Tuesday, December 29, 2015

The Washington Post discusses compensation for organ donors

Frank McCormick alerts me that the Washington Post yesterday took the recent article he coauthored in the American Journal of Transplantation as a jumping off point to discuss the pros and cons of addressing the shortage of transplantable kidneys by allowing the government to pay donors (the article proposed that only the government could pay, and considered payments of $45,000 for a living donor kidney).

 The  WaPo starts with a general description of the opposing positions:  Compensation for organ donors: A primer.

Their brief discussion sets the stage with lots of links (and will be familiar to readers of this blog who have been following my several posts on  compensation for donors).  

They end with this promise of more discussions, which I'll link to below as they appear (spoiler--Sally Satel is pro compensation, and Frank Delmonico doesn't think it's a good idea):
"Over the next few days, we’ll hear from:
Sally Satel, resident scholar at the American Enterprise Institute and practicing psychiatrist at the Yale University School of Medicine,
Francis Delmonico, Harvard Medical School professor of surgery at the Massachusetts General Hospital, and Alexander Capron, professor of law and medicine at the University of Southern California,
Scott Sumner, economist at Bentley University and blogger at The Money Illusion,
Benjamin Humphreys, program director at the Harvard Stem Cell Institute,

{Josh Morrison, who wasn't on the original list but is a great choice...}
Nancy Scheper-Hughes, founder of Organ Watch and anthropology professor at University of California, Berkeley."
Taking the opposite point of view (but arguing that we should do more to reduce financial disincentives to donating, by paying for donor expenses): Francis Delmonico and Alexander Capron December 29, Our body parts shouldn’t be for sale
Scott Sumner's headline and sub-headline also speaks for itself:   We can save lives and cut costs with one change in policy. 
Will lab-grown kidneys fix our transplant waiting lists?: Benjamin Humphreys is optimistic that they will, eventually.
It’s time to treat organ donors with the respect they deserveJosh Morrison is a kidney donor and the executive director of WaitList Zero, a nonprofit devoted to representing living donors and supporting living donation.

Scott Carney disagrees, on practical grounds (he thinks that a legal US market would foster badly regulated overseas markets): If you’re willing to buy a kidney, you’re willing to exploit the poor: Legalizing the sale of kidneys in America would lead to a booming black market everywhere else.

Nancy Scheper-Hughes, who has spoken to many black market kidney sellers, thinks that legal markets couldn't funcion much differently: The market for human organs is destroying lives We don't have "spare" kidneys. They shouldn't be up for sale.


Monday, December 28, 2015

Open access to The Art of Designing Markets, in HBR

The Harvard Business Review (HBR) has a pretty high and well defended paywall, but they have made my October 2007 article, The Art of Designing Markets, freely available.
https://hbr.org/2007/10/the-art-of-designing-markets

Here's the first paragraph:
"Traditional economics views markets as simply the confluence of supply and demand. A new field of economics, known as “market design,” recognizes that well-functioning markets depend on detailed rules. For example, supply and demand drive both stock markets and labor markets, but someone who wants to buy or sell shares in a company goes through very different procedures from those followed by a job seeker or an employer. Moreover, labor markets work differently from one another: Doctors aren’t hired the way lawyers, professional baseball players, or new MBAs are. Market designers try to understand these differences and the rules and procedures that make various kinds of markets work well or badly. Their aim is to know the workings and requirements of particular markets well enough to fix them when they’re broken or to build markets from scratch when they’re missing."

Sunday, December 27, 2015

There is no law against cannibalism in England

The Guardian has the story: Eating people is wrong, but is it against the law?

"Has José Salvador Alvarenga been reaching for the fava beans and chianti? The 36-year-old sailor survived at sea for more than a year after being cast adrift by a storm. But now the family of his fellow sailor, 22-year-old Ezequiel Córdoba, say the older man turned cannibal to survive. Alvarenga insists Córdoba died because he could not stomach the raw birds and turtle blood that were their only source of food. But Córdoba’s family are suing the Salvadorian fisherman for $1m for eating their relative.
It would not be the first time a survivor in extreme circumstances had tucked in to a fellow traveller. After a plane crash in the Andes in 1972, passengers ate the frozen remains of those who had perished, surviving 72 days before they were rescued. In 2000, three migrants from the Dominican republic survived for three weeks when their boat engine failed at sea, only by devouring some of the 60 others who succumbed to dehydration and exposure.
But is eating someone’s flesh in such extreme conditions against the law? Not in the UK, according to Samantha Pegg, senior lecturer at Nottingham Trent University. “There is no offence of cannibalism in our jurisdiction,” Dr Pegg says. She points out that Alvarenga’s story is similar to a famous case in legal history. In 1884, a four-man crew sailing from England to Australia were shipwrecked with almost no food. When the 17-year-old cabin boy became ill, two of the men, Stephens and Dudley, decided to kill and eat him. Five days later they were rescued and charged with murder. The third man was not charged, despite eating his companion’s flesh. Although their lawyers argued that killing the cabin boy was a necessity for the survival of the three other men, Stephens and Dudley wereconvicted of murder and sentenced to death – later commuted to six months’ imprisonment. “This set a precedent that there is no necessity defence for murder,” points out Pegg.
In cases of serial killers or sexually motivated cannibals, the charge is always murder, she says. In Germany, where there is also no offence of cannibalism, a court had to wrestle with a case where a man “offered” himself to be killed and consumed by an IT expert called Armin Meiwes – Meiwes was still convicted of murder. Last year, a German police officer was sentenced to eight-and-a-half years for a similar crime of “murder and disturbing the peace of the dead”. However, because his victim was said to be “willing”, he was not given the maximum sentence.
Other would-be cannibals could face charges of outraging public decency or preventing a lawful burial, says Pegg. In 1988, performance artist Rick Gibson ate human tonsils on the street; he claims to be “the first cannibal in British history to legally eat human meat in public.” With a rise in “body food”, and eating your partner’s placenta, he may not be the last."

Saturday, December 26, 2015

Maiden names are repugnant in Japan

The NY Times has the story: Japan’s Top Court Upholds Law Requiring Spouses to Share Surname

"Japan’s highest court upheld a law dating back more than a century that requires married couples to share the same surname, rejecting a claim on Wednesday that it discriminates against women by effectively forcing them to give up their names in favor of their husbands’.

"The ruling was a blow to Japanese women seeking to keep their maiden names after marriage. Some couples have chosen not to register their marriages — opting instead to stay in common-law relationships with fewer legal protections — in order to keep separate surnames.
...
"The prohibition against separate surnames has survived decades of challenges in the courts and in Parliament, but it was the first time a suit seeking to overturn it had reached the Supreme Court. Ten of the court’s 15 justices ruled that the ban, first imposed in 1898, was consistent with constitutional protections for gender equality.

"Although the law does not specify which spouse’s surname must be used, wives adopt their husbands’ names in an estimated 95 percent of cases.

"The chief justice, Itsuro Terada, said the law did not impose an undue burden on women in part because they could continue using their maiden names in their professional lives, a practice that has become more widely accepted in recent years.

"The government began allowing married civil servants, for instance, to use their former surnames for official business in 2001.

“The issue of separate names for spouses should be debated in Parliament,” Justice Terada said, throwing the issue back to the legislature.

"The government of Prime Minister Shinzo Abe will have to calibrate its response carefully. Mr. Abe has positioned himself as an ally of working women, contending that Japan needs to keep more women in the labor force as its population shrinks and ages. But many members of his right-leaning Liberal Democratic Party support the surname law, and the party has quashed previous parliamentary initiatives aimed at changing it.

Newspaper surveys have shown that a slim majority of the public favors changing the law to allow couples to keep separate surnames."

Friday, December 25, 2015

A logistically complicated 14-person kidney exchange chain in Australia--with an aircraft failure--but a happy ending

There was an aircraft failure while one of the kidneys was being shipped:

One altruistic donor, six hospitals hundreds of specialists and seven transplant patient lives saved

"All 14 patients involved in Australia’s first seven-way paired kidney swap have ­recovered well after the transplants at Victoria’s Monash Medical Centre and Royal Melbourne and Austin hos­pitals, in co-ordination with NSW’s Westmead, Prince of Wales and John Hunter ­hospitals.

For five anxious hours, the team battled to overcome a “hiccup” when a malfunctioning aircraft was forced to return to Sydney mid-flight with a Melbourne-bound kidney, but still managed to complete the operations safely on ­November 19.

After three months’ planning, Australian Paired Kidney Exchange Program director Professor Paolo Ferrari said the transplants were “an amazing team effort”.

“It is always an effort when you have two, three, four or, in this case, seven,” Prof Ferrari said.

“Although this ­occurred recently, the actual match-up that told us there was a possibility for these ­patients to have a kidney transplant first came in ­August. Because of the excitement on that day — mostly ­because of the complexity of having all the centres involved and the little hiccup — there was a lot of tension.
...
"At 8am, simultaneous operations began in seven operating theatres in the three Melbourne and three Sydney hospitals, as the first stage to remove the kidneys from the donors.

The second-stage ­operations began at a Melbourne hospital at 12.23pm when an organ couriered across town was taken off the ice and implanted into a lucky recipient.

Five other synchronised transplants occurred progressively across the two cities over the afternoon as the kidneys arrived via Qantas flights and StarTrack couriers.

But a problem with an ­anaesthetic machine delayed one Sydney retrieval and the kidney had to be placed on a flight 30 minutes later than planned.

The problem was compounded when the aircraft developed its own issues mid-flight and had to return to Sydney with its precious cargo.

Five hours later, the kidney finally arrived in Melbourne still in good health, where the Austin Hospital team led by Associate Professor Frank Ierino was able to begin the final transplant at 9.30pm."

Thursday, December 24, 2015

Market making and law breaking: Ben Edelman considers Uber et al.

Ben Edelman considers the many efficiencies that Transportation Network Companies (TNCs) like Uber provide, but also notes that they may be shifting costs to the public as they disregard laws and regulations regarding commercial drivers:
Whither Uber?: Competitive Dynamics in Transportation Networks
Benjamin Edelman — November 2015, forthcoming, Competition Policy International

"But what about the myriad other requirements the legal system imposes on commercial drivers?
Consider: In most jurisdictions, a “for hire” livery driver needs a commercial driver’s license, a background check and criminal records check, and a vehicle with commercial plates, which often means a more detailed and/or more frequent inspection. Using ordinary drivers in noncommercial vehicles, TNCs skip most of these requirements, and where they take such steps (such as some efforts towards a background check), they do importantly less than what is required for other commercial drivers (as discussed further below). One might reasonably ask whether the standard commercial requirements in fact increase safety or advance other important policy objectives. On one hand, detailed and frequent vehicle inspections seem bound to help, and seem reasonable for vehicles in more frequent use. TNCs typically counter that such requirements are unduly burdensome, especially for casual drivers who may provide just a few hours of commercial activity per month. Nonetheless, applicable legal rules offer no “de minimis” exception and little support for TNCs’ position."
**********

See also
Efficiencies and Regulatory Shortcuts: How Should We Regulate Companies like Airbnb and Uber?
by Benjamin G. Edelman and Damien Geradin
************

I was recently in Toronto, when taxi drivers blocked some intersections to protest what they saw as lack of law enforcement regarding Uber, and earlier I was in Vancouver, where Uber was no longer operating, after a brief foray into that market.

On the other hand, it's clear that Uber is providing services that are being eagerly consumed by a public that hasn't been adequately served by existing taxis and delivery services. (In Toronto, one colleague told me that when he goes to the business school cafeteria and sees a long line, he can order lunch from UberEATS and walk out to the street to pick it up faster than if he waited on the cafeteria line...)

Similarly for Airbnb (see this earlier post): while some hosts may be in violation of local laws, Airbnb is serving (and creating) a big market.

So, things are in flux: we'll see new regulations, that will presumably reach a compromise between serving these new markets while constraining and shaping them.

If you teach in a Business school, how should you advise your entrepreneurial students about market making and law breaking?

When I was recently in Russia, I gave a talk that touched on some of this, about markets as a source of sometimes disorderly growth, called "Markets, businesses, and governments: a complicated triangle."

Wednesday, December 23, 2015

Rhino horns: flood the market with sustainable horn, instead of prohibiting the market?

The WSJ and the NYT consider the problem of poached Rhino horns.
Here's the WSJ:
Would a Legalized Horn Trade Save Rhinos?
With poaching on the rise, ranchers in South Africa want to flood the market—but conservationists warn of corruption and cruelty

"The global rhino population has dwindled from 500,000 at the beginning of the 20th century to about 29,000 today. The surging trade in illicit horn has cut the population of the three remaining Asian species to just a few thousand, including about 40 Javan and less than 100 Sumatran rhinos. Just about 20,000 Southern White Rhinos and 5,000 black rhinos, which include three subspecies in Africa, survive.
...
"Black-market rhino horn can fetch as much as $100,000 a kilogram in Vietnam and other Asian countries, where it is peddled as a cure for ailments ranging from headaches to cancer. Many conservationists say that a legal marketplace would only raise demand. They argue instead for publicity campaigns to debunk the myths that lead many in Asia to pour rhino-horn powder into useless pills.

Others warn that rhinos can’t wait for those beliefs to wither. “I do not think we have a significant amount of rhinos left to invest in education,” said Louise Joubert, founder of SanWild Wildlife Sanctuary, a rehabilitation center and reserve in South Africa’s Limpopo province. Rhinos “are on a ticking time bomb down to extinction.” Mr. Hume and many ranchers argue that legalizing the trade and flooding the market with sustainably harvested horn could sate demand, lower prices and cut poachers out of the equation.

Rhino horn is made of keratin, like human fingernails. It grows as much as 5 inches a year. Biologists say that as long as a stump of 2 to 3 inches remains, it can be trimmed, doing a rhino no more harm than a manicure. “There are no nerves in rhinos’ horns,” said Raoul du Toit, director of Zimbabwe’s Lowveld Rhino Trust. He said there is no evidence that the procedure affects rhinos’ breeding practices or leaves them more susceptible to predators. “Why would you hunt a rhino for seven, eight, nine, 10 kilos of horn when, in a lifetime, it can grow 70 kilos of horn?” Mr. Hume asked.

"Animal-rights activists, conservationists and South Africa’s government are skeptical. Critics say that Mr. Hume and other large ranchers stand to profit if they can sell horn harvested from their herds.

“Where we differ is with your attitude towards the exploitation of an endangered species with the intention of making large profits,” Margot Stewart, founder of the nonprofit group Wild and Free South Africa, wrote in an open letter to Mr. Hume. She argues that rhinos are wild animals and should not be kept in paddocks like sheep or cows—and that it is unethical to farm and sell rhino horn since it has zero medicinal value. “Only two parties want this to continue: the rhino farmers and organized crime syndicates,” she added.

"Mr. Hume petitioned South Africa’s High Court in Pretoria to lift the moratorium in September. A judgment is expected in the next few weeks. “I honestly believe the more horn we can sell to people who are using it, the less pressure there will be on my rhinos and Kruger Park’s rhinos,” Mr. Hume said, alluding to South Africa’s premier national park.
...
"Mr. du Toit, the conservationist in Zimbabwe, warns that poverty and graft in the region are too widespread to trust that the rhino-horn market would be restricted to sustainably trimmed horns. Corruption “is our biggest problem,” he said, and it would “pervade the supply chains” of a legalized horn trade.

"The sides argue about precedents. A one-off sale of elephant-ivory stockpiles from four southern African nations in 2008 only whetted appetites for tusks, and elephant poaching has since soared to all-time highs. But a sustained, legal tide of supply—not a brief flood—has worked for other species, like South America’s vicuña, a llama relative. Mr. Hume notes that vicuñas were once slaughtered for their softer-than-cashmere coats but are now farmed sustainably, back from the edge of extinction."
**************
Here's the NYT:
U.S. Pours Millions Into Fighting Poachers in South Africa

JOHANNESBURG — The Obama administration is stepping up efforts here to combat illegal wildlife poaching, an expanding criminal enterprise in South Africa that has driven several animal species toward extinction and fueled the growth of international gangs.
But the effort is coming as South Africa wrestles with its own strategy, which could diverge significantly from Washington’s. Just last month, a South African court lifted a ban on domestic trade in rhinoceros horns, reigniting a debate between those who claim that a legal trade within South Africa’s borders could help stem the poaching crisis and those who say it would only worsen it.



HT: Sangram Kadam (he's on the market, you could hire him...)

Tuesday, December 22, 2015

Short book review that I liked

One of the fun things about writing Who Gets What and Why was figuring out how to write about economics in a way that might be accessible to non-economists. So I was heartened by this line from a very short recent book review:


"Reading this book will make you proud of yourself because you read something about economics, written by a Nobel-Prize-winning economist, and you understood it."

Videos of the Simons Institute lectures on Algorithmic Game Theory and Practice

The archived videos from Algorithmic Game Theory and Practice Workshop at the Simons Institute for the Theory of Computing can be found by clicking on the titles of individual talks on the schedule (below) or on the Simons Institute YouTube channel.

9:30 am – 10:10 am
10:10 am – 10:40 am
Break
10:40 am – 11:20 am
11:20 am – 12:00 pm
12:00 pm – 1:30 pm
Lunch
1:30 pm – 2:10 pm
2:10 pm – 2:50 pm
2:50 pm – 3:20 pm
Break
3:20 pm – 4:00 pm
4:00 pm – 5:00 pm
Reception
Tuesday, November 17th, 2015
9:00 am – 9:30 am
Coffee & Check-In
9:30 am – 10:10 am
10:10 am – 10:40 am
Break
10:40 am – 11:20 am
11:20 am – 12:00 pm
12:00 pm – 1:30 pm
Lunch
1:30 pm – 2:10 pm
2:10 pm – 2:40 pm
Break
2:40 pm – 4:00 pm
Wednesday, November 18th, 2015
9:00 am – 9:30 am
Coffee & Check-In
9:30 am – 10:10 am
10:10 am – 10:40 am
Break
10:40 am – 11:20 am
11:20 am – 12:00 pm
12:00 pm – 1:30 pm
Lunch
1:30 pm – 2:10 pm
2:10 pm – 2:50 pm
2:50 pm – 3:20 pm
Break
3:20 pm – 4:00 pm
Thursday, November 19th, 2015
9:00 am – 9:30 am
Coffee & Check-In
9:30 am – 10:10 am
10:10 am – 10:40 am
Break
10:40 am – 11:20 am
11:20 am – 12:00 pm
12:00 pm – 1:30 pm
Lunch
1:30 pm – 2:10 pm
2:10 pm – 2:50 pm
2:50 pm – 3:20 pm
Break
3:20 pm – 4:20 pm
Open Directions Session
Friday, November 20th, 2015
9:00 am – 9:30 am
Coffee & Check-In
9:30 am – 10:10 am
10:10 am – 10:40 am
Break
10:40 am – 11:20 am
11:20 am – 12:00 pm

Monday, December 21, 2015

Recap of the Sonnenschein celebration at Chicago (with a video)

Here's a recap from the Becker Friedman Institute: The Path Ahead for Economic Theory



Here's the video of a panel discussion on the future of economic theory, in which I get to talk about the work of Eric Budish, among other things, as an example of economic engineering. .(I speak for about 10 minutes after the introduction by Nancy Stokey, then Roger Myerson, Ariel Rubinstein and Lars Hansen speak)

Sunday, December 20, 2015

From Bolivia, where the legal working age is now 10 years old

Nico Lacetera points me to this NY Times video on the differing views about child labor in Bolivia, where the legal working age has been lowered to 10, and there is some sentiment for lowering it further (and, of course, opposition as well):
http://www.nytimes.com/video/world/americas/100000003982850/in-bolivia-legitimizing-child-labor.html

Saturday, December 19, 2015

Voluntary deceased organ donation in China

It's always hard to parse the Chinese organ data, and know what is going on in the military hospitals, but here's an encouraging story

Chinese Organ Donation on the Rise
   2015-12-06 21:11:39    Xinhua      Web Editor: Guan Chao

"Chinese organ donation has been on the rise after the country banned the use of prisoners' organs for transplant starting Jan. 1 this year, a top medical expert said Sunday.

As of Nov. 9, China has recorded 5,384 voluntary organ donors, who donated 14,721 various organs, said Huang Jiefu, head of a national human organ donation and transplant committee and former vice health minister.

China is expected to top the world in terms of organ donation in several years, said Huang at a forum in the central city of Changsha.

"As long as the donation system is transparent, most of citizens will be willing to join the program," he said.

The shortage of qualified transplant doctors is a major bottleneck. There are only 169 hospitals across the country eligible for organ transplant, with some 100 doctors able to do the operation, said Huang.

Huang called for speedy training of medical talent and expanding the number of hospitals eligible for organ transplant to 300 and the number of doctors to 400 to meet the public demand.

China began a voluntary organ donation trial in 2010 and promoted the practice across the country in 2013. Now, it tops Asia in the number of organ donations."

Friday, December 18, 2015

A skeptical look at "nudges" in the Atlantic (which reminds me of Loewenstein's 2010 op-ed in the NY Times)

In the Atlantic, a recent complaint about the tendency to over-promote the efficacy of"nudges" as inexpensive solutions to big problems:

Why 'Nudges' Hardly Help by Frank Pasquale

"...the nudge is really a fudge—a way of avoiding the thornier issues at stake..."
**********

I think the promises and perils of relying on nudges as primary tools of policy were set forth elegantly in a 2010 NY Times op-ed by George Loewenstein and Peter Ubel, who spoke of the relative magnitudes of the effects of nudges compared to e.g. changes in price:

Economics Behaving Badly

 "Behavioral economics should complement, not substitute for, more substantive economic interventions. If traditional economics suggests that we should have a larger price difference between sugar-free and sugared drinks, behavioral economics could suggest whether consumers would respond better to a subsidy on unsweetened drinks or a tax on sugary drinks."

Loewenstein, of course, is one of the founding giants of behavioral economics.

Thursday, December 17, 2015

American Medical Association adopts resolution calling for increased incentives for organ donation

I'm not completely clear on the parliamentary procedures of the American Medical Association's House of Delegates, but Frank McCormick draws my attention to a recently passed resolution:
RESOLUTION 007 - REMOVING DISINCENTIVES AND  STUDYING THE USE OF INCENTIVES TO INCREASE  THE NATIONAL ORGAN DONOR POOL

The AMA site itself requires a login, but here's an ungated site with an account of the resolution:

"Unanimous testimony was offered in support of the medical student resolution* to remove disincentives and study the use of incentives to increase the national organ donor pool. Misery and disability due to lack of organs is evidenced every day in our practices. The HOD voted first to support a study on use of incentives, including valuable consideration, second to eliminate disincentives and third to remove legal barriers to research investigating the use of incentives."


*Here's the draft of the resolution as initially submitted: 


***********
But don't get too excited,  the working group on The Delivery System reporting in The Surgeon General's Workshop on Increasing Organ Donation held in. July 1991  also recommended removing disincentives and studying the possible use of incentives to increase organ donation.

p59: "RECOMMENDATIONS
II-A.1 Maintain the current approach of organ and tissue donation based on
voluntary, altruistic choice and family participation, but continue to explore the
potential impact of possible alternative approaches, such as financial incentives and presumed consent.
II-A.l.Str.1: DHHS should support the collection and further analysis of
existing data on the attitudes of the public as well as those involved in the
donation process regarding the issues of financial incentives and presumed
consent. "