange transplantation to increase living donor pool in India: A cohort study involving non-anonymous allocation,”Nephrology, September 2024, https://onlinelibrary.wiley.com/doi/10.1111/nep.14380  

"In India, 85% of organ donations are from living donors and 15% are from deceased donors. One-third of living donors were rejected because of ABO or HLA incompatibility. Kidney exchange transplantation (KET) is a cost-effective and legal strategy to increase living donor kidney transplantation (LDKT) by 25%–35%.

"3.3 Non-anonymous allocation

"The THOA*, which regulates KET in India, is silent on the need for anonymity, so there is no legal requirement for anonymity in India, as compared with other countries, such as the Netherlands and Sweden. Our experience was that 90% of iDRP [incompatible Donor-Recipient Pairs] requested the opportunity to meet their matched donor and recipient pair (mDRP) and 10% asked the treating physician to decide if they should meet. None of the iDRP requested anonymity. Therefore, we have practiced absolute non-anonymity, meaning that all mDRPs meet and share medical reports after a potential exchange is identified, but before the formal allocation of pairs. If an iDRP requests anonymity, we would be willing to accommodate them, but to date, none have done so.

"Upon meeting with their mDRP, the iDRP can refuse the proposed exchange option without reason and continue to be on the waitlist and active in the KET pool. iDRPs must complete transplant fitness and legal documents required for transplant permission from the health authority before they are given the opportunity to meet their mDRP. A meeting between mDRPs occurs in the presence of a transplant physician, who can help solve any query before the proposed match is accepted by the involved pairs. iDRP are introduced to their mDRP prior to scheduling transplants to avoid chain collapse due to iDRP refusal of the mDRP. The mDRP shares medical reports of donors with each other, can also discuss with their other family members, and consults with their family physician/nephrologist before deciding whether to proceed. Living kidney donors are fully informed of perioperative and long-term risks before making their decision to donate. In India, donor age group matching is most commonly expected for all iDRP in the KAS."

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Earlier:

Monday, September 18, 2023

Kidney Paired Donation in Developing Countries: a Global Perspective

*Here's the THOA, THE TRANSPLANTATION OF HUMAN ORGANS AND TISSUES ACT, 1994

Yale celebrates Vahideh Manshadi

Vahideh Manshadi is the Michael Jordan of Operations.

 Here's the announcement from Yale News:

Vahideh Manshadi appointed the Michael H. Jordan Professor of Operations. Manshadi investigates the operations of online and matching platforms, and studies algorithmic fairness.

"Vahideh Manshadi, who investigates the operations of online and matching platforms, and studies algorithmic fairness and inclusion has been named the Michael H. Jordan Professor of Operations, effective immediately.

...

"She has pioneered the study of emerging systems and platforms with societal impact, including crowdsourced food recovery, volunteer crowdsourcing, refugee resettlement, and organ allocation. She has collaborated with nationwide platform-based nonprofits, including Feeding America, Food Rescue US, VolunteerMatch, and national kidney exchange programs, and often impacted the practice of these organizations.

...

"She received her Ph.D. in electrical engineering at Stanford University, where she also received M.S. degrees in statistics and electrical engineering. Before joining Yale, she was a postdoctoral scholar at the MIT Operations Research Center."

Preference signaling for urologists (including Flush Day)

 It's been very interesting for me to watch the growth of preference signaling to combat congestion in applications and interviews, from its beginnings in the job market for new Ph.D. economists, to its spread through the medical specialty job markets hosted by the National Resident Matching Program (NRMP), and on to medical specialties that run their own matches, such as urology.

So, if you want to be a urologist, take note of the signaling deadline today:

The Society of Academic Urologists Resident Match Program 

Applicant Preference Signaling Deadline is today, September 16, 2024

The SAU has a good deal of supporting material on their site. 

Here's a summary of their interview and offer procedures: Interview Offer Summary (which includes an appropriately named Flush Day for finalizing interviews).

And here's their page on Preference Signaling, linking to this Overview, FAQs, and webinar.

The SAU invites applicants to send up to 30 signals, and encourages them to include programs that know them well on their signaling list.  So (as I've remarked in previous posts) I think this is likely to work as a soft cap on applications.

HT: Mike Rees

Practical insights from market design, in Japan

I was recently interviewed by Fuhito Kojima as part of a symposium conducted by the University of Tokyo Market Design Center on practical insights from market design. The whole symposium is available on YouTube.

All but one of the presentations are in Japanese (summarized below by Fuhito):

1. Introduction (Fuhito) 

 2. Our interview (in English) 

3. More explanation of the stable matching problem and its application to personnel assignment (Shunya Noda)

4. Application of stable matching algorithm in personnel allocation in a firm: My team helped our partner firm, Sysmex, introduce the DA algorithm (in fact, a modified "flexible" deferred acceptance algorithm proposed by Kamada and Kojima 2015 AER) in the assignment of new employees to different divisions of the firm. The firm has been using matching algorithm for 4 years now. Our partner from the firm talks about their experience.

5. Application to daycare assignments: My team is collaborating with a major government contractor for municipal governments IT system, CyberAgent. The project studies daycare-related data provided by  municipal governments and helps those government introduce and improve their matching algorithms of daycare seats to children. Our partner from the firm talks about our team's effort, e.g., how we convinced one city change algorithm from Boston-like mechanism to DA, and how we helped fine-tune their priority design to cope with problems in which kids with siblings were not matched as well as single kids.

 6. Application to auction: Shunya and his team helped an auction platform firm to introduce an auction mechanism for selling used electronic devices. His partner company, Aucnet, shares their experience.

 7. Q&A and closing remark (Fuhito)

Here's my interview with Fuhito

 

Interview about repugnance (and this blog) in Hungary

 Here's a link to an interview about repugnance in the Hungary Daily News. The  last question and answer was about this blog.

“Repugnance in human transactions became interesting to me” – interview with Alvin Roth

  "You have been writing the blog Market Design since 2008, and since then you have written almost every day a post. What motivated you to start this blog and what role does it play in your professional life? 

Alvin Roth: I started it for my class. I wanted the students to know that the way to think of ideas for market design is not just to read papers in economics journals but to read the newspaper and follow why markets weren’t working well. Many of my blog posts are short comments on a newspaper article about something in the world. Since I started, it’s also proved to be a useful tool for me to remember things. So, it’s a kind of intellectual diary, as well. I’m currently working on a book on controversial markets and I look at my blog posts for each chapter. Market Design blog is my memory for everything related to market design."

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Related:

Sunday, July 7, 2024

Mechanism and Institution Design in Budapest, in honor of Vince Crawford's 75th birthday: July 8-12 at Corvinus University

Guns for everyone, from 3-D printers

 Unregulated guns made on 3-D printers are now becoming more available.  

The NYT has the story:

He’s Known as ‘Ivan the Troll.’ His 3D-Printed Guns Have Gone Viral.  From his Illinois home, he champions guns for all. By Lizzie Dearden and Thomas Gibbons-Neff

"Most of the mass-produced weapons of the 20th century, even those now marketed for personal defense, were originally designed for militaries and hunters. The FGC-9, by contrast, was created with the explicit goal of arming as many everyday people as possible.

"FGC is an abbreviation that represents what its creators think of gun control. Nine is for the 9-millimeter bullet it fires.

"The use of the FGC-9 by insurgents opposed to the military junta in Myanmar is part of its creators’ stated plan, a realization of the hope that guns could be used to stand up to the state.

...

"Mr. Duygu’s design was published in March 2020 with the stated goal of circumventing gun laws. Homemade firearms have been around for centuries, but Mr. Duygu’s was a breakthrough. The FGC-9 could be built entirely from scratch, without commercial gun parts, which are often regulated and tracked by law enforcement agencies internationally.

"Anyone with a commercial 3D printer, hundreds of dollars in materials, some metalworking skills and plenty of patience could become a gun owner."

Should you get a Ph.D.?

 One of the emails I answered yesterday asked 

"As I get closer to graduation, I’m really curious about how people balance academic research with practical applications.  ... how do you see the future of combining theory with real-world impact? And what advice would you give someone like me who’s trying to decide between diving deeper into academic research or jumping into industry?

Here is how I replied:

Hi: academia versus industry isn’t a once and for all decision, but going for a PhD is, and it’s definitely worth thinking about.

Getting a PhD is pretty much essential for entry into an academic career, but is at least somewhat optional for most other careers (although sometimes particular specialties in computer science or biotech require a PhD even for industrial jobs).

So…the downsides of getting a PhD are pretty clear.  It’s hard, not always fun, it takes a long time, and doesn’t come with any guarantees.

The upsides are more subtle: it can be fun, and it opens up new ways of thinking, and things to think about.  But the big reward, if it is a reward, is the entry into academia.  And the big reward of academia is the ability to schedule your own mind—to be able to think about what you want, as long as you want.

If that doesn’t sound like a huge prize, then there are lots of rewarding things to do outside of academia (and many of them pay better).  The world is full of interesting, important, hard problems, and many of those are most actionable outside of universities, in industry or non-profits, or governments and NGOs. 

But the world has its own schedule and priorities, you can’t always choose what to think about, and you often have to come to a conclusion and move on before you’re ready…

So, for me universities have been great.  I’ve been able to engage with the world too.  And I couldn’t have gotten the job without a PhD (although I’m an economist whose PhD wasn’t in Economics).

I can’t guess what’s right for you, but those are some things to think about.

############

If the question had touched more on teaching, I could have added that a Ph.D (or other terminal degree) is  largely needed for teaching in research universities and liberal arts colleges, where you can teach the most advanced students. But there are obviously lots of teaching opportunities that don't require a Ph.D., and ways to be a mentor that aren't formal "teaching," so some of the above comments apply there too.

First kidney exchange in Kuwait

 The Arab Times has the story:

Breakthrough in organ transplant: Kuwait conducts first family kidney exchange

##########

The phrase "family exchange" is being used to describe kidney exchange programs in which the intended patient-donor pairs have to be related (but when exchange is carried out and each patient receives a compatible kidney from another patient's donor, the actual transplants don't have to be between family members.)

Earlier:

Tuesday, August 20, 2024

Inter-hospital kidney exchange in Saudi

Kidney exchange chains between Israel and Cyprus

 Israel Hayom has the story. (Itai Ashalgi's software gets a shout-out):

Unprecedented Israel-Cyprus kidney exchange saves 8 lives. Cross-border medical collaboration showcases the power of organ donation and transplant innovation.    By  Eleanor Favriker/Makor Rishon

"In a remarkable display of international medical cooperation, eight kidney transplants have been performed across Israel and Cyprus as part of a pioneering cross-border organ exchange program. The intricate operation, involving multiple hospitals and a meticulously coordinated logistics effort, was made possible by two altruistic donors who approached the National Transplant Center, initiating a "transplant chain."

"The joint operation, conducted on Monday, saw five procedures taking place in Israel and three in Cyprus. The National Transplant Center matched the pairs using specialized computer software, drawing from an international database containing incompatible family member pairs.

"Starting at 5:00 a.m., kidneys harvested at Hadassah and Soroka hospitals were transported by ambulance to the airport and flown to Cyprus. Concurrently, another kidney from Hadassah was transferred to Soroka, while one from Beilinson was sent to Hadassah. At 2:00 p.m., two kidneys arrived from Cyprus, destined for Beilinson and Hadassah. By 6:00 p.m., all transplants were completed in both countries, with recipients in good condition and new kidneys functioning.

"In Israel, three transplants occurred at Hadassah, one at Beilinson, and one at Soroka, with an additional Hadassah transplant performed a day earlier. In total, Israel saw 10 surgeries: five kidney removals and five transplants.

"Professor Shlomo Mor Yosef, chairman of the Steering Committee, said, "I commend the cooperation between Israel and Cyprus. These exchanges provide solutions for patients with antibodies. I urge every family with a patient needing a kidney transplant to join the exchange database if no match is found among them."

"Dr. Tamar Ashkenazi commented, "This marks our first two-way kidney exchange with Cyprus. Their single transplant center in Nicosia performed six surgeries in one day, supported by a surgeon from England. I'd like to thank Ms. Rona Simon, who manages our exchange database, facilitating over 60 successful cross-transplants annually. Israel maintains similar programs with the Czech Republic, Austria, and the United Arab Emirates."

Anticipating kidney exchange in Germany in the Frankfurter Allgemeine Zeitung

  Here's an op-ed in the Frankfurter Allgemeine Zeitung, celebrating the anticipated beginning of kidney exchange in Germany.

Der Volkswirt Hoffnung durch Tausch  by Ágnes Cseh, Christine Kurschat, Axel Ockenfels und Alvin E. Roth

Here's the English translation (from a slightly earlier draft):

Hope through exchange

Germany's new draft law on kidney donation

Imagine this: Your child needs a kidney transplant, but due to tissue incompatibility you cannot be a donor yourself. And it's the same for me. What if you donated a kidney to my child and I donated a kidney to yours in return? Through this ‘cross-donation’ we could give our children the chance of a longer life with a better quality of life.

In Germany, such cross-donations are not usually permitted. Only people who are ‘obviously close in a special personal relationship’, such as relatives and spouses, are allowed to donate kidneys. This is now set to change. The Federal Cabinet has presented a draft bill to amend the Transplantation Act, which would allow cross-donations and other forms of living kidney donation. These include ring exchanges with more than two participating couples as well as longer donor chains initiated by a non-directed, anonymous donation.

People who hear about cross-donation for the first time are sometimes skeptical. However, these concerns can be dispelled on closer inspection. In our neighboring countries and in many other countries, such donations have long been successfully established in compliance with the highest ethical standards.

In cross-donation, no prices are paid for kidneys and there is no trading in kidneys. A system in which potential cross-donors are registered and referred centrally can be implemented in an abuse-proof manner, as experience abroad has shown. The Ministry of Health's draft calls for a close relationship to continue to exist between donor and recipient who register together in the kidney donation program, but no longer necessarily between the donor of an organ and the recipient of the same organ. The couples involved can be guaranteed anonymity, so that mutual influence can be ruled out and at the same time the altruistic motive for donating to the next of kin remains unchanged.

But what happens if the donor has already donated their kidney, but the cross-donor suddenly cancels? To avoid such situations, the two kidneys are removed from the two donors at the same time, and the two patients also receive the two organs at the same time. The four surgical teams communicate in order to coordinate the procedure safely.

The argument that authorizing cross-donation could increase the pressure on potential donors does not stand up to closer scrutiny either. The option of cross-donation does not create any additional pressure that is not already exerted on compatible donors. Instead, cross-donation merely expands the pool of potential donors. 

Incidentally, cross-donation also shortens the waiting list for post-mortem donations, so that patients without donors can also be helped. At the same time, cross-donation can protect the legitimate interests of those people who do not wish to donate if it is implemented in a suitable institutionalized manner and the best possible information is provided.

Germany now has the opportunity to learn from the existing systems in Europe in order to avoid mistakes in the regulations and their implementation for the benefit of organ recipients and donors. This applies, for example, to the establishment of a nationwide kidney donation program, from funding and equipment to biomedical expertise. The Federal Ministry of Health is making important proposals here. The large gaps in data on potential donors and recipients could soon be closed, the option of enabling international coordination of cross-donations is being considered from the outset, and the transplant centres are being encouraged to register all donor-patient pairs centrally for referral. Without such regulations, individual clinics could be incentivized to only selectively register pairs, with the result that fewer transplants can be carried out overall.

Other aspects of the draft should be reconsidered. For example, it is not advisable that couples can only participate in the kidney exchange program if donor and recipient are incompatible. Compatible couples can receive a more suitable kidney through participation and at the same time other patients can be helped, as more cross-donations are made possible through participation. This in turn can shorten the waiting list for all patients who do not have their own donor and therefore cannot participate in the kidney exchange program.

It is good news that new forms of living organ donation are now also to be made possible in Germany. The precise organization of these new forms of organ donation is crucial to their success. It can be modelled on the experiences of other countries and at the same time adapted to the specific legal, historical and ethical framework conditions in Germany. The initial investment would be amortized very quickly through the savings in treatment costs for expensive dialysis. 

In view of the draft law, we are optimistic that the wish of many potential donors to help can be fulfilled in the future, thus improving the care situation for kidney patients in Germany.

Ágnes Cseh (University of Bayreuth), Christine Kurschat (University of Cologne), Axel Ockenfels (University of Cologne and Max Planck Institute for Research on Collective Goods in Bonn) and Alvin E. Roth (Stanford University)

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Here's the (rather opaque) graphic the newspaper created (maybe it's a celebration by kidneys):

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Here's a link to what I think was my first op-ed in German on allowing kidney exchange there...

Thursday, March 17, 2016

German organ transplant law should be amended or reinterpreted to allow kidney exchange: my op-ed in Der Tagesspiegel

Simulating kidney exchange policies in Germany

 Here are a set of simulations designed to help Germany establish a national (rather than a fragmented) kidney exchange system.

Itai Ashlagi, Ágnes Cseh, David Manlove, Axel Ockenfels & William Pettersson,  Designing a kidney exchange program in Germany: simulations and recommendations. Central European Journal of Operations Research  (2024). https://doi.org/10.1007/s10100-024-00933-0

"Abstract: We examine some of the opportunities and challenges concerned with establishing a centralized national kidney exchange program in Germany. Despite the many advantages of a national program, without deliberate design and policy intervention, a fragmented kidney exchange program may emerge. We study a number of collaboration strategies, and resulting simulations suggest that transplant centers may find it advantageous not to fully participate, resulting in a net reduction in the number of transplants. These results also suggest that allowing more forms of kidney exchange, such as three-way exchanges and non-directed donations, can significantly increase the number of transplants while making participation in a national program more attractive and thus national coordination and cooperation more robust. We propose a multi-level policy approach that is easy to implement and would promote an efficient German kidney exchange program that benefits recipients, donors and hospitals."

...

The concluding sentence of the paper is:

"Germany should establish a robust, well-functioning national KEP that can be easily and straightforwardly integrated into an international KEP."

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Background:

Thursday, July 18, 2024

Kidney exchange in Germany: draft of a proposed law