Uber and "safety by design"

I've written a lot about how marketplaces have to help markets become thick, deal with the congestion that can accompany thick markets, and make the market safe to participate in.  I just got a nice email from Uber illustrating how they are thinking about that third point, on the rider side of the market.

BACKGROUND CHECKS Drivers pass federal, multi-state, and county background checks before driving. Extensive Screening Uber prohibits drug or alcohol offenses, severe traffic violations, and sexual offenses. Insurance From pick up to drop off, your ride is covered by a $1M commercial insurance policy.

REQUEST A RIDE

Safe Pickups The app pinpoints your location so you can request a ride from anywhere and wait safely. Nobody’s A Stranger Your driver's name, photo, and vehicle information appear in the app. Disguised Phone Numbers Communication between riders and drivers is anonymized to protect private phone numbers.

DURING YOUR TRIP

Always On The Map The GPS-enabled map provides your driver's location and trip details in real-time. Share My ETA Share your ETA with friends and family to keep track of your ride and safe arrival. Hassle-Free Payments Your credit card is on file so you never need to carry cash or stop at an ATM.

AFTER YOU RIDE

Actionable Feedback You rate your experience after every trip and drivers do the same. Trip History After each ride, you receive a detailed email receipt with trip route, driver name, and total fare. 24/7 Support Lose something? Have questions? Contact our 24/7 customer support.

Food trucks trade assigned spaces in Washington DC

D.C. food trucks look to new platform to swap spaces assigned in lottery

"It didn’t take long after D.C. started doling out parking spaces to the city’s food trucks that the D.C., Maryland and Virginia Food Truck Association hit on one unfailing principal of economics: Where one market pops up, a secondary market will surely follow.

Food truckers, after getting their assigned spaces in the city's mobile roadway vending zones each month, were frantically hitting up the association’s message board with requests to trade days. It made for way too many emails, and not a lot of successful trades.

So the DMVFTA decided to find a better way. Now, a few months later, the association is about to launch its very own digital trading platform on its website.

...

"Hoffman had a group of masters students who needed a final project. With her guidance, those students developed a proof-of-concept program that took into account the truckers’ preferences for trades and automatically assigned new slots. In the end, the program spits out a new schedule for assigned spots that can be submitted to the D.C. Department of Consumer and Regulatory Affairs, so they are able to enforce the assignments."

HT: Paul Milgrom

Commerce and peer review: pay for speed?

Science has the story (and science is the story):
Editor quits journal over pay-for-expedited peer-review offer

"With a tweet yesterday, an editor of Scientific Reports, one of Nature Publishing Group’s (NPG’s) open-access journals, has resigned in a very public protest of NPG’s recent decision to allow authors to pay money to expedite peer review of their submitted papers. “My objections are that it sets up a two-tiered system and instead of the best science being published in a timely fashion it will further shift the balance to well-funded labs and groups,”
...
"The flap shines a light on a fledgling industry where several companies are now making millions of dollars by privatizing peer review. This niche is being exploited because journal peer review is usually a slow process. After all, it is typically an anonymous, volunteer effort for which scientists receive nothing more than thanks from journal editors and the good feeling of contributing to the scientific community. But for a price at some journals, authors now have the option of fast-tracking their submitted papers through an accelerated peer-review process.

NPG announced earlier this week that it was trying out the peer-review service, called Rubriq, provided by Research Square, a company based in Durham, North Carolina. For a $750 payment to NPG, authors are guaranteed a review within 3 weeks or they get their money back. NPG declined to say how much of that money goes to Research Square.

How does the company perform such quick reviews? “We have about 100 employees with Ph.D.s,” says Research Square’s CEO, Shashi Mudunuri. That small army of editors recruits scientists around the world as reviewers, guiding the papers through the review process. The reviewers get paid $100 for each completed review. The review process itself is also streamlined, using an online “scorecard” instead of the traditional approach of comments, questions, and suggestions. The company also offers services directly to authors, saying it can help them improve papers and find placement with a journal. Business is bustling for Research Square. So far, Mudunuri says, the company has about 1400 active reviewers who have scored 920 papers. The company pulled in $20 million in revenue last year. Mudunuri declined to name the other publishers with which the company has cut deals"

A problem for the NRMP that may be growing

I've had correspondence and conversations with a number of residency program directors, about a common problem that may interfere with how safe they feel about rank-ordering residency and fellowship applicants according to their true preferences.

I'll quote from some emails without identifying the senders.

"I oversee the xxx residency match ....

"There is a terrible game that is going on in some surgical fields, though.  Program directors feel that it is prestigious not to go down their lists very far.  A program director may boast to his/her Chair, "This year we only needed to go down to #6 on our list to fill our (3) positions."  This ambition to not go down far on a list, as evidence that a program is highly desirable, is often achieved by pressuring candidates in the following way, "If you want to come here, you really need to let us know," which translates to "tells us we are your #1 and then you will have a chance to match here."  These actual or implied quid pro quos are a shame and pervert the intent of the match and your good work.  I know the NRMP considers them illegal or at least poor practices, but they are common, unfortunately."

**********

"I work in xxx [non-surgical specialty], which is a specialty that is very competitive for the match.  Although the system that you helped develop should match applicants and residency programs based on the rankings that applicants and programs provide according to their independent preferences, some prestigious residency programs in xxx (and likely other specialties) are being evaluated by hospital presidents or other administrative officials by how far down the rank list they must go to fill their complement of residents.  This in turn has created an environment where some programs are ranking applicants according to the likelihood that the applicant will rank the program in the top slot rather than if they believe that the applicant is truly the best applicant for their program.  While I believe that each residency  program should be able to use whatever criteria they want to for ranking applicants, the problem is that some residency program directors or department chairs are contacting applicants or faculty at which the medical students train to find out if their program is at the top of the applicant’s rank list.  This puts the applicants in an awkward position and in my opinion likely biases the match result to hurt some applicants.

In an ideal world, such behavior by residency programs could be prevented by explaining that it violates the principles of the match.  However, I am afraid that this approach will be unlikely to remove the cause of this problem: pressure that some departments feel from administrators and hospital presidents."
************

Perhaps the community (directors and NRMP) could be persuaded that residency directors shouldn’t show their rank order lists to their deans and chairs?  

Organ donors increase in California, as undocumented residents become eligible for driver's licenses

Organ donors increase in California

"BAKERSFIELD, Calif. (KBAK/KBFX) - There has been a recent hike in people registering as organ donors in California.

"Reports show that the increase just might be linked to AB 60, the new law helping undocumented residents obtain driver's licenses. More than 60,000 people have been added to the California organ and tissue donor registry, bringing it up 29 percent from the same time last year.

"Lori Malkin is the founder of JJ's Legacy, a local nonprofit group aimed at educating the community about the importance of becoming an organ donor.

"If you are registered donor, you can save and heal lives through organ, eye, and tissue donations," said Malkin.

She launched JJ's Legacy in honor of her son, Jeffery Johns.

"I am a donor mother. My son was killed in an automobile accident and died from a head injury," said Malkin. "He had the opportunity to donate all of his organs and his corneas and tissue. He enhanced and saved eight lives through organ donation, and he also enhanced and saved 58 lives through tissue and cornea donation."

How the United States Stacks Up to Other Countries in Chronic Kidney Disease, by Elisa Gordon

How the United States Stacks Up to Other Countries in Chronic Kidney Disease by Elisa Gordon, is full of links to useful data sources

Bargaining, and the law of one price on the internet: Axiomatic Models of Bargaining

Sometimes price variation on the internet is explained by search costs, etc., but below is an example that is hard to explain that way, since all the options are on the same page (e.g. who would rent a book for more than its purchase price?)  The example below is for my book, Axiomatic Models of Bargaining, which is available for free here (although just in pdf, not in the collectors' edition, which you can buy from Springer for $69.95).

A first non-directed donor kidney exchange chain in Italy

with help from G-translate:
Trapianti: in Italia il primo caso di donatore samaritano
"Transplantation: in Italy the first case of Samaritan donor
"For the first time a woman gave a kidney for free without knowing [to whom it] would go.
...
"As a result of the chain of 'cross over' following the first donor transplant Samaritan made ​​in Italy, were transplanted kidneys in 5 couples incompatible."


HT: Nicola Lacetera

The Orthopedic Surgery Fellowships

I recently occupied the attention of some knee surgeons, with whom I had interacted in a very different way when writing about how fellowship matches might be implemented for orthopedic surgeons (Harner, Christopher D., Anil S. Ranawat, Muriel Niederle, Alvin E. Roth, Peter J. Stern, Shepard R. Hurwitz, William Levine, G. Paul DeRosa, Serena S. Hu, "Current State of Fellowship Hiring: Is a universal match necessary? Is it possible?," Journal of Bone and Joint Surgery, 90, 2008,1375-1384.)

So I read this state-of-the-match report with interest...

Orthopedic Surgery Fellowships: The Effects of Interviewing and How Residents Establish a Rank List

Matthew C. Niesen, MD; Jeffrey Wong, MD; Edward Ebramzadeh, PhD; Sophia Sangiorgio, PhD; Nelson Fong SooHoo, MD; James V. Luck, MD; Jeffrey Eckardt, MD
Orthopedics
March 2015 - Volume 38 · Issue 3: 175-179

"Prior to the establishment of the Orthopaedic Fellowship Match in 2008, orthopedic residents had to decide where to complete fellowship training in an environment without a formal match system.1 Annual meetings were “free-for-alls” with both programs and residents anxious to make a deal. If interviews occurred, they were uncoordinated and happened earlier and earlier in the process as programs competed for top candidates and residents tried to secure positions at the best programs. Often, both sides involved in the process had to make a decision without knowing what alternatives might exist or arise in the future. Residents frequently were uncertain whether they would receive additional offers and were pressured to commit to a fellowship, while fellowship programs had high interview cancellation rates because residents had already taken other positions. This system may have caused residents and fellowship programs to settle for a less than ideal “match.” A 2008 American Orthopaedic Association symposium indicated that more than half of all residents surveyed accepted their first fellowship offer. The same survey showed that 78% of residents favored a transition to a centralized match.2

One of the primary goals of the Orthopaedic Fellowship Match was to create a fairer and more coordinated process in which both applicants and fellowship programs had time to evaluate and consider their training options. However, with the establishment of the match, new complications arose. Fellowship programs require additional planning for interviewing and ranking a large number of residents, residencies need to find coverage for residents away from their clinical duties, and residents face the additional issues of cost and time away from service. The magnitude of these factors is currently unknown. A primary goal of this study was to establish benchmark values for these factors and to quantify the financial impact and time away from service, specifically for residents. This information will be valuable to residents and both residency and fellowship programs as they complete the fellowship match process.

After applying to and interviewing for fellowships, residents have the task of establishing a final rank list. Several studies have identified the factors medical students in the United States and Canada consider most important when establishing a rank list for residency positions.3–5 The factors that are commonly ranked the highest for residency positions include clinical experience, location, and academic reputation. After a brief review of the literature, it is apparent that limited data exist identifying what factors are most important for residents of all specialties in medicine and surgery when choosing a fellowship program or establishing a rank list. A recently published study evaluated what factors residents pursuing pediatric otolaryngology positions considered to be most important when establishing a rank list for fellowship positions.6For these applicants, appropriate experience, faculty reputation, and location were ranked as the most important factors when choosing a program. Accreditation Council for Graduate Medical Education (ACGME) accreditation, fellowship longevity, and salary were less important. The factors orthopedic surgery residents consider most important when establishing a rank list for fellowships have not been investigated. Thus, this was a second goal of this study.

...

Conclusion

The Orthopaedic Fellowship Match has created an environment in which residents can consider a greater number of options without feeling pressure to make a quick decision. The vast majority, nearly 96%, of orthopedic surgery residents pursue fellowship training; sports medicine, hand, and adult reconstruction were the most popular subspecialties in this study. The interview process has financial implications and draws residents away from clinical services. The estimated cost of the orthopedic fellowship interview process was $4671±$2454, with a median of 10 days off service required to interview. These are the first benchmark values established for these variables.

Residents should attempt to be more selective with their application choices to minimize unnecessary costs, time off service, and associated stress and fatigue. Finally, this study is the first to demonstrate what factors orthopedic surgery residents consider most important when establishing a final rank list for fellowships. Residents value operative experience, autonomy, and fellowship staff members the most and place the least importance on research opportunities and salary. Fellowship programs may find this information useful as they choose which aspects of their programs to highlight during recruitment activities.

History of Experimental Economics -- Andrej Svorenčik

History is happening fast...now featuring "the last third of the 20th century."

The Experimental Turn in Economics: A History of Experimental Economics

Andrej Svorenčík 

University of Mannheim - Department of Economics
Abstract:       The emergence of experimental economics in the last third of the 20th century revisited the long-standing belief that economics is a non-experimental discipline. The history of this new practice reveals this went further than simply introducing the experimental method to economics. Its history shows individual economists and research communities above all redefining the relationship between economic theory and rigorous data. Replicable data that were specifically created to satisfy conditions set by theory in controlled environments could not be avoided by economists or explained away as irrelevant to economic theory. The reconceptualization of the relationship between economic theory and rigorous experimental data culminated at the end of the 1980s in what I call the experimental turn, after which the experimental method became accepted in the wider economics community.

Universal enrollment--some benefits in New Orleans school choice

An editorial in the Times-Picayune remarks on some of the benefits of having school choice using a universal enrollment system that allows all schools to be applied to with one application. Before that was in place, there were questions about whether some charter schools were filling their places selectively, but that seems to have been resolved by the current system.
Principals' confessions to manipulating enrollment prove importance of OneApp: Editorial

"It's no surprise that some New Orleans principals try to manipulate which students they get even though their schools are supposed to be open to any child. But a new study by the Education Research Alliance for New Orleans quantifies how prevalent the practice has been. One-third of 30 public school principals surveyed during the 2012-13 school year admitted that they contrived to get higher-achieving studentsenrolled over other students. Eight of those 10 schools had no special entrance requirements and were supposed to take any student on a first come, first served basis.

To avoid students they didn't want, principals said they pressured some children to transfer, kept quiet about open seats, accepted only the best students as mid-year transfers and held invitation-only recruitment events. Neither the schools nor the principals were named in the study.

Before 2012, it was easy for a school to exclude students it didn't want. After the old public school system was mostly replaced post-Katrina by independent charter schools, children could attend any school in the city. But there was no universal enrollment system, which meant families had to apply at individual schools. If a school didn't want a child, all it had to do was claim there were no spots available.

That was a bad approach. It was a hassle for parents to go from school to school to put in multiple applications. And, as the Education Research Alliance study shows, students didn't always have a fair shot of getting into the school they wanted and should have been able to attend.

The state-run Recovery School District rolled out OneApp, a computerized enrollment system, in February 2012. That allowed parents to fill out one application and rank several school choices.

OneApp that year didn't include any of the traditional or charter schools that remained under the Orleans Parish School Board's control post-Katrina. But the wrangling wasn't confined to those schools. Five of the principals who told researchers they excluded students were under the Recovery School District.

OneApp has been refined since 2012. And researcher Huriya Jabbar said, "I don't think it's possible for schools" to do now what the principals described in the study."

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

And here's the story about the study: New Orleans school principals tried to pick students, study says, while here is a blog post that critiques it: EDUCATION RESEARCH ANNOYANCES IN NEW ORLEANS--THREE QUESTIONS RAISED BY ERA'S LATEST STUDY ON COMPETITION AMONG NOLA SCHOOLS

Kidney exchange may be imminent in Sweden

Two articles in the Swedish press reflect the growing preparations there for kidney exchange:

Matchning av donatorer kan öka tillgången på njurar--Har provats i andra länder
(G Translate: Matching of donors can increase the supply of kidneys--Have been tried in other countries)

"Cooperation in Sweden will take place between the four hospitals that carry out kidney transplants, in Stockholm, Gothenburg, Malmö and Uppsala.

Already have begun to collect possible pairs to the database, and at some point during the year, it hopes to implement the first draw."
*********

Organutbytesprogram ska ge fler njurar (Organ Exchange will provide more kidneys)
"A new exchange system will reduce the waiting time.
- In this way you can do two transplants that previously could not do any at all, says Lars Wennberg, chief of transplant clinic at Karolinska University Hospital"
...
"The project is already underway and we hope that in 2015 implementing the first exchange. In the future it may also be necessary to work the same way in Scandinavia."
************

See my earlier post:

Tommy Andersson.on the prospects for kidney exchange in Scandinavia

University governance, at Harvard

In The Chronicle of Higher Education, Charles Fried and Bob Mnookin write about the increased centralization of governance at Harvard: The Silencing of Harvard’s Professors.

They make many points, here are two:
"Today’s official mantra is One Harvard. In the last 20 years there has been a vast expansion of the central administration and an increasing degree of centralization. This is hardly a trend specific to our campus. Colleges and universities across the country both public and private are grappling with this same issue. Today at Harvard, not only is there a provost, who is the university’s “chief academic officer,” there are also a deputy provost, a senior vice provost for faculty development and diversity, three vice provosts (for research, for advances in learning, and for international affairs), a senior associate provost who is the chief technology officer, and four associate provosts for institutional research, for science, for social sciences and the professions, and for arts and culture, as well as assistant provosts — all with staffs. In addition there is a cadre of high-level administrators such as an executive vice president and senior nonacademic officials with central administrative responsibilities.
...

"On everybody’s return from summer vacation we were met with a ukase imposing a single set of sexual-harassment policies and procedures, and a new central bureaucracy combining under one head compliance, enforcement, investigating, and adjudicating functions for the whole university. These policies and procedures were arrived at by a working group of administrators (some of whom were drawn from the administrative staffs of the schools) and then adopted by the president and fellows. There were no law faculty members involved. When our law faculty had a good look at these procedures at a meeting with the general counsel we made it plain that we considered the procedures inconsistent with due process and if radical changes were not made it was probable that a large majority of Harvard’s law faculty would publicly denounce them. In response the university authorized the law dean to appoint a faculty redrafting committee and now there are for the law school alone disciplinary procedures worthier of a leading law faculty. Those alternative procedures were overwhelmingly approved by vote of the law faculty."

Recent transplantation news

The latest issue of the American Journal of Transplantation (Volume 15, Issue 4 Pages 851 - 1129, April 2015) has a number of interesting articles and news notes. Here are some that caught my eye:

More Than 2 Million Years of Life Saved in 25 Years of Transplant

According to a report published in January 2015, OPTN/UNOS records of more than 1.1 million patients indicate that approximately 2.2 million years of life were saved via transplantation from 1987 to 2012:

• Kidney transplant: 1.3 million years of life saved;
• Liver transplant: 465,296 years saved;
• Heart transplant: 269,715 years saved;
• Lung transplant: 64,575 years saved;
• Pancreas–kidney transplant: 79,198 years saved;
• Pancreas transplant: 14,903 years saved; and
• Intestine transplant: 4,402 years saved.

The report says that the shortage of donors continues to hamper the field of transplantation: Only 47.9% of patients on the waitlist during the 25-year study period underwent a transplant.

Reference: Rana A, Gruessner A, Agopian VG, Khalpey Z, Riaz IB, Kaplan B, et al. Survival benefit of solid-organ transplant in the United States [March 2015, Vol 150, No. 3 ]. JAMA Surg. doi: 10.1001/jamasurg.2014.2038.

*******

Lung Transplantation With Donation After Circulatory Determination of Death Donors and the Impact of Ex Vivo Lung Perfusion

1. T. N. Machuca, 
2. O. Mercier, 
3. S. Collaud, 
4. J. Tikkanen, 
5. T. Krueger, 
6. J. C. Yeung, 
7. M. Chen, 
8. S. Azad, 
9. L. Singer, 
10. K. Yasufuku, 
11. M. de Perrot, 
12. A. Pierre, 
13. T. K. Waddell, 
14. S. Keshavjee and
15. M. Cypel^*

Article first published online: 13 MAR 2015

 (If I understand this one, it is involved with the observation that the cells in your lungs get oxygen from the air in your lungs, not from your blood, and so your lungs can stay pink and transplantable after your circulatory system shuts down..._)

********

Socioeconomic Status and Ethnicity of Deceased Donor Kidney Recipients Compared to Their Donors

1. J. T. Adler^1,2, 
2. J. A. Hyder^1,3, 
3. N. Elias^2,4, 
4. L. L. Nguyen^1,4,5, 
5. J. F. Markmann^2,4, 
6. F. L. Delmonico^2,4 and
7. H. Yeh^2,4,*

ABSTRACT

Public perception and misperceptions of socioeconomic disparities affect the willingness to donate organs. To improve our understanding of the flow of deceased donor kidneys, we analyzed socioeconomic status (SES) and racial/ethnic gradients between donors and recipients. In a retrospective cohort study, traditional demographic and socioeconomic factors, as well as an SES index, were compared in 56,697 deceased kidney donor and recipient pairs transplanted between 2007 and 2012. Kidneys were more likely to be transplanted in recipients of the same racial/ethnic group as the donor (p < 0.001). Kidneys tended to go to recipients of lower SES index (50.5% of the time, p < 0.001), a relationship that remained after adjusting for other available markers of donor organ quality and SES (p < 0.001). Deceased donor kidneys do not appear to be transplanted from donors of lower SES to recipients of higher SES; this information may be useful in counseling potential donors and their families regarding the distribution of their organ gifts.

**********

The Impact of the Israeli Transplantation Law on the Socio-Demographic Profile of Living Kidney Donors

H. Boas¹, E. Mor², R. Michowitz², B. Rozen-Zvi³ and R. Rahamimov

Abstract

The Israeli transplantation law of 2008 stipulated that organ trading is a criminal offense, and banned the reimbursement of such transplants by insurance companies, thus decreasing dramatically transplant tourism from Israel. We evaluated the law's impact on the number and the socio-demographic features of 575 consecutive living donors, transplanted in the largest Israeli transplantation center, spanning 5 years prior to 5 years after the law's implementation. Living kidney donations increased from 3.5 ± 1.5 donations per month in the pre-law period to 6.1 ± 2.4 per month post-law (p < 0.001). This was mainly due to a rise in intra-familial donations from 2.1 ± 1.1 per month to 4.6 ± 2.1 per month (p < 0.001). In unrelated donors we found a significant change in their socio-demographic characteristics: mean age increased from 35.4 ± 7.4 to 39.9 ± 10.2 (p = 0.001), an increase in the proportion of donors with college level or higher education (31.0% to 63.1%; p < 0.001) and donors with white collar occupations (33.3% to 48.3%, p = 0.023). In conclusion, the Israeli legislation that prohibited transplant tourism and organ trading in accordance with Istanbul Declaration, was associated with an increase in local transplantation activity, mainly from related living kidney donors, and a change in the profile of unrelated donors into an older, higher educated, white collar population.

The market for orgies

The Telegraph reports on The rise and rise of the upmarket orgy
"Behind the Dominique Strauss-Khan pimping trial lurks the extraordinarily widespread popularity of the sex party"

"Strauss-Kahn’s parties, which he described as “recreational sessions in a hectic life”, adding “six girls at once did not seem a considerable number”, appear to have been organised by friends in venues round the world, including Les Chandelles, an exclusive Paris swingers’ venue, and wife-swapping clubs at the Carlton Hotel in Lille, the Amigo Hotel and Tantra in Brussels, and his own bachelor flat on Rue d’Iena, close to his main Parisian residence.

“I hear about parties like these all the time, they’ve been going on for centuries,” says Emma Sayle, founder of Killing Kittens, which holds 14 upmarket sex parties a month in locations around the globe. Sayle considers the four-a-year tally to be “average” for her 50,000 members, though some attend one a week."
...
"Chris Reynolds Gordon runs Heaven SX, which bills itself as Britain’s most “elite” purveyor of sex parties – achieved by vetting wannabe guests’ photos. “Our parties are in gorgeous mansions, we only want gorgeous people in their twenties and thirties, though we do have some very attractive people in their forties as well,” he says.
...
"According to Sayle, 36, who attended private school Downe House with Kate Middleton, many sex parties – especially those with big age gaps between the men and women – are full of hookers. “Having said that, there are always some women who are attracted by power and lifestyle.”

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

Stay tuned: Verdict in Strauss-Kahn pimping trial set for June

In defense of pilot studies for organ donor incentives

The third in the series of forthcoming AJT papers about incentives/disincentives for donation discusses the basis for pilot studies (see earlier posts 1 and 2)

Between Scylla and Charybdis: Charting an Ethical Course for Research Into Financial Incentives for Living Kidney Donation
J. S. Fisher1, Z. Butt, J. Friedewald, S. Fry-Revere, J. Hanneman, M. L. Henderson, K. Ladin, H. Mysel, L. Preczewski, L. A. Sherman, C. Thiessen andE. J. Gordon*
Article first published online: 31 MAR 2015
DOI: 10.1111/ajt.13234

"The transplant community appears to be in a state of equipoise regarding the ethical soundness of empirically investigating a regulated system of financial incentives for living kidney donation. ...Proponents of financial incentives for nondirected living donors posit that incentives would increase the supply of high quality organs, prolong quantity, improve quality of life of recipients, and offset the societal cost by reducing the patient population receiving dialysis [10, 11]. Opponents argue that financial compensation beyond recovering expenses would: (1) cause undue pressure to donate, (2) exploit at-risk individuals (such as the poor), (3) commodify the human body, (4) exacerbate disparities in access to transplants between different socioeconomic strata, and (5) negatively impact public opinion and potentially lead to decreased organ donation rates [12, 13]. However, the debate over the intended and unintended effects of a federally regulated system of financial incentives in the United States remains unresolved partly due to a lack of empirical data.

Critics commonly turn to national programs outside the United States (e.g. India, China, Philippines, Eastern Europe) where black market incentives are the rule to justify concerns that financial incentives are exploitative of living donors. We do not disagree that paying donors illegally is exploitive. Other countries like Israel, Saudi Arabia, Iran, Singapore, and Ireland, however, have implemented legal compensation policies that assist living kidney donors to varying degrees and with varying success. However, these programs developed organically without extensive transparency or oversight, rather than as part of a prospective study designed with embedded outcome measures. Thus, it is unclear whether the successes of such policies are translatable to the US context given the differences in our governmental, medical, and societal infrastructures. Until rigorous, relevant data are properly collected, there is no way to determine whether concerns are warranted about potentially adverse effects of financial incentives on patient safety, exploitation, autonomy, and public trust as part of a US federally regulated system.

Members from several academic and professional organizations have called for pilot studies to investigate the provision of financial incentives to eligible living kidney donors to increase donation rates [14-17]. Logistical parameters for such studies have been suggested [18, 19]. However, while proposals for pilot studies commonly advance arguments for financial incentives, they have not systematically addressed the ethical concerns raised by opponents of a pilot study. This paper provides an ethical justification for conducting a pilot trial to study the feasibility and impact of a federally regulated system utilizing financial incentives on living kidney donation rates.''
...
in conclusion...
"the first step to resolve equipoise will require one or more carefully designed pilot studies to assess individual perceptions to determine if a course can be charted between exploitation and undue influence. Only such pilot studies can inform the transplant community as to whether larger, randomized controlled trials may be ethically undertaken to determine if ultimately, a federally regulated financial incentives program could feasibly and effectively increase living kidney donation rates without living donors incurring perceptions of negative psychological experience or generating negative public reaction.