Kidney exchange comes to Hungary

Péter Biró  writes with good news about kidney exchange in Hungary.

 Here's the announcement from the  University of Pécs, of the first kidney exchange performed in Hungary, following the first legislation passed to legalize kidney exchange in 2014. (And more details follow from a second announcement below.)

The first cross-donation kidney transplant was performed in Hungary at the University of Pécs Clinical Center  2026.01.29

"The first cross-donation kidney transplant performed in Hungary a few days ago can be considered a new milestone in the history of organ transplantation in Hungary. Within the framework of the living donor kidney exchange program, two women received new kidneys at the Department of Surgery of the University of Pécs Clinical Center (PTE KK), which gives them the opportunity for a better quality of life. It is particularly interesting that in both cases the organ donor was a male member of the other couple.

...

"In his speech, Dr. Péter Szakály, Head of Department of the Department of Surgery of the University of Pécs, emphasized that: The establishment of a national pool was of fundamental importance in this program, and this program will be able to operate successfully in the future as well if there are as many such couples as possible. He also added that compared to traditional kidney transplantation, living donor transplantation is always a much greater challenge (...) Transplantation with a living donor comes with increased responsibility, as it involves a healthy donor. In this case, two surgeries were performed at the same time: Ádám Varga, assistant professor, and I simultaneously removed and replaced the organs between the two pairs from the adjacent operating room. 

"Since 2014, the law allows this type of transplant, but no specific surgeries have been performed so far. Recognizing this shortcoming, at the initiative of the National Hospital Administration, the four kidney transplant centers in Hungary and the Regional Kidney Transplant Committees operating there, in cooperation with the National Blood Transfusion Service, have developed a nationally uniform program in accordance with the legislation in force, which ensures equal opportunities for all patients who voluntarily enter the program. This became the living donor kidney transplant exchange program, which was launched in Hungary on June 21, 2024. The search for optimally compatible pairings between the pairs applying for the program is carried out with the help of a software developed for this purpose." 

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And here is the emailed announcement forwarded by Peter Biro, who has been a champion of kidney exchange in Europe for many years now:

Dear EURO-KEP Colleagues,

 

We are pleased to inform you that we have reached a significant milestone within the Hungarian Kidney Paired Kidney Exchange Program (HKEP), in line with the objectives of the EURO-KEP initiative.

 

On January 20, 2026, the first two kidney transplants were successfully performed in Hungary within the national living donor kidney exchange program. The surgeries took place at the University of Pécs Clinical Centre, marking the first realization of kidney cross-over donation in the country.

We believe that this milestone, supported by a well-structured professional and patient information campaign lasting more than a year and a half, will contribute to increasing the number of living donor kidney transplants and encourage more patients and voluntary donors to join kidney exchange programs. This, in turn, will support further kidney exchanges and improve equal access to transplantation.

 

Chronology and key developments of the Hungarian KEP

• June 2024 – With the support and authorization of the National Directorate General for Hospitals (OKFŐ), a nationally unified kidney paired exchange program was launched, coordinated by the National Blood Transfusion Service, with the participation of all four Hungarian kidney transplant centers and regional waiting list committees.
• Since the launch – The matching algorithm has been run every three months; to date, six matching runs have been completed, involving 57 donors and 44 recipients. The seventh run is scheduled for tomorrow.
• July 2025 – A key legislative amendment entered into force, allowing:
• simultaneous transplants among more than two donor–recipient pairs in a closed chain,
• transplant surgeries to be performed in different centers, enabling patients to remain at their original listing centers and
• not only incompatible pairs can join the program, but compatible pairs in the hope of better matching.
• Following the legal amendment, an updated and detailed printed patient information package was distributed nationwide, with the involvement of all dialysis units and transplant centers.
• During the optimization process, a clinically acceptable match was identified between two married couples. In both cases, the male partner donated a kidney to the female recipient of the other couple. The transplant surgeries were performed on 20 January 2026 at the Surgical Clinic of the University of Pécs Clinical Centre. In both cases, graft function started immediately. The recipients and donors are in good condition and both patients were discharged home on Friday.

We consider this achievement a significant milestone in Hungarian transplantation and a meaningful contribution to the shared European objectives of the EURO-KEP project. We remain committed to continuing this work in the service of saving lives.

 

Best regards,

 

Dr. Sándor Mihály, Ph.D  
Director of transplantation

Honorary College Associate Professor at Semmelweis University

General Secretary of the Hungarian Transplant Society

EDTCO Past-Chair 2023-2025

 

 

Organ Coordination Office

Central Waiting List Office

National Organ and Tissue Donation Opting-out Registry

Hungarian Stem Cell Donor Registry

 

Spam invitation to be featured in a book club

 As the author of a forthcoming book (Moral Economics) I now get book-related emails from publicists, podcasters and others.  But I suspect I was the first human to see the email below, inviting me to be featured in a book club, which began with this sentence:

"I’m writing because "The Nash solution and the utility of bargaining" has stayed with me, thoughtful, layered, and resonant in a way that invites real conversation. It felt like the kind of book our readers would want to spend time with."

 It purported to come from the organizer of an apparently real book club (Bellatrist), but alas the return email didn't pass the smell test (despite coming from such a perceptive reader of the paper below...)

 Roth, Alvin E. "The Nash solution and the utility of bargaining." Econometrica (1978)

 Abstract: "It has recently been shown that the utility of playing a game with side payments depends on a parameter called strategic risk posture. The Shapley value is the risk neutral utility function for games with side payments. In this paper, utility functions are derived for bargaining games without side payments, and it is shown that these functions are also determined by the strategic risk posture. The Nash solution is the risk neutral utility function for bargaining games without side payments."

 

Thoughtful, layered and resonant.   

Kidney donation, in today's NYT

 Here's an article and an argument from a nondirected kidney donor, in today's NYT

 Want to Make a Difference? Donate Your Kidney.  by German Lopez, Feb. 2, 2026, 

"Nearly 50,000 people in the United States die each year because there are not enough kidneys for transplant, which adds up to more than double the number of annual murder victims. Hundreds of thousands more are on dialysis, a lifesaving but time-sucking and physically draining treatment. Humans need only one kidney to live, but we have two. Giving away my kidney, to a 23-year-old woman I didn’t know, has been the most fulfilling experience of my life.

...

"The chain is a wonderful, and fairly recent, innovation that has allowed many more people to get lifesaving transplants. Imagine three people — Patients A, B and C — need kidneys. B’s and C’s spouses are willing to donate, but Spouse B is a match for Patient A and Spouse C is a match for Patient B. They all agree to pull the trigger if a donor can be found for the remaining patient, C. An undirected donor can come in at that point to complete the chain of donations. The largest chain on record led to 126 transplants.

...

"I also learned about some of the health care system’s absurdities. As a gay man, I could donate my kidney but not my blood. The government prohibited blood donations from sexually active gay men until 2023, thanks to outdated fears about H.I.V. My kidney was fine, although the doctors had to inform the receiver that it was “higher risk.” Thankfully, the threat assessment did not deter the recipient from accepting my gay kidney.

...

My donation felt like a rejection of the day’s politics — and not just because it required overcoming some light homophobia. It felt like an act of defiance; I was plugging a small hole in a porous health care system while our leaders’ proposed cuts to Obamacare and Medicaid attempted to open a chasm."   

Tobacco banned in Indian state of Odisha

 Here's the story from the Times of India, Govt notifies ban on all chewable tobacco, nicotine products | Bhubaneswar News - The Times of India.  It remains to be seen how enforceable a statewide ban will be. (Local bans on something as addictive as nicotine are likely to face black markets sourced from neighboring jurisdictions without a ban.)

 

  

 

Tim Harford on British queues (and how queues get long)

 Here's a column in the FT on congestion and growing queue length, which (also) shows why Tim Harford is one of my favorite economics journalists.

How British Queues Got Out of Hand 

[Why are ambulances increasingly delayed?] "The obvious explanation is that there are not enough ambulances, but the deeper problem is that ambulances themselves are being delayed in discharging patients into A&E units, which are themselves often overwhelmed: in the first quarter of 2014, 134 patients waited more than 12 hours in A&E before being admitted; 10 years later the figure was 141,693. The long delays in A&E are in part the result of the hospital beds all being full and that, in turn, is in part because hospitals sometimes struggle to discharge vulnerable patients into an overstretched social care system. All of these problems are a kind of queue and they all interact in a surprising way: you can die waiting for an ambulance because there aren’t enough nursing homes in your area.

...

"when bottlenecks feed into bottlenecks, some strategic thinking is required to fix the system. There is often more than one bottleneck in a congested system and opening that bottleneck will sometimes mean the same queue builds up somewhere else."

Alex Chan on market design and organ transplants (and how to begin a video)

Alex Chan, at HBS:) 

https://youtu.be/8n6A9wO1yt0?si=VsaT0AVNgYc7VdnB

Redesigning transplant and OPO center incentives (Chan and Roth in JAMA; Bae, Sweat, Melcher and Ashlagi in JAMA Surgery)

 

Chan A, Roth AE. Reimagining Transplant Center Incentives Beyond the CMS IOTA Model. JAMA. Published online January 26, 2026. doi:10.1001/jama.2025.26194 

 "On July 1, 2025, the Centers for Medicare & Medicaid Services (CMS) launched the Increasing Organ Transplant Access (IOTA) model, a national experiment in revising how transplant centers are evaluated and paid.

"For decades, transplant centers were primarily judged by 1-year graft and patient survival for patients who underwent a transplant. That standard, designed to safeguard quality, sometimes constrained access to transplants by rewarding risk avoidance rather than expansion. This contributed to persistent kidney shortages, alongside continued organ nonutilization.1

"The IOTA model marks a deliberate rebalancing. CMS is tying payment not primarily to short-term survival, but to 3 domains: achievement (60 points for transplant volume), efficiency (20 points for kidney offer acceptance), and quality (20 points for graft survival).

...

"A kidney transplant begins with an organ procurement organization (OPO). Yet OPOs remain outside the IOTA payment framework, perpetuating fragmentation between procurement and transplant.

"Recent experience with OPO performance metrics illustrates how narrow incentives can distort behavior. After CMS introduced tier-based OPO evaluations in 2021, lower-performing OPOs increased organ recovery, which also sharply increased discards, reliance on higher-risk organs, and out-of-sequence kidney placements,3 raising concerns about fairness to waitlisted patients.4 

...

"Emerging economic and experimental research suggests that joint accountability—rewarding procurement and transplant entities together for improving population health—can both shift recovery, discard, and transplant numbers and produce improved gains in patient health (Table).1 Without such system-level metrics spanning OPOs and transplant centers, IOTA will operate within a fragmented ecosystem where incentives push procurement and transplant in different, sometimes counterproductive, directions."

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See also

Bae H, Sweat KR, Melcher ML, Ashlagi I. Organ Procurement Following the Centers for Medicare and Medicaid Services Performance Evaluations. JAMA Surg. 2026;161(1):97–100. doi:10.1001/jamasurg.2025.5074 

 

Jennifer Mnookin to be Columbia University's next president

Among President Mnookin's many accomplishments is one that I haven't seen mentioned in the announcements of her appointment. 

 Here's the announcement from Columbia:

Columbia University’s Board of Trustees has appointed Jennifer L. Mnookin, a nationally recognized legal scholar who serves as the Chancellor of the University of Wisconsin-Madison, to be the next president of Columbia University, effective July 1, 2026. 

Here's the NYT:

Columbia Selects University of Wisconsin Chancellor as Its President.
Jennifer Mnookin has led the flagship campus of the state university system since 2022. She takes the helm at Columbia after a tumultuous period.    By Sharon Otterman

 

And here's the very different context in which I first came to know of her:

Father and daughter legal scholars complete successful kidney transplant  By Stephanie Francis Ward  December 15, 2020,

"When Robert Mnookin, a longtime Harvard Law School professor, needed a new kidney, he got some help from another member of the legal academy—his daughter, Jennifer Mnookin, the dean of the University of California at Los Angeles School of Law. "

Repugnance: two overviews (one by humans, one by Ai)

Here are two overviews of repugnance, one by economists in a forthcoming book chapter, and one from xAi via its large language model, in Grokipedia.

First, here's the human report, by three veteran scholars of repugnant transactions and controversial markets:

 The Morality of Market Exchanges: Between Societal Values and Tradeoffs   by Julio J. Elias, Nicola Lacetera & Mario Macis
NBER Working Paper 34647 DOI 10.3386/w34647  January 2026

"Certain behaviors in markets are unambiguously unethical. In other cases, however, voluntary exchanges that can create gains from trade remain contested on moral grounds, because of what is traded or of the price at which the exchange occurs. This chapter offers a framework to analyze these contested markets and provides examples of two general instances. First, we examine “repugnant” transactions involving the human body—such as compensated organ donation and gestational surrogacy—where concerns about dignity, exploitation, and inequality conflict with welfare gains from expanding supply. Second, we study price gouging in emergencies, where demands for a “just price” clash with the incentive and allocation roles of price adjustments under scarcity. Across both cases, we synthesize evidence on societal attitudes and highlight how support for policy options depends on perceived trade-offs between autonomy, fairness and efficiency, and on institutional features that can separate compensation from allocation."
 

And here's the first sentence of a long overview of repugnance at Grokipedia, an Ai generated encyclopedia launched in October 2025:

Repugnancy costs
"Repugnancy costs denote the multifaceted disutilities—including reputational harm, social sanctions, moral distress, and enforcement expenses—that emerge when voluntary transactions clash with dominant cultural or ethical norms, effectively rationing or prohibiting markets even among consenting parties. "

Peer review isn't sufficient to detect/deter fraud in science

 Economists shouldn't be surprised that, in many fields of science, there is some incidence of deliberate fraud.  Being a scientist is an attractive job, and to some extent a competitive one.  Rewards flow to those who publish in top (read "competitive")  journals.  In big lab based, grant-dependent science, the ability to keep working may even depend on such publications coming at a steady rate, to keep the grants coming to keep the lab funded.  

Most journals do their gatekeeping by peer review.  But peers aren't detectives, they are volunteers who can mostly judge a paper primarily by what evidence it presents.* So we are seeing some growth in after-publication review by fraud hunters, typically also volunteers.

Here's an article by two interesting, interested observer/participants,  Ivan Oransky (a co-founder of Retraction Watch) and Alice Dreger: 

Science journals retract 500 papers a month. This is why it matters
A small team of volunteers is tracking thousands of falsified studies, including cases of bribery, fraud and plagiarism  by Ivan Oransky | Alice Dreger 

 "So, how bad is the whole problem now? Much worse, it turns out, than when Retraction Watch was founded in 2010.

...

"The Dana-Farber case, unearthed by whistleblower Sholto David, exemplifies a key change behind the massive rise in retractions. Sleuths such as David — typically volunteers — function as true heroes of modern science, spending days and nights detecting plagiarism as well as suspicious data, statistics and more. Looking at studies by Dana-Farber researchers, David found that images of mice, said to have been taken at different stages of an experiment, appeared to be identical, and identified bone marrow samples taken from humans that were presented in a misleading way. This kind of painstaking work has only become possible on any sort of scale thanks to the development of forensic tools, some powered by AI. 

...

"All the large publishing houses now employ research integrity teams to review allegations and retract papers if necessary.  

 ...

"Rather than giving up, we should pay more attention to how we create perverse incentives — promoting quantity of publication over quality, and sexiness over meticulousness. Perhaps most importantly, we need to help the world understand that, when splashy results turn out to be incorrect and are retracted or amended, that’s all part of how we get closer to the truth. 

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*Peer review is not without other problems, don't get me started. But my sense is that, not unlike democracy, it does pretty well by comparison with alternatives. 

Organ attack (the game)

 Here's a game that looks like it could be a gift for the organ trafficker in your life. (It was sent to me by a former student.)  The subtitle of the game is "The Family Friendly Game of Organ Harvesting."

  We opened it after a recent dinner with transplant-adjacent colleagues, but found to our disappointment that it was better suited to epidemiologists than to organ traffickers--the attacks you can make on other players' organ cards are all diseases, so you can't ever take possession of another player's organs. Without the prospect of the advertised organ harvesting, my fellow traffickers and I lost interest.

 

 

HT: Jacob Leshno 

Noam Nisan and Ariel Procaccia recognized as ACM Fellows

The  Association for Computing Machinery (ACM) has named a new cohort of Fellows,  including Noam Nisan and Ariel Procaccia, who will be familiar to the readers of this blog for their contributions to economics and computation in the spirit of market design.

Here's the press release citing all the new Fellows:

Excellence and Impact Recognized by World’s Preeminent Computing Society
Association for Computing Machinery Selects 72 Professionals for Outstanding Achievements 

"Noam Nisan
Hebrew University
For contributions to complexity theory, and for pioneering the field of economics and computation."

"Ariel Procaccia
Harvard University
For contributions to AI, algorithms, and society, including foundational work and practical  impact."

 

HT: Yannai Gonczarowski 

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Earlier posts:

Friday, September 9, 2016 Knuth award to Noam Nisan

Sunday, August 15, 2021 Fair algorithms for selecting citizen assemblies, in Nature

 

 

Kidney exchange in Brazil (a clinical trial)

Here's a video in which Mike Rees, the founder of the Alliance for Paired Kidney Donation (APKD) describes how (with the help of a grant from Stanford Impact Labs) the APKD is helping Brazilian transplant docs get kidney exchange going there. 

 

Earlier:

Tuesday, February 27, 2024  Stanford Impact Labs announces support for kidney exchange in Brazil, India, and the U.S.

 

Thursday, October 10, 2024  Kidney exchange in Brazil, continued (with pictures)

 

 

How will the Army build AI and robotics expertise in uniform?

 The US armed services have an unusual labor market.  Most soldiers, sailers, airmen and now space forcers join the military pretty much right out of high school, either directly, or in college ROTC (Reserve Officer Training Corps), or in one of the military academies.  Two exceptions are lawyers and doctors, who can join as officers without prior military experience (i.e. they can become officers without ever having learned how to salute).

Now that computer science of various sorts is entering warfare, cyber warriors are also needed.  But there's only so much you can do with contractors and consultants.  

This month, the Army is introducing a new career path for officers:

Army establishes new AI, machine learning career path for officers 

"The U.S. Army has established a new career pathway for officers to specialize in artificial intelligence and machine learning (AI/ML), formally designating the 49B AI/ML Officer as an official area of concentration. It advances the Army's ongoing transformation into a data-centric and AI-enabled force.

Full implementation of the new career field will be phased. The first selection of officers will occur through the Army's Volunteer Transfer Incentive Program (VTIP) beginning January 2026. The officers will be reclassified by the end of fiscal year 2026."

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And here's another report that indicates that some CS experts have also been laterally recruited into the officer corps.

 Army creates AI career field, pathway for officers to join

"In June, the Army directly commissioned several tech executives with artificial intelligence backgrounds from companies such as Meta and Palantir as lieutenant colonels as part of its Executive Innovation Corps (EIC). Those executives serve in the reserves as “senior advisors,” the Army said. 

The job market for economists, 2026

 The WSJ has the story:

Economists Are Studying the Slowing Job Market—and Feeling It Themselves
Newly minted Ph.D.s tend to work for universities, government agencies and big white-collar companies. It’s not a great hiring time for any of them.  By  Justin Lahart 

"The economics job market is getting buffeted by a confluence of forces. Worries about federal funding have led many major universities to reduce, or even freeze, hiring. Jobs within the federal government have dried up. The private sector, where demand for economists has been intense in recent years, has pulled back. 

“It’s like a perfect storm,” said Syracuse University economist John Cawley, who heads the American Economic Association’s job market committee.

"The tough market for doctoral students finishing up their studies is hardly unique to economics. What’s different about economists is that they are intensely interested in measuring and understanding how labor markets work—and they have brought that to bear on their own profession. As a result, armed with data from the AEA and all the knowledge they gained in graduate school, doctoral students in economics have a much more precise grasp of what type of environment they are facing than their counterparts in political science, philosophy or biophysics.

...

"The economics job market has its own peculiar rhythms and hierarchies. In the fall, students who are finishing their Ph.D.s, as well as economists in postdoctoral programs, apply for jobs that typically start the following summer. But because students can apply to dozens, or even hundreds, of jobs, this creates a matching problem: How does a prospective employer know which candidates are serious?

"Economists, being economists, have tried to solve this. When a candidate applies for jobs via JOE, they are able to send up to two “signals” of interest for jobs they are particularly interested in—almost like a winking emoji on a dating app. That signaling system was put together with the help of Stanford economist Alvin Roth, who also developed systems for matching kidney donors with patients and New York City schoolchildren with schools." 

AEA Code of Conduct: (I can't answer "no" to all of the screening questions)

 When I was president of the American Economic Association, we began to think it would be prudent to have a formal code of conduct (see the link below for details).  But part of that effort resulted in a disclosure questionnaire required of all those who would serve on AEA committees. As I recall, I felt that one of the questions was too broadly posed. 

I've agreed to serve another term on the Committee on the Job Market, so I get to fill out the questionnaire, once again.  My responses are below. You should be able to guess the question I thought was phrased too broadly.

AEA Disclosure Questionnaire

Please review and respond to the disclosure questions below, with explanations as needed. It is important that you answer truthfully. Your answers to the questions will be reviewed by the President and Secretary-Treasurer and will be shared with other members of the Executive Committee only if necessary and on a need-to-know basis.

Affirmative answers to questions would not necessarily be disqualifying but will be considered during the review. To expedite this process, I ask that you please respond to these questions at your earliest convenience.

For more information, see the AEA Professional Code of Conduct and the policy on harassment, discrimination, and retaliation.

Here are the questions, and my answers. 

  

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 I would have had more reason(s) to answer "yes" if I had played on any  gender-segregated athletic teams.

Religion and gender turn out to be complicated (and therefore well worth studying). 

Copyright transfer clause: blacklisted countries

Here's something I hadn't encountered before, in the copyright transfer form of a prominent international transplant journal:

"6. TRADE COMPLIANCE: Each author warrants that if the author, any of the author’s coauthors or any other individual whose content is included in the Work resides in Iran, Cuba, Syria, North Korea, Crimea, the Donetsk People’s Republic (DNR) or the Luhansk People’s Republic (LNR) regions of the Ukraine, the Work has been prepared in a personal, academic, or research capacity and not as an official representative or otherwise on behalf of the relevant government" 

The post-Nobel career of Adam Riess, and controversies in cosmology

The Atlantic has a story about a controversy in cosmology about the expansion of the universe, and whether its explanation requires the hypothesis of dark energy.  But what caught my eye is the author's apparent surprise that a Nobel laureate at the center of the controversy continued his research career, post-Nobel.

Here's the link, and the paragraphs that caught my eye: 

The Nobel Prize Winner Who Thinks We Have the Universe All Wrong  Cosmologists are fighting over everything.  By Ross Andersen 

  "Adam Riess was 27 years old when he began the work that earned him the Nobel Prize in Physics, and just 41 when he received it.

...

"When he returned from Stockholm with his prize in 2011, he found that his academic life had changed. People around him started to behave oddly, he told me. Some clammed up. Others argued with him about trivial things, he said, perhaps so they could boast of having dunked on a Nobel laureate. Riess was besieged with invitations to sit on panels, give talks, and judge science fairs. He was asked to comment on political issues that he knew nothing about. He told me he was even recruited to run major scientific institutions. 

"Riess wondered about that path—being the big boss of a NASA mission or gliding around a leafy university as its chancellor. He could see the appeal, but he hated fundraising, and unlike other, older Nobel laureates, he said, Riess still felt that he had scientific contributions to make, not as an administrator, but as a frontline investigator of capital-n Nature. “Scientists sometimes tell themselves this myth: I’ll go lead this thing, and then I’ll come back and do research,” he told me. But then, by the time they’ve finished up with their administrative roles, they’ve lost touch with the data. They become clumsy with the latest software languages. “The science passes them by,” Riess said.

"Riess decided to stick with research. "

Offering deceased donor transplants out of sequence when there is a chance the organ will (otherwise) be unutilized (Ashlagi and Roth in AJOB)

 Itai Ashlagi and I weigh in on recent controversy about "out of sequence" offers of organs for transplant, with some ideas about how the current system might be redesigned and maintained so as to reduce organ discards while maintaining transparency about how and to whom organs are offered.

 Itai Ashlagi and Alvin E. Roth (2026). Out of Sequence Offers: Towards Efficient, Equitable Organ Allocation. The American Journal of Bioethics, 26(1), 5–8. https://doi.org/10.1080/15265161.2026.2594937  

"Organs for transplant are very scarce compared to the need, and so the allocation of organs from deceased donors raises questions about both efficiency and fairness. Because offers of organs take time to consider, and because the viability of organs from deceased donors decreases over time, efficiency sometimes requires increasing the chance of reaching a patient who will accept the organ while it remains viable. So fairness and efficiency, concerning who gets to consider the next offer, and the probability that the organ on offer will be accepted in time for it to be transplanted, may sometimes be in conflict, or at least appear to be. And even the appearance of unfairness may undercut trust in the system of organ donation and transplantation. 

"This conflict between fairness and efficiency has resulted in controversy about offers made “out of sequence” (Covered in a lead article in the NYT article (Times 2025)) 

...

"Collecting data is essential for both efficiency and transparency. It is unfair to future patients not to have transparent allocation systems that can be studied with precision (with causal inference from experimentation), so that it can be improved over time. It is also unfair to future patients who will join increasingly congested waiting lists as a result of the failure to utilize a large number of transplantable organs.

Public data about transplant centers’ performance and patients’ waiting times would further allow patients to choose, based on their own preferences, a transplant center that fits their need. 

...

"Policies to expedite the placement of marginal quality organs that can be tested over time and studied with experiments include when to determine an organ is hard-to-place and when and how to adapt the priority list.

"In summary, it is sometimes desirable to expedite an organ that risks being unused, by offering it to a patient or transplant center that is likely to accept it if the offer is received in a timely way. But it is important to make sure that this flexibility does not promote unfairness to patients or transplant centers. Increasing the transparency and efficiency of the system for expediting organs can address both these issues."

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The same issue of the journal contains a number of articles discussing organ allocation out of sequence  

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Earlier:

Friday, May 23, 2025  Deceased organ allocation: deciding early when to move fast