Wednesday, September 24, 2014

Kidneys for sale: debates about Iran and it's implications for markets in the West

As I indicated in my post yesterday, the conversation about compensating kidney donors is heating up. Various email correspondents brought to my attention the latest issue of the American Journal of Bioethics, which has a "target" article by Julian Koplin of Monash University and a number of responses and comments. Koplin argues that the experience of kidney sales in Iran should give pause to advocates of (even) regulated markets in the developed world. A number of the commentators argue that the evidence that he cites from Iran is now outdated, among other things. But the conclusions of the commentators are all over the map, from pro to anti and including appeals for allowing some experimentation to gather more evidence, and arguments against 'crossing the Rubicon' by allowing such trials.

I don't know of an ungated URL where you can read this, but of course if you have electronic access to a University library you can likely download it there.

Volume 14, Issue 10, 2014< Prev

The American Journal of Bioethics

ISSN
1526-5161 (Print), 1536-0075 (Online)
Publication Frequency 
12 issues per year
 

Editorial

Nancy S. Jecker
pages 1-6

  • DOI:10.1080/15265161.2014.953858
  • Published online: 17 Sep 2014
  • Citing articles: 0
  • Article Views: 18

Target Article

Julian Koplin
pages 7-18

  • DOI:10.1080/15265161.2014.947041
  • Published online: 17 Sep 2014
  • Citing Articles:
    CrossRef (16) 
  • Article Views: 15
Further Information

Open Peer Commentaries

I. Glenn Cohen
pages 19-21

  • DOI:10.1080/15265161.2014.947787
  • Published online: 17 Sep 2014
  • Citing articles: 0
  • Article Views: 7

James Taylor
pages 21-22

  • DOI:10.1080/15265161.2014.947802
  • Published online: 17 Sep 2014
  • Citing Articles:
    CrossRef (1) 
  • Article Views: 9

Alexander M. CapronGabriel M. Danovitch & Francis L. Delmonico
pages 23-25

  • DOI:10.1080/15265161.2014.947048
  • Published online: 17 Sep 2014
  • Citing articles: 0
  • Article Views: 10

Alberto Giubilini
pages 25-27

  • DOI:10.1080/15265161.2014.947797
  • Published online: 17 Sep 2014
  • Citing Articles:
    CrossRef (1) 
  • Article Views: 11

Erik Malmqvist
pages 27-29

  • DOI:10.1080/15265161.2014.947799
  • Published online: 17 Sep 2014
  • Citing Articles:
    CrossRef (1) 
  • Article Views: 7

Samuel J. Kerstein
pages 29-30

  • DOI:10.1080/15265161.2014.947798
  • Published online: 17 Sep 2014
  • Citing Articles:
    CrossRef (1) 
  • Article Views: 7

Benjamin Hippen
pages 31-33

  • DOI:10.1080/15265161.2014.947047
  • Published online: 17 Sep 2014
  • Citing Articles:
    CrossRef (1) 
  • Article Views: 7

Monir Moniruzzaman
pages 33-35

  • DOI:10.1080/15265161.2014.947801
  • Published online: 17 Sep 2014
  • Citing Articles:
    CrossRef (1) 
  • Article Views: 6

Kiarash Aramesh
pages 35-37

  • DOI:10.1080/15265161.2014.947044
  • Published online: 17 Sep 2014
  • Citing articles: 0
  • Article Views: 8

Sigrid Fry-Revere
pages 37-38

  • DOI:10.1080/15265161.2014.947042
  • Published online: 17 Sep 2014
  • Citing Articles:
    CrossRef (1) 
  • Article Views: 11

Miran Epstein
pages 39-40

  • DOI:10.1080/15265161.2014.947043
  • Published online: 17 Sep 2014
  • Citing Articles:
    CrossRef (1) 
  • Article Views: 6

Atieh PajouhiFarzaneh ZahediZeinab Pajouhi & Bagher Larijani
pages 40-42

  • DOI:10.1080/15265161.2014.947443
  • Published online: 17 Sep 2014
  • Citing articles: 0
  • Article Views: 6

Ryan Tonkens
pages 42-44

  • DOI:10.1080/15265161.2014.947046
  • Published online: 17 Sep 2014
  • Citing articles: 0
  • Article Views: 7

Julie AllardAviva Goldberg & Marie-Chantal Fortin
pages 44-45

  • DOI:10.1080/15265161.2014.947442
  • Published online: 17 Sep 2014
  • Citing articles: 0
  • Article Views: 7

Dominique Martin & Sarah White
pages 46-48

  • DOI:10.1080/15265161.2014.947045
  • Published online: 17 Sep 2014
  • Citing Articles:
    CrossRef (1) 
  • Article Views: 7

Tuesday, September 23, 2014

Pope Francis on organ donation and organ trafficking

The Declaration of Istanbul Custodian Group (DICG) requested an audience with Pope Francis: Pope Francis meets with DICG representatives (some links have gone stale, see update at bottom...)
"The DICG delegation included Executive Director Professor Francis Delmonico, executive board member Dr Beatriz Dominguez-Gil, Dr Mirela Busic and Professor Mehmet Haberal, who supports the DICG through the Haberal Foundation. Professor Ignazio Marino, the Mayor of Rome, arranged the meeting at the request of the DICG.

A review of the global state of affairs in organ donation and transplantation was presented to the Pope, and the ongoing challenges of meeting needs for transplantation and preventing organ trafficking were discussed. DICG members expressed concern about recent proposals to introduce financial incentives for organ donation in the United States, particularly with regards to the potential influence of such proposals on policy and practice in developing countries most vulnerable to organ trafficking.

The importance of legal measures combatting organ trafficking, such as the recent Council of Europe Convention, was noted. The DICG also reported on recent successful progress in donation and transplantation in countries and regions such as Spain, Croatia, and Eastern Europe, and the importance of eliminating barriers to organ donation, for example through measures to remove or reimburse costs associated with living kidney donation.

At the conclusion of the meeting, Pope Francis expressed his conviction that "organ trafficking and commercialization are immoral".
***********

Here's some other coverage of that meeting:

Pope calls for more people to donate organs – Rome mayor
"“The pope authorised me to say that in his view organ donation through generosity must be encouraged, but the commercial use of organs is immoral,” mayor Ignazio Marino said, after meeting with Francis on Friday.
“We need to explain that donating organs is a gesture of love. Each of us, for example, has two kidneys, and giving one of them to a relative or a person we love is a beautiful gesture. Entering into the spiral of trade and sales is a crime,” the pope said, according to Marino.
The meeting with Marino and a world delegation of transplant experts came as the United States debates whether or not to introduce financial incentives for organ donation, which could include reimbursing costs of travel for donors and lost wages, as well as providing long term health insurance.
Lengthy waiting lists, with thousands dying through a lack of organs, have lead some in the US to suggest the market for human organs should be legalized.
The Buenos Aires pope slammed those who profit from the poor to traffic organs, saying he had seen “many Argentine children with long scars on their backs because their families had sold one of their kidneys,” Marino said.
“Exploiting the poverty of a mother who sells a kidney to feed her children, for a few hundred euros (dollars), with that kidney then trafficked and sold on for hundreds of thousands of euros, that is a crime,” he said.
The Holy See did not publish a transcript of the audience."
*************

and from the Vatican news service:
Pope Francis meets a group of transplant surgeons; including the mayor of Rome
"Pope Francis met on Friday morning with the mayor of Rome, Ignazio Marino, who was accompanied by a group of surgeons who specialize in organ transplants.  The mayor is a transplant surgeon himself, and trained at the Transplant Centre of the University of Cambridge and the University of Pittsburgh's Starzl Transplantation Institute.
...
"No statement was released by the Holy See Press Office after the meeting with the Holy Father, but Marino spoke about his conversation with Pope Francis.
“The Pope did not mince his words,” Marino told journalists. “"He has authorized us to say publicly  that we need to encourage the donation of organs out of compassion, but the trade in organs is immoral and a crime against humanity.”


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

For background, here are all my many posts related to compensation for donors, including this one perhaps reflecting the American proposals that the DICG is concerned about:

Many groups are starting to advocate experiments on compensating organ donors 

**********
Updated to replace stale link (updated June 2022)
Try this one:


Monday, September 22, 2014

Golden Goose Award festivities and video on the simultaneous ascending auction design by McAfee, Milgrom and Wilson

The awards ceremony was on Thursday in Washington.
Bob and Mary Wilson go to Washington (photo by Peter Cramton)


Here's the 2014 Golden Goose Award video: the first segment, three and a half minutes, is devoted to the work of Preston McAfee, Paul Milgrom and Bob Wilson on the simultaneous ascending auction for spectrum.

The 2014 Golden Goose Awards from DOCUinc on Vimeo.


Here's my earlier post.

Sunday, September 21, 2014

The Onion proposes a school choice lottery

The Onion notices that school choice is a high stakes game: New Charter School Lottery System Gives Each Applicant White Pill, Enrolls Whoever Left Standing

"Introducing key changes to the lottery system that governs the admissions process, the New York City Charter School Center notified potential students this week that openings will now be filled by randomly distributing white pills to applicants and enrolling those left standing.

"In place of the existing electronic lottery system conducted in the spring, education officials explained that applicants would receive identical white pills, among them a small number of innocuous placebos corresponding to the amount of open spots, and then wait approximately 30 minutes to determine the survivors and new charter school enrollees."

Saturday, September 20, 2014

Same sex marriage still widely regarded as repugnant in Egypt, and a little less so in China

Two prohibited same sex marriages, one in Egypt and one in China (in the British embassy there) draw very different reactions.

The BBC has the story from Egypt.

Arrests over Egypt 'gay wedding'

The Egyptian authorities have arrested seven men accused of appearing in a video apparently showing a gay wedding.
The video, showing a group of men celebrating on a Nile river boat, was widely shared on social media.
The men could face charges of inciting debauchery and spreading images that violate public decency.
Homosexuality is not explicitly outlawed in Egypt, but gay men are periodically accused of charges such as scorning religion or debauchery.
line
Gay rights around the world
Map showing anti-gay laws around the world
line
(The link goes to an interactive version of the above map, where you can mouse-over to see the sometimes chilling state of affairs in far flung places.)


The Telegraph has the story from China

British diplomat's gay marriage draws attention in China

Gay marriage at residence of British ambassador to Beijing goes viral on Chinese internet

"A British diplomat has become a gay icon in China after marrying his American partner on the lawn of the ambassador's residence in Beijing.
...
"Gay unions are not legal in China, where the government adopts a "three nots" approach to homosexuality: not approved, not disapproved, not promoted."

Friday, September 19, 2014

Diverse approaches to surrogacy in the U.S.

The NY Times has an interesting survey about the divided state of the union regarding surrogacy, with different approaches among states in the U.S.: Surrogates and Couples Face a Maze of Laws, State by State

"While surrogacy is far more accepted in the United States than in most countries, and increasing rapidly (more than 2,000 babies will be born through it here this year), it remains, like abortion, a polarizing and charged issue. There is nothing resembling a national consensus on how to handle it and no federal law, leaving the states free to do as they wish.

"Seventeen states have laws permitting surrogacy, but they vary greatly in both breadth and restrictions. In 21 states, there is neither a law nor a published case regarding surrogacy, according to Diane Hinson, a Washington, D.C., lawyer who specializes in assisted reproduction. In five states, surrogacy contracts are void and unenforceable, and in Washington, D.C., where new legislation has been proposed, surrogacy carries criminal penalties. Seven states have at least one court opinion upholding some form of surrogacy.

"California has the most permissive law, allowing anyone to hire a woman to carry a baby and the birth certificate to carry the names of the intended parents. As a result, California has a booming surrogacy industry, attracting clients from around the world.
...
"Many states are now considering certain limits and trying to find middle ground.

“My sense of the big picture is that we’re moving toward laws like the one in Illinois, which accepts that the demand for surrogacy isn’t going away but recognizes the hazards and adds regulations and protections,” said Joanna L. Grossman, a family law professor at the Hofstra University law school.

"The Illinois law requires medical and psychological screenings for all parties before a contract is signed and stipulates that surrogates be at least 21, have given birth at least once before and be represented by an independent lawyer, paid for by the intended parents.

"The law allows only gestational surrogacy, in which an embryo is placed in the surrogate’s uterus, not the traditional kind, in which the surrogate provides the egg. In addition, it requires that the embryo created in a petri dish must have either an egg or a sperm from one of the intended parents.

“That eliminates some of the concerns about designer babies,” Professor Grossman said.

Lawmakers in New York, Washington, D.C., and elsewhere are considering measures to allow surrogacy.

"But not all states are moving in that direction. In Kansas, for example, there was a hearing in January on proposed legislation that would have imposed a $10,000 fine, or a year in prison, on those entering into a surrogacy contract. The proposal was shelved after a hearing that was packed with supporters of surrogacy, including women who had been surrogates and parents who brought their children through surrogacy, arguing passionately for the benefits.
...
"The Louisiana bill, like some others, would only have allowed “altruistic” surrogacy, in which the surrogate, usually carrying a baby for a friend or relative, receives no compensation beyond the reimbursement of expenses."

Thursday, September 18, 2014

Kidney exchange at Google Zeitgeist 2014: 15 minute video

On Tuesday I spoke about kidney exchange at Google's Zeitgeist conference. I was the second to last speaker, right before President Clinton, who spoke last. There are subtitles for the hearing impaired.




And here is a very short introduction to that talk, a two minute video introduction of matching markets (basically the first two minutes of my talk, as far as I can see).

Wednesday, September 17, 2014

Surgical Grand Rounds at U of Cincinnati Hospital

I'll be giving two lectures today at the U of Cincinnati. Steve Woodle is there, one of the pioneers of kidney exchange.


Grand Rounds With Nobel Laureate Alvin Roth  http://healthnews.uc.edu/news/?/25102/
Date:Wednesday, Sept. 17, 2014
Time:9 a.m. - 3:30 p.m.
Location:Surgical Amphitheater and Kresge Auditorium

Description:

Alvin Roth, PhD, co-winner of the Nobel Memorial Prize in Economics  in 2012 and a founder of the New England Program for Kidney Exchange, will give two presentations. His visit is hosted by the Department of Surgery, Division of Transplantation.

9 a.m.: J. Wesley Alexander Lecture, Surgical Grand Rounds, Surgical Amphitheatre, "Application of Market Design Principles for Kidney Exchange."

2:30 p.m.: UC College of Medicine Special Lecture, Kresge Auditorium, "Design of Markets for the National Residency Matching Program."

















Tuesday, September 16, 2014

John Van Huyck, 1956-2014

John and Patsy and their (then) two boys spent a memorable year visiting at Pittsburgh when Emilie and I were there. I teach his papers just about every year.

Here's the obituary: the link at the end leads to a page on which condolences and memories can be left.

July 17, 1956 – September 11, 2014

John Bronston Van Huyck, age 58, died in his home in College Station, TX, on September 11, 2014. The Funeral Service will be held at 11:00am on Thursday, September 18th, at St. Mary's Catholic Church, 603 Church Avenue, College Station, with Deacon Ted Baker presiding. A reception will follow immediately after in the parish activity center. John's remains will be laid to rest at the family farm in Virginia.

John was born in Aberdeen, MD, July 17, 1956, the son of Alfred and Mary Elizabeth Van Huyck. He lived for four years in India growing up, and traveled widely throughout his life, including biking across Europe and driving across the continental US. He dreamed of eventually sailing across the Mediterranean in a small boat with his friends and family, and enjoyed taking multiple trips to Europe with his sons, of which he had three from his marriage to Patsy Johnson. John graduated from the University of Virginia with a Bachelor's degree, and went on to Brown University where he earned both a Masters and a Doctorate in economics.

He applied his talents to the study and teaching of economics as the Rex B. Grey professor at Texas A&M University. In this role, he was a scholar’s scholar and as such made contributions that changed the way economists look at the world. From the very beginning of his academic career, John produced influential works over a broad range of subjects. He began this work with contributions to the way the economy in general is understood and progressed to becoming one of the world’s premier figures in experimental economics and economic game theory.

John played a large part in the acceptance of experiments as a method to improve understanding of economic behavior and to predict the impact of events on the economy. He was instrumental in illustrating how people learn from events and how this learning contributes to stability in the complex economic world. John’s work in no small way contributed to the fundamental acceptance of experimental methods in economics, a branch that has produced several Nobel Laureates.

"Today, economists have absorbed so well what Van Huyck, [Raymond C.] Battalio and [Richard O.] Beil showed that we find it natural, but it was a big surprise when they published the first paper... He had three experiments... that helped economists understand why coordination is hard, even when it’s in everyone’s interest to coordinate. He showed it with a set of experiments using games in which even though everyone knew that everyone wanted to coordinate on a high number, the fear that someone else would slip up caused coordination to fail." (Alvin E. Roth, Nobel Laureate)

He was more than just an academic thinker. He was a true renaissance man. He was deeply interested in the relation between governmental actions, political behavior and the freedom of individuals to pursue their own independent interests. Any one of the many economists who had the privilege of interacting with John came away with a better understanding of the world around them.

Above all else, John loved being a father. He sometimes told the story of how he had wished for a son at a neighborhood wishing well, and was overjoyed to be given three. John served as a Cub Scout den leader for Pack 317, and his oldest two sons both achieved the rank of Eagle Scout. He kept himself abreast of the advances in technology, taking advantage of new forms of media to create home video recordings of his family's life, and teaching his sons computer programming. John held himself to high standards in his work and his personal life, and strove to be a great man of virtue and character.

He is survived by his beloved sons, Carl Phillips, Don Ashfield and Bjorn Bennett Van Huyck; their mother, Patsy; his parents, Alfred and Betty Van Huyck; and his sister, Nancy Chockley, her husband, Frederick, and their children, Katherine and Wilson.

The family requests memorial contributions be made towards the funding of a scholarship in John's name at Texas A&M University. Please send contributions to Texas A&M Foundation in memory of John B. Van Huyck, Ph.D., 301 Coke Building, 4223 TAMU, College Station, TX 77843-4223.


Please share memories and tributes to John at www.hillierfuneralhome.com.

Monday, September 15, 2014

Profile of Ken Arrow

My office neighbor Ken Arrow is profiled by Janet Stotsky in the September 2014 issue of the IMF's magazine Finance and Development. At 93, he continues to be a role model: Path Breaker 

Here are the concluding paragraphs:

"Arrow, 93, said he has always been more stimulated by working out problems and that once he works them out “I must say I kind of lose interest.” That’s why even though he received a Nobel Prize for his work on general equilibrium theory, he is prouder of his work on social choice theory.
Several other researchers, such as the late Lionel McKenzie, were working on the same problems in general equilibrium theory at the time Arrow and Debreu formulated their model. “In some respects . . . if I weren’t there, it wouldn’t have made that much difference.”
But no one else was asking the social choice questions. “So that I am proud of.”

Sunday, September 14, 2014

Living kidney donors to get expenses reimbursed in Ireland

Here's the story from the Irish Times: Living kidney donors to get expenses reimbursed. Note the "fine balance" the director of organ donation speaks of--the question of compensation for donors remains one that people treat very gingerly.

"People who donate their kidneys while alive are to get out-of-pocket expenses paid back in a scheme to encourage more organ donation.
"The Department of Social Protection has agreed to continue payments to living kidney donors during the period of donation and recuperation, according to a briefing note prepared for Minister for Health Leo Varadkar.
"It says the removal of financial disincentives would potentially increase the number of living donors. “It is generally accepted that living kidney donors should not be unduly burdened with the financial costs associated with donation. Several countries currently provide reimbursement of non-medical expenses associated with donation.”

"Organ Donation and Transplant Ireland director Dr Jim Egan said good progress had been made on the policy and it would be ready soon. A fine balance has to be struck between covering legitimate expenses and not “incentivising” people to donate organs, he said.Although the briefing note says the policy would go to Mr Varadkar “shortly” for approval and would start at the beginning of September, the deadline was not met.
"Last year, there were 294 transplants, of which 185 were kidney transplants. The organs came from 86 deceased and 38 living donors. The number of living donors is up from two in 2005, when the practice began."

Saturday, September 13, 2014

Obesity is a growing medical problem...in unexpected ways

Obesity contributes to many diseases, including kidney and liver diseases that eventually require transplants. But it impacts the medical system in other ways. The Telegraph has the story:  Hospitals buy special fridges to store overweight bodies as obesity crisis escalates: Doctors warn Britain's obesity crisis could 'cripple' the NHS as hospitals are being forced to buy and rent specialist equipment to deal with overweight patients

"Britain’s obesity crisis is so serious that hospitals are buying specialist equipment to keep bodies cool because they are too large to fit into mortuary fridges."

Friday, September 12, 2014

Speaking about school choice to high school teachers (video)

I recently gave a talk at SIEPR, to high school teachers, about school choice. They had good questions, which start after minute 38 in the video (the early questions are hard to hear, but you can infer their gist from my answers, and the later questioners have a microphone...)

Thursday, September 11, 2014

Many groups are starting to advocate experiments on compensating organ donors

There's a lot of discussion these days about clinical trials of incentives for organ donation as a way of increasing supply.

Here's a blog post from the AST, the American Society of Transplantation, on removing financial disincentives:  The Cost of Giving

" it is increasingly obvious that we impose on donors’ financial risk, a concept that threatens our perceptions of donation as an altruistic act. Gill et al (JASN, 2014 Jul 17, epub) documented, in the recent economic downturn, greatest decline in living donation among those most challenged socioeconomically, indicating the role of financial risk in discouraging “altruistic” donors.
All this is occurring against a backdrop of intense controversy regarding “incentives” for donation that has raged for years, incorporating both national and global perspectives on ethics, economics, black markets, free markets, and so on. Amidst so much controversy, though, some light is beginning to emerge. Strong ethical and economic arguments can be advanced for and against incentives. The Declaration of Istanbul outlines important precepts that address unethical practices, including underground markets, on a global basis. However, in the United States, with a well-developed organ recovery infrastructure and rule of law, examples from the underground market (as were the basis of a recent New York Times expose) may be less relevant. There is emerging support in the US for a regulated infrastructure that could address the financial implications of organ donation. The National Living Donor Assistance Center (NLDAC) already offers limited assistance for those means-tested as unable themselves to underwrite the cost of donation. Extending assistance to eliminate all financial costs regardless of means, including access to healthcare, is now considered a mainstream view (far from the reception for a similar proposal from a small working group eight years ago: Gaston et al, AJT 6: 2548, 2006).
...
"Participants in two recent meetings (both held in Chicago in June and sponsored in part by AST) will soon be publishing white papers that seek to clarify the discussion regarding compensation of living donors in the US. It is obvious that a great deal can be done within NOTA to remove disincentives (as both white papers are likely to endorse). In medicine, it is usually desirable to address controversy with evidence, as might be obtained via limited demonstration projects of targeted incentives. Though these would likely require amendment of NOTA, such has already occurred twice with the Charlie Norwood and HOPE acts, both crafted in response to a changing environment and both endorsed by AST. Our task, if we are to do everything possible for our wait-listed patients and protecting all the interests of potential donors, is to make sure we get the nuances right."


And here is an open letter, signed by a variety of interested parties
HOW TO END THE WAIT FOR ORGAN TRANSPLANTS

"We support current efforts to prevent diabetes and hypertension and to make the donation process fairer and more efficient, but they will not resolve the shortage. Additional approaches must be tried. Sadly, transplant policy has been governed by an unsubstantiated assumption: that donors cannot receive benefits for donating without being exploited or coerced. It is critical to examine that assumption. We hereby call for the swift initiation of evidence-based research on ways to offer benefits to organ donors in order to expand the availability of transplants."

Wednesday, September 10, 2014

Brand names and informed consumers--pharmacists seem to like generic drugs

Here's an illuminating look at the economics of brands, as in brand-name products, when there are close substitutes available.

"Do Pharmacists Buy Bayer? Sophisticated Shoppers and the Brand Premium" 
Chicago Booth Research Paper No. 14-17
by BART J. BRONNENBERG,  JEAN-PIERRE H. DUBE,  MATTHEW GENTZKOW,  JESSE M. SHAPIRO

We estimate the effect of information on consumers’ willingness to pay for branded goods in physically homogeneous consumer packaged goods categories. In a case study of headache remedies, we find that college education, working in a healthcare occupation, and other proxies for product knowledge predict more purchases of private labels relative to brands. Pharmacists devote almost 90 percent of headache remedy purchases to private labels, against 71 percent for the average consumer. The effect of knowledge is similar across a broad set of health products, and in a set of relatively homogeneous food products, but smaller for food and drink products overall. We conclude that a significant share of the willingness to pay for brands in these categories would disappear in a world where consumers were fully informed.