Transplants under lockdown (but beginning to pick up)

Since the beginning of pandemic lockdowns, living donor kidney surgeries in the U.S. have almost ceased (partly because living donor surgeries aren't emergency surgeries, and were being cancelled with all elective surgeries as hospitals readied themselves for covid-19 patients, who materialized in large numbers in some places but not others). Deceased donor transplants have also been down, for a variety of corona-related reasons, which means that donor organs are going to waste.

Here's an aggregate graph from https://unos.org/covid/

And here's a story from Statnews.com

Transplants plummet as overwhelmed hospitals focus on the coronavirus
By ELIZABETH COONEY

"Organ transplant medicine is always a high-wire act, balancing too many people’s needs with too few matches. The coronavirus epidemic has only heightened the significant risks and hoped-for benefits of transplant surgery. Organ donations are down by a third and the health care system itself is in full-blown scarcity, triaging elective surgeries to some unknown future date so only emergency cases find their way into precious operating rooms and intensive care beds. As life-saving as they are, even many transplants are being put off.

"For people who need a transplant, their fate depends on the organ and how sick they are. Pancreas transplants are on hold indefinitely, classified as “life-enhancing,” not life-saving because patients can survive on insulin. Kidney patients who can continue to function on dialysis have been taken off waiting lists while still accruing waiting time for the day when non-urgent transplants resume. Heart patients who are not already in the hospital on mechanical heart-assist devices and who may be able to wait a few weeks will do so.
...
"Prospective transplant recipients can’t have Covid-19, either. The immune-suppression drugs they must take to prevent organ rejection would prevent them from fighting off the virus and make them super-shedders of the virus, placing those around them at hugely increased risk of being infected.

Transplant emergencies mean people who can’t wait another week or even another day. But these patients are also balancing on a knife’s edge: They have to be sick enough to be near death but well enough not to need long ICU stays in hospitals overwhelmed by coronavirus patients who need weeks on ventilators so they can breathe.

“Our ability to do a liver transplant is not always just about the [risk of Covid-19] exposure to the patient,” said David Mulligan, chief of transplantation surgery and immunology at Yale. “It’s also, do we have a bed? Do we have a ventilator to take care of the patient? Can we isolate the patient from other Covid-infected patients? Do we have enough time to do this operation, get them through it, keep them away from Covid, and then get them out of the hospital safely? That’s what we’re shooting for.”
...
"The widespread delays in testing people for the coronavirus have also meant delays in testing organs, said Gabriel Danovitch, medical director of UCLA’s kidney and pancreas transplant program. “When the virus was first detected, we didn’t have the capacity to test all potential donor organs. And a lot of organs were wasted because of concern of possible infection.”

Repugnance watch: Hungary moves to roll back legal recognition of transsexuality

The covid-19 pandemic has allowed a consolidation of authoritarian power in Hungary, as also elsewhere, which can take some odd forms.

The Guardian has the story:

Hungary prepares to end legal recognition of trans people
Trans people fear more discrimination as Orbán pushes through law defining gender based on ‘sex at birth’

"Hungary’s rightwing government looks likely to push through legislation that will end the legal recognition of trans people by defining gender as “biological sex based on primary sex characteristics and chromosomes” and thus making it impossible for people to legally change their gender.
...
"“In Hungary, you need to show your ID to rent a bike, buy a bus pass or to pick up a package at the post office. It basically means coming out as trans to complete strangers, all the time. The good version is they are nice about it, but there are situations where people turn quite hostile,” said Ivett Ördög, a 39-year-old trans woman living in Budapest."
*********

Here's the background story:
Hungary seeks to end legal recognition of trans people amid Covid-19 crisis

"The Council of Europe’s commissioner for human rights, Dunja Mijatović, called on Hungary’s parliament not to adopt the law, and said the measure was in contravention of human rights standards and the case law of the European court of human rights."

Test design and gender gaps in performance--evidence from a national exam in Chile, by Coffman and Klinowski

Here's a recent paper from PNAS:

The impact of penalties for wrong answers on the gender gap in test scores
Katherine B. Coffman and   David Klinowski
PNAS April 21, 2020 117 (16) 8794-8803;

Abstract:
Multiple-choice examinations play a critical role in university admissions across the world. A key question is whether imposing penalties for wrong answers on these examinations deters guessing from women more than men, disadvantaging female test-takers. We consider data from a large-scale, high-stakes policy change that removed penalties for wrong answers on the national college entry examination in Chile. The policy change reduced a large gender gap in questions skipped. It also narrowed gender gaps in performance, primarily among high-performing test-takers, and in the fields of math, social science, and chemistry.

Yelping about restaurant health violations, by Dai and Luca

Online reviews, like Yelp, can play an effective role in disseminating information about restaurant hygiene scores...

Digitizing Disclosure: The Case of Restaurant Hygiene Scores†
By Weijia Dai and Michael Luca*
American Economic Journal: Microeconomics 2020, 12(2): 41–59


Abstract: Collaborating with Yelp and the City of San Francisco, we revisit a canonical example of quality disclosure by evaluating and helping to redesign the posting of restaurant hygiene scores on Yelp.com. We implement a two-stage intervention that separately identifies consumer response to information disclosure and a disclosure design with improved salience—a consumer alert. We find score posting is effective, but improving salience further increases consumer response.

They write:

"The rise of online platforms raises the opportunity to revisit disclosure initiatives and to use a design economics lens to improve decisions about where and how disclosure is delivered.
...
"Our intervention proceeds in two stages. In the first stage, which begins in early 2013, Yelp starts posting hygiene scores on San Francisco restaurants. We analyze the impact of the score posting using a difference-in-differences strategy, comparing differential changes in restaurant demand after the score posting between restaurants with low hygiene scores that are more likely to be affected by the score posting (as predefined by the city) and those with higher scores.2  To shed light on demand,
we drew on purchase intention measures, such as a user calling or seeking directions to a restaurant or clicking on the restaurant’s own website link. We find that hygiene score posting on Yelp leads to a 13 percent decrease in purchase intentions for restaurants with low hygiene scores.
...
"Following the initial hygiene score posting intervention, in the second stage, we worked with Yelp in 2015 to develop a “hygiene alert”—a salient message that appears only on the Yelp pages of restaurants with low hygiene scores. Such low-score restaurants are identified by the city as having “poor” operating conditions with “high-risk” hygiene violations.

"We find a further 7 percent decrease in purchase intentions for restaurants with low scores due to hygiene alerts, and an 11 percent decrease in the number of reviews, nearly doubling the effect of the score posting for these businesses. On the restaurant side, although there is no evidence showing an improvement of restaurant hygiene scores across restaurants, we find suggested evidence of a decrease in the probability that the low-score restaurants will receive low scores again after the alert."

When supply chains break down, brokers make markets

During the Arab oil embargo of the U.S. in 1973, I remember hearing an oil broker discuss his day. He would cold call companies that used oil and ask if they had any to sell. Almost always he was told they were looking to buy oil, because their usual suppliers had gone dry. He'd write that down and go on to the next call.  Sometimes he'd find someone with oil to sell--maybe the general economic slowdown had reduced their consumption, but since they were normally buyers and not sellers they hadn't sold their surplus.  That kept the broker in business, he was able to help them sell their excess.

When well-established supply chains break down (e.g. as factories close in China and hospitals in NY are short of supplies, both because of the covid-19 pandemic), brokers are becoming important. Brokers work to piece together pieces of broken supply chains by connecting buyers and sellers. Even in times of shortages there can be sellers, with stock in their warehouses, who no longer have connection to buyers...

The NY Times has the story:

Marc Benioff’s $25 Million Blitz to Buy Protective Gear From China
A call from a university chancellor set in motion a private-sector effort to procure 50 million masks, gowns and swabs for American medical facilities.
By David Gelles

"The university’s usual suppliers in the United States were short on masks and face shields, and there was no sign that the State of California or the federal government was coming to the rescue. “The supply chain had really dried up,” Mr. Hawgood said.

"So Mr. Hawgood called Marc Benioff, the hyperconnected billionaire who is a founder and the chief executive of Salesforce.
...
"that phone call set off a frenzied effort by Mr. Benioff and his team that drew in major companies like FedEx, Walmart, Uber and Alibaba. In a matter of weeks, the team spent more than $25 million to procure more than 50 million pieces of protective equipment. Fifteen million units have already been delivered to hospitals, medical facilities and states, and more are on the way.

"The relative ease with which Salesforce acquired so much protective gear stands in sharp contrast to the often chaotic government efforts. While states have had to compete against one another for scarce supplies and the strategic national stockpile of protective gear is depleted, Mr. Benioff and his team simply called up their business partners in China and started writing checks.
...
"After Mr. Benioff got off the call with Mr. Hawgood on that Thursday, he called Daniel Zhang, chief executive of Alibaba, the enormous e-commerce marketplace. Last year, Salesforce and Alibaba announced a partnership meant to give Salesforce customers better access to the Chinese market, and teams from the two companies had been working closely.
...
"In San Francisco, Mr. Aytay and his team decided to buy only from companies that someone they knew well could personally vouch for. “Setting up a trust network was very important,” Mr. Aytay said.

"By March 22, the Salesforce team identified the first promising tip. The Jointown Pharmaceutical Group, a large Chinese company, had 500,000 surgical masks in a warehouse in Los Angeles."
*************

Of course there are perils in dealing with unusual suppliers, so the broker has to be reliable and have reliable connections.  After all, what could go wrong?

Buzzfeed news has the story:

After One Tweet To President Trump, This Man Got $69 Million From New York For Ventilators
The Silicon Valley engineer, who had no background in medical supplies but was recommended by the White House, never delivered the ventilators.

Hoarding and price gouging during Corona troubles

It appears we now have a Federal price gouging law.
Bloomberg has the story:

Accused New York Mask Hoarder Is First Charged Under Defense Act
By Patricia Hurtado

"In response to the Covid-19 pandemic, President Donald Trump on March 18 issued an executive order making it illegal to hoard medical supplies and devices which the U.S. has designated as scarce or sell them at excessive prices.
...
"Singh sold three-ply disposable face masks for $1 each, after having bought them for 7 cents -- a markup of about 1,328% -- Donoghue said, citing records seized from the store. Bulk sales were made to organizations serving vulnerable senior citizens and children battling the virus, according to the records.

"Singh “saw the devastating Covid-19 pandemic as an opportunity to make illegal profits on needed personal protective equipment,” said Craig Carpenito, the U.S. Attorney for the Eastern District of New Jersey who also heads the U.S. Department of Justice’s Covid-19 Hoarding and Price Gouging Task Force.

"U.S. postal inspectors seized 23 shipping pallets containing more than 100,000 face masks, 10,000 surgical gowns, 2,500 full-body isolation suits and more than 500,000 pairs of disposable gloves at Singh’s warehouse."
**********

And many states have had price gouging laws on the books for a long time. Here's a story from the WSJ:

Texas Attorney General Accuses Largest U.S. Egg Producer of Price-Gouging
Lawsuit alleges Cal-Maine Foods sold eggs at over 300% of their normal cost in coronavirus pandemic      By Rebecca Davis O’Brien

"The lawsuit shows the concern among law-enforcement officials and consumer-protection authorities over price-gouging on essential goods during the pandemic.
...
"Before the pandemic, between December 2019 and February 2020, Cal-Maine’s prices in Texas were around $1.02 for generic eggs and $1.89 for specialty eggs, according to the lawsuit.

"According to the lawsuit, as of 2015, Cal-Maine operated more than 90% of the largest egg-processing facilities in Texas. Nationally, Cal-Maine is the largest producer and marketer of shell eggs in the U.S., with a 19% overall market share, the lawsuit alleges, citing company statements.

"According to the lawsuit, Cal-Maine’s price jumps weren’t justified because its egg supply wasn’t affected—the company has said its facilities have been fully operational, with no disruptions to delivery or its supply chain. “During this pandemic, neither production costs nor contractual obligations forced Cal-Maine to charge exorbitant prices,” the lawsuit alleges.

"The lawsuit also alleges that Cal-Maine has misled the public about its egg prices, citing an April entry on the company website stating that “wholesale shell egg market prices…are outside of our control.” In fact, the attorney general alleges, there is no egg-market exchange, and Cal-Maine can exert control over prices."

AEA Awards: Clark Medal and Distinguished Fellows

Here's the AEA announcement:

2020 American Economic Association Awards
Congratulations to the 2020 John Bates Clark Medalist, Melissa Dell, and to the newly elected Distinguished Fellows: Katharine Abraham, Shelly Lundberg, Paul Milgrom, and Whitney Newey. View the Press Release for all award announcements.

Melissa Dell, Clark Medalist 2020

Distinguished Fellows
The Award of Distinguished Fellow was instituted in 1965. Past Presidents of the Association and Walker Medalists shall be Distinguished Fellows. Additional Distinguished Fellows may be elected, but not more than four in any one calendar year from economists of high distinction in the United States and Canada. The following economists have received this award:

2020

• Katharine Abraham
• Shelly Lundberg
• Paul Milgrom
• Whitney Newey

Mentoring women assistant professors of Economics: an RCT (and some thoughts on the word "mentor")

From the NBER:

Can Mentoring Help Female Assistant Professors in Economics? An Evaluation by Randomized Trial
Donna K. Ginther, Janet Currie, Francine D. Blau, Rachel Croson

"Women continue to be underrepresented in academic ranks in the economics profession. The Committee on the Status of Women in the Economics Profession of the American Economics Association established the CeMENT mentoring workshop to support women in research careers. The program was designed as a randomized controlled trial. This study evaluates differences between the treatment and control groups in career outcomes. Results indicate that relative to women in the control group, treated women are more likely to stay in academia and more likely to have received tenure in an institution ranked in the top 30 or 50 in economics in the world."

***************
There is probably no appropriate place to bring this up, but the word "mentor" always seemed to me to be faintly inappropriate in the particular context of addressing the difficulties associated with doing economics while female.

In Homer's Odyssey, Mentor is a man. But in fact, it is the goddess Athena who (in Alexander Pope's translation) " took Sage Mentor’s form, and thus like Mentor spoke." That is, often the advice that appears to come from (male) Mentor, in fact came from (female) Athena, disguised as Mentor.

So maybe female mentors of female economists should be athenas?

Corona virus research networks for economists

Corona virus, and the lockdowns and other policies it elicits, are attracting considerable attention from economists.  Below are some efforts to coordinate these research activities.

Stockholm School of Economics (SSE) is sponsoring the:
SSE CORONA ECONOMIC RESEARCH NETWORK

"The SSE Corona Economic Research Network (SSE-CERN) brings together researchers in economics and other disciplines that conduct research or policy work related to the Covid-19 pandemic. The network aims to stimulate research related to Covid-19, for example by communicating research and policy ideas and by organizing webinars. We also provide a list of research questions that we believe need to be answered and links to useful material about Covid-19."

**********
David Levine at the European University Institute (EUI) is coordinating a site for
COVID 19 RESEARCH 
Researchers collaborating for the endgame of the pandemic.

"Statement of Purpose: The purpose of this group is to draw on the talents and technical expertise of researchers to provide cost benefit analysis of mitigation measures and policy recommendations to be adopted, particularly for the endgame. The aim is to provide a conduit through which research can flow: matching expertise with questions and taking advantage of economies of scale to establish a credible organization that will be taken seriously by policy makers. The disease is international and so are we."

***********

And the European Economic Association is maintaining a List of Projects on corona virus related topic.

City of Science museum in Naples

Last June I gave some talks in Italy (back when there were airplanes, and in-person talks--remember?) One side trip took me to the City of Science museum in Naples.  I've just now come across a web page that memorialized that visit, with some pictures that reminded me of what a fine science museum it is.  (I still enjoy science museums, even though I'm temporarily out of kids to bring with me...)

Il Premio Nobel per l’Economia 2012 Alvin Eliot Roth in visita a Città della Scienza
19 giugno 2019

More essential services, from the lockdown in New Zealand

The Guardian has the breaking news from New Zealand (and the sub-headline makes you glad for experts..):

Sex toy sales triple during New Zealand's coronavirus lockdown
Speculation rife about an impending baby boom, but experts say uncertain times mean this is unlikely

"New Zealanders are permitted to leave their homes only to access essential services or take walks during the national shutdown, which began a fortnight ago and will remain in place for at least a further two weeks.
...
"The restrictions also prompted a tripling of sex toy sales in the 48 hours before the lockdown was imposed on 25 March
...
"“We’re selling a lot of beginner toys ... all our beginner ranges are very popular,” said Emily Writes, a spokesperson for the business. “It definitely looks like people are saying: ‘I’ve got time, I might try something new.’”

"Sales of condoms, lubricant, and menstrual cups were among the other purchases that spiked after Ardern announced the lockdown, as well as adult board games and – perhaps reflecting a wider trend towards disinfecting behaviour – sex toy cleaner.
...
"Adult Toy Megastore was deemed an essential service by New Zealand’s government and was allowed to continue operating during the shutdown because it sells condoms and medical items."

Rabbi Yeshayahu Haber (1965-2020), who founded "Gift of Life" kidney donor organization

Rabbi Yeshayahu Haber, who founded the Matnat Chaim ("Gift of Life") organization of kidney donors in Israel, has died of coronavirus. He was 55 years old.

YNet has the story:
הרב שהציל חיים נפטר מקורונה (Google Tranlate: The rabbi who saved lives died of corona)

Here's a story in English from Vos Iz Neias? (Yiddish: "What's New?")
Rabbi Yeshayahu Haber, Who Founded “Gift Of Life” For Kidney Donations, Passes Away From Coronavirus

and this from the Jerusalem Post:
'Gift of Life' founder Rabbi Haber passes away at age 55 due to COVID-19

"Haber's funeral will take place at 2 a.m. in Jerusalem. The public is asked not to come to the funeral procession."

GIFT OF Life: Matnat Chaim donors, 2016-2017.

Here are all my posts on Matnat Chaim, which recently recorded its 800th kidney donation.

Gaming organ allocation: Heart failure treatment responds to changes in the priority rules for heart transplants

Recent changes in the allocation of deceased donor hearts for transplantation have focused on what kinds of mechanical interventions a patient has.  And as choice of alternative interventions has changed priorities for donation, cardiologists have responded by changing the interventions they choose.

Several articles in JAMA Cardiology speak to this and related matters, and here's an editorial describing the issue:

Anticipating a New Era in Heart Transplantation
Clyde W. Yancy, MD, MSc1,2; Gregg C. Fonarow, MD3,4
JAMA Cardiol. Published online April 15, 2020. doi:10.1001/jamacardio.2020.0611

The first paragraph gives this capsule history:

"The 50th anniversary of heart transplantation was celebrated in 2018. During those 50 years, heart transplantation as treatment of advanced heart failure evolved from a heroic intervention with uncertain outcomes to a guideline-directed treatment appropriate for selected patients to restore quality of life and to improve survival. Today, 1-year survival after heart transplant is nearly 90%, and the conditional half-life after heart transplant is now 13 years.1 Those robust outcomes reflect myriad breakthrough initiatives, including the definition of brain death; introduction of routine endomyocardial biopsy for rejection surveillance, development of potent immunosuppressive therapies, particularly those inhibiting calcineurin and in turn interleukin 2 production, and advances in therapies to support the failing ventricle, especially mechanical circulatory support devices. For more than 2 decades, the number of heart transplants performed in the United States has been approximately 2000 per year and, having recently increased, was 3551 in 2019.2 Taken together, the observed early and late benefits of heart transplant punctuate an incredible journey from heretical concept to clinical standard of care. The courageous pioneer physicians and especially the early patients who faced overwhelming risks are revered for establishing a foundational pillar in the care of patients with advanced heart failure. It is reasonable to assert that after 50 years, heart transplantation is a well-established success poised for the next era."

They then turn their attention to ways in which cardiologists have responded to changes in the deceased donor allocation system:

"Three articles in this issue of JAMA Cardiology further address new challenges in the process of care improvement for heart transplantation, some of which we think may require urgent attention.

"The first of these articles, by Hanff and colleagues,7 evaluated changes in the use of mechanical circulatory support under the auspices of new organ allocation rules introduced in October 2018 by the Organ Procurement and Transplantation Network. The new system was intended to redirect available donors to those patients of greatest need. The original status IA category was partitioned into 3 categories, and the original status IB category became category 4. A patient with advanced heart failure supported with a left ventricular assist device (LVAD) without LVAD-associated complications became a status 4 candidate. A similar patient with advanced heart failure experiencing manageable LVAD-associated complications became a status 3. Status 2 now captures those patients with LVAD device malfunction who may be facing eminent demise or need for LVAD replacement, whereas status 1 captures patients with life-threatening arrhythmias or patients being supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO). Evaluating data through June 2019, Hanff and colleagues7 noted an abrupt increase in the use of VA-ECMO support that was temporally associated with implementation of the new system. Concomitantly, LVAD support for advanced heart failure in patients awaiting heart transplant abruptly decreased from 35.1% before implementation of the new rules to 24.5% after their implementation."

Finally, they also consider center variability to understand what happens to patients when a proffered heart transplant is declined:

"In another article in this issue of JAMA Cardiology, Choi et al10 evaluated data in the US National Transplant Registry between 2007 and 2017 with the intention to assess transplant center variability in donor organ acceptance. The evaluable data emanated from 93 transplant centers and encompassed 19 703 donors and 9628 candidates, with 32% of the donors accepted as first-ranked candidates. After adjustment for pertinent donor, candidate, and geographic covariates, the center variability in acceptance rates was quite remarkable at 12% to 62%. For every 10% increase in center acceptance rate, waiting-list mortality decreased by 27%. Those centers with lower acceptance rates experienced higher waiting-list mortality among candidates listed for a heart transplant..."

Surrogacy finally becomes legal in New York

Passed last month, to come into effect next year, New York follows most of the rest of the country into the American consensus on surrogacy, including commercial surrogacy (so very different than in Europe).

The New York Daily News had this account:

Good news for couples who want children and need a surrogate as N.Y. legalizes the process
By DENIS SLATTERY

"New York legalized paid gestational surrogacy Thursday as lawmakers approved a sweeping budget package containing the measure.

"Gay and infertile couples in the Empire State can now enter into a contract and pay a woman to carry a baby to term through in-vitro fertilization.

"Gov. Cuomo made the measure a priority over the past year and a half as New York remained one of only three states that explicitly banned the practice.

"Pushback from an unlikely combination of religious organizations and women’s groups concerned about the potential exploitation of surrogates, particularly those from low-income backgrounds, preceded the bill’s failure to gain enough support in the Assembly during the last legislative session.Assemblywoman Amy Paulin (D-Scrasdale), who first introduced a bill to lift the ban back in 2012, applauded the inclusion in the budget.

“Today, we bring New York law in line with the needs of modern families, while simultaneously enacting the strongest protections in the nation for surrogates," she said.
...
"The measure also streamlines the “second-parent adoption” process by requiring only a single visit to court to recognize legal parenthood while the child is in utero. Once all of the requirements set forth in the law are met, the intended parents can seek an “Order of Parentage” from a court, which becomes effective immediately upon birth."
***********
Here's an earlier post, about the complicated coalitions involved in last year's failure to pass the bill

Friday, June 21, 2019  Surrogacy in NY...remains complicated

***********
Here's a link to and snippets of the new statute itself:


TITLE OF BILL:  An act to amend the family court act, in relation to
establishing the child-parent security act; and to repeal section 73 and
article 8 of the domestic relations law, relating to legitimacy of chil-
dren born by artificial insemination and surrogate parenting contracts

PURPOSE OR GENERAL IDEA OF BILL:
To legally establish a child's relationship to his or her parents where
the child was conceived through third party reproduction including those
children born through gestational surrogacy arrangements.
 ...
"JUSTIFICATION:
New York law has failed to keep pace with medical advances in assisted
reproduction, causing uncertainty about who the legal parents of a child
are upon birth. In many cases, the parentage of children created through
donated sperm, eggs and embryos is unsettled or open to attack at the
time of the child's birth and thereafter. Confusion or uncertainty
regarding the parental rights of donors and intended parents (both
genetic and non-genetic) who participate in the conception of the child
through assisted reproduction is detrimental to the child and secure
family relations. Where children are born to a gestational carrier the
parentage of the intended parents may not be recognized under current
law. This is not only detrimental to the child; it also causes confusion
in many critical situations. For example, a hospital does not know who
must give consent when a newborn requires medical procedures.

"The Child Parent Security Act will provide clear and decisive legal
procedures to ensure that children born through third party reproduction
have secure and legally recognized parental relationships with their
intended parents.The law will make it clear that donors do not have
parental rights or obligations and that those rights and obligations
reside with the Intended Parents.

"Importantly, this legislation lifts the ban on surrogacy contracts to
permit enforceable gestational carrier agreements and sets forth the
criteria for such agreements. When all of the requirements set forth in
the law are met, the intended parents can seek an "Order of Parentage"
from a court, prior to the birth of the child, which becomes effective
immediately upon birth. The requirements are designed to ensure that all
parties enter into the agreement on an equal footing and with full know-
ledge of their duties and obligations. For example, all parties must be
represented by independent legal counsel, and the agreement may not
limit the right of the carrier to make her own healthcare decisions.

"Because of existing New York laws, couples facing infertility and same-
sex couples are forced to go out of state in order to have a child with
the assistance of a gestational carrier. This is overly burdensome to
the parents, who have often struggled for many years to have a child.
Having an out-of-state gestational carrier may make it difficult, if not
impossible, for the parents to fully participate in the pregnancy by
attending doctor's appointments, etc. It also requires the participants
to use out-of-state clinics and medical professionals despite the fact
that New York is home to world-class medical facilities and fertility
professionals.

"New York appellate courts have repeatedly called upon the Legislature to
act to provide much needed clarity to the essential question of who is a
parent. The need to answer that call is more important today than ever
as increasing numbers of children are being conceived and born through
third party reproduction. The Child-Parent Security Act clarifies the
issue of who is a parent and establishes clear legal procedures which
ensure that each child's relationship to his or her parent(s) is legally
recognized from birth. As the New York Court of Appeals held in Brooke
S.B. v Elizabeth A.C.0 biology and adoption are not the only touchstones
to determine parentage. The Child Parent Security Act provides a frame-
work for determining the parentage of the large number of children
unprotected under existing New York state law.


...
 PART 5
    34                 PAYMENT TO DONORS AND GESTATIONAL CARRIERS
    35  Section 581-501. Reimbursement.
    36          581-502. Compensation.
    37    §  581-501.  Reimbursement.   (a) A donor who has entered into a valid
    38  agreement to be a donor, may  receive  reimbursement  from  an  intended
    39  parent  for  economic  losses  incurred  in connection with the donation
    40  which result from the retrieval or storage of gametes or embryos.
    41    (b) Premiums paid  for  insurance  against  economic  losses  directly
    42  resulting  from  the  retrieval  or  storage  of  gametes or embryos for
    43  donation may be reimbursed.
    44    § 581-502. Compensation.  (a) Compensation may be paid to a  donor  or
    45  gestational  carrier based on services rendered, expenses and or medical
    46  risks that have been or will be incurred, time, and inconvenience. Under
    47  no circumstances may compensation be paid to purchase gametes or embryos
    48  or to pay for the relinquishment of a parental interest in a child.
    49    (b) The compensation, if any, paid to a donor or  gestational  carrier
    50  must be reasonable and negotiated in good faith between the parties, and
    51  said  payments to a gestational carrier shall not exceed the duration of
    52  the pregnancy and recuperative period of up to  eight  weeks  after  the
    53  birth of the child.
    54    (c)  Compensation may not be conditioned upon the purported quality or
    55  genome-related traits of the gametes or embryos.
        A. 6959--A                         12

     1    (d) Compensation may not be conditioned on actual genotypic or  pheno-
     2  typic characteristics of the donor or of the child.

Residential real estate sales, social distancing, and traditional marketplace institutions

In some places, residential real estate is an essential service (open houses allowed) and in others not.  Virtual, internet showings are becoming more important.
But some of the particular marketplace institutions, of closing and title ceremonies (including notarized signatures) resist social distancing, and in many U.S. states must be conducted in person. Of course, the security of undisputed ownership is of huge importance in real estate, and online security is imperfect (I'm told...), so it isn't clear how to proceed here.

Here's a story from the Washington Post:

With hand sanitizer and elbow bumps, real estate agents are still selling during pandemic
By Kathy Orton

"Now, as nonessential businesses are shuttering to wait out the pandemic, some real estate professionals are carrying on as usual — albeit with masks, gloves and hand sanitizer. Agents were holding open houses until they were prohibited by local officials. Nearly 200 open houses were listed last weekend and more than 600 open houses the week before in the D.C. region on the area’s multiple listing service. Mayor Muriel E. Bower (D) banned open houses as of Saturday; Maryland Gov. Larry Hogan (R) and Virginia Gov. Ralph Northam (D) forbid them as of Monday.

"Home appraisers and inspectors are donning masks and gloves. Settlement companies are putting buyers and sellers in separate conference rooms and opening a new box of pens for each client who comes to a closing.
...
"Illinois, despite being hit hard by the coronavirus outbreak, has said that real estate is an essential service, and therefore is not required to close like retail outlets and restaurants.

"But California, New York and Pennsylvania have said it is not. Seattle’s multiple listing service no longer allows agents to post open houses.
...
"The number of 3-D home tours created on Zillow went up 326 percent on March 20.
...
"Although many aspects of buying a home can be done online, certain parts of the process — inspection, appraisal, closing — typically are done in person.
...
"According to Todd Ewing, chief executive at Federal Title, Fannie Mae and Freddie Mac are reluctant to buy loans without legislation that allows for remote online notarization.

"Some states, including Virginia, permit remote online notarization, but others such as the District and Maryland, do not. Federal legislation was introduced on March 18 that would allow it in all states."

Organ donation after medically assisted dying, in Canada

In the New England Journal of Medicine, with many authors,
Organ Donation after Medical Assistance in Dying — Canada’s First Cases

February 6, 2020
N Engl J Med 2020; 382:576-577
DOI: 10.1056/NEJMc1915485

"In 2016, following the Supreme Court of Canada’s Carter Decision,1 medical assistance in dying (MAID) became possible with individual court orders. However, owing to the lack of a centrally coordinated Canadian response to the requests of some patients for voluntary euthanasia, as well as concern for individual repercussions, many Canadian providers of assisted dying operate largely independently. With 3 years now passed since euthanasia was approved, it is important to ensure our understanding of current practice for the purpose of quality assurance, provider education, and future research opportunities geared to improve patient-centered practice. Among the practices related to the legalization of euthanasia, organ donation raises challenging issues.

"We performed a historical cohort study of completed MAID organ-donation cases using data from three Canadian provincial organ-donation organizations (Trillium Gift of Life Network, Transplant Québec, and British Columbia Transplant) from June 2016 through January 2019 to describe the initial experience with euthanasia-associated organ donation. A total of 56 patients were referred as potentially eligible for organ donation after MAID on the basis of preliminary assessment by one of the three organ-donation organizations. The mean age was 61 years; 39% of the patients were female. The most common diagnosis was amyotrophic lateral sclerosis, followed by end-stage chronic obstructive pulmonary disease and Parkinson’s disease. Although the majority of Canadian euthanasia cases have involved patients with active cancer,1 our data showed that there is a substantial variety of conditions for which organ donation is a viable possibility. Among the 56 patients in the study, 30 were able to become donors and donated 74 organs. Twenty patients were single-organ donors, while 10 were multiorgan donors. 

Bike matching in NYC

Program Matches Bicycles To Essential Workers Who Need Them In New York 

ARI SHAPIRO, HOST: If you're looking for ways that you can help out these days, there's plenty of need. Food pantries need non-perishable food. Hospitals need masks. And lots of people, it turns out, need wheels.

MARY LOUISE KELLY, HOST: Yeah. That is the idea behind a new program from the New York City-based advocacy group Transportation Alternatives.

"SHAPIRO: Danny Harris says they've matched 42 people with bikes so far, and many more are in the works.
...
"SHAPIRO: And Salazar says with car traffic way down, biking in New York City these days is actually quite nice."

HT: Ellen Kominers

Covid-19 is now a leading cause of death in the U.S.

The Washington Post has the story:

Covid-19 is rapidly becoming America’s leading cause of death
By Dan Keating and Chiqui Esteban

Kidney disease is moved down to number 10.

Of course, "cause of death" is a squishy kind of data, since a given death can be recorded in different ways. See yesterday's post on how Covid-19 also contributes to kidney failure, (and how dialysis in crowded clinics can expose kidney failure patients to infections of all sorts, including corona virus).

Covid-19, kidney failure, and dialysis

Corona virus and kidney failure are a bad combination, whichever way you look at it. On the one hand, Covid-19 is causing kidney failure. On the other, if you are already on dialysis, you are exposed to Covid-19 infection whenever you go to spend a few hours at a crowded dialysis clinic.

Frank McCormick points me to this story from Politico:
U.S. races to stock up on dialysis supplies as kidney failure ravages virus patients
Approximately 20 percent of coronavirus patients in intensive care around the city need the kidney treatment, often for weeks.

"Hospitals in New York City are running out of dialysis fluids as thousands of coronavirus patients develop kidney failure, an unexpected development that could presage the next critical supply shortage nationwide.

"Approximately 20 percent of coronavirus patients in intensive care around the city need the kidney treatment, often for weeks, a development that many providers did not see coming. FEMA held a call Monday with FDA and CMS to discuss the possibility of issuing emergency use authorizations to import more dialysis fluids, according to a document obtained by POLITICO.
...
"Gov. Andrew Cuomo recently said that New York’s ventilator needs are beginning to plateau, and he has begun diverting the equipment to states in greater need. But hospital staff say that the extended nature of dialysis treatment means that shortages of fluids, trained personnel and even equipment there could just be starting."
**********

And here's a NY Times story on dialysis patients and clinics:

 Dialysis Patients Face Close-Up Risk From Coronavirus
As the pandemic sweeps the United States, patients needing kidney dialysis and employees of the clinics worry about keeping the virus at bay in such tight spaces.

"As the coronavirus rages from state to state, the 500,000 people whose failing kidneys require them to get dialysis are among the most vulnerable. Each clinic may have dozens of patients during a single shift, often sitting less than the recommended six feet apart for hours.
...
"Infection has traditionally been one of the industry’s biggest problems.

“The second leading cause of death among hemodialysis patients is infections,” said Dr. Alan Kliger, a Yale nephrologist who is leading efforts to control the spread of coronavirus among dialysis patients. As many as one in 10 patients die from complications from an infection, often at the site where a patient has a catheter.

Corona lockdown, and the food supply chain in India, by Matt Lowe and Ben Roth

Matt Lowe and Ben Roth look at the effect of India's corona virus lockdown on the food arriving at the big wholesale produce market in Delhi.  They describe breakdowns in the supply chains.

Arrivals Dropped 50% Post Lockdown. When Will Azadpur Mandi’s Supply Return to Normal?
Since the lockdown has been extended till May 3, it has become all the more crucial for the government to intervene and ensure that the broader food supply chain operates smoothly. 

"The disruption can already be seen in Delhi’s (and Asia’s) largest wholesale fruit and vegetable market – the Azadpur mandi – which has seen a precipitous decline in the volume of fruits and vegetables flowing through the market.

"Relative to the three prior years, the volume of produce arriving at Azadpur fell by about half on March 24, and has hovered at around that level since (Figure 1).