Choosing between public and private schools: vouchers in Arizona

There's a fight over public versus private school funding in Arizona. Here's the background:

Arizona OKs Biggest US School Voucher Plan, Faces Challenge. Republican Gov. Doug Ducey has signed a massive expansion of Arizona’s private school voucher system.  AP, July 7, 2022

"Republican Gov. Doug Ducey on Thursday signed a massive expansion of the state’s private school voucher system, even as he faced a promised effort by public school advocates to block the bill and ask voters to erase it during November’s election.

"The expansion Ducey signed will let every parent in Arizona take public money now sent to the K-12 public school system and use it to pay for their children’s private school tuition or other education costs.

...

"Ducey has championed “school choice” during his eight years in office. He signed a universal voucher expansion in 2017 with enrollment caps that was referred to the ballot by a grassroots group called Save Our Schools Arizona.

"Voters soundly rejected the expansion by a 2-to-1 vote in the 2018 election, but advocates of what are formally called “Empowerment Scholarship Accounts” pushed ahead with new expansions anyway. The universal voucher bill passed with only support from majority Republican lawmakers in the legislative session that ended early on June 25."

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And Salon brings us up to date:

Arizona's school privatization battle heats up: Will the voters get to decide?  Republicans' massive school voucher plan may yet be defeated (again) — but the challenge is stiffer this time By KATHRYN JOYCE, SEPTEMBER 20

"A fight over the future of the most sweeping school voucher program in the country has heated up in Arizona over the last few weeks, as public school advocates race to gather enough signatures to trigger a ballot referendum aimed at overturning a voucher law recently passed by the state's Republican-dominated legislature. The referendum campaign, which faces a crucial deadline this Friday, has drawn intense opposition from Arizona conservatives. This has included funding for multiple anti-referendum websites, roadside protests starring Republican legislators and, over the last two weeks, conflicts between activists both on social media and in the streets. 

...

"Under the new law, any Arizona parent who opts their children out of public school will receive a debit card with an average balance of just under $7,000, which they can use to spend on almost any educational needs they choose, from private school tuition to homeschooling expenses to buying computers to hiring private teachers for "microschools." Public education advocates immediately warned that such a huge transfer of public funds to private hands could be the death knell for public schools, which would likely have to make untenable cuts to teaching staff and school programs.

...

"From the inception of Arizona's ESAs, critics have charged that they're little more than a workaround to funnel public tax dollars to private schools. The idea was born after a court found in 2009 that two earlier Arizona school voucher programs were unconstitutional, violating the state's prohibition on using public money for private education. In 2011, under the guidance of the Goldwater Institute, a conservative think tank, the state launched an ingenious alternative: sending state funds directly to parents, who spend the money as they see fit. The ESA option then became a nationwide model, copied in numerous other states and increasingly seen by conservative education reform activists as "the purest form of school choice." 

HT: Bertan Turhan

Market design workshop at Iowa State University

 I'll give a public talk this evening to open a market design workshop tomorrow and Saturday:

Two-day Workshop: September 23-24, 2022, Heady Hall 360A, Iowa State University

Organizers: Ran Shorrer, Bumin Yenmez, Bertan Turhan  

Program: MARKET DESIGN WORKSHOP PROGRAM

Day 1: Friday, September 23, 2022 (Heady Hall 368A)

SESSION 1

8:00-8:40 Rakesh Vohra (w/ Thanh Nguyen)

“(Near) Substitute Preferences and Equilibria with Indivisibilities”

8:40-9:20 Federico Echenique (w/ Sumit Goel and SangMok Lee)

“Stable Allocations in Discrete Economies”

9:20-10:00 Marzena Rostek

“Decentralized-Market Design”

Chair: Tarun Sabarwal

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BREAK: 10:00-10:30

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SESSION 2

10:30-11:10 Karam Kang (w/ Giulia Brancaccio)

“Search Frictions and Product Design in the Municipal Bond Market”

11:10-11:50 Mariana Lavarde

“Distance to Schools and Equal Access in School Choice Systems”

11:50-12:30 Atila Abdulkadiroğlu (w/ Aram Grigoryan)

“Priority-based Assignment with Reserves and Quotas”

Chair: David Cooper

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LUNCH: 12:30-1:40 (Heady 360)

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SESSION 3

1:40-2:20 Bumin Yenmez (w/ Isa Hafalir and Fuhito Kojima)

“Design on Matroids: Diversity vs Meritocracy”

2:20-3:00 Orhan Aygün (w/ Bertan Turhan)

“Affirmative Action in India: Restricted Strategy Space, Complex Constraints, and

Direct Mechanism Design”

3:00-3:40 Nick Arnosti

“Explainable Affirmative Action”

Chair: Atila Abdulkadiroğlu

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BREAK: 3:40-4:10

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SESSION 4

4:10-4:50 Eric Budish

“The Economic Limits of Bitcoin and Anonymous, Decentralized Trust on the Blockchain”

4:50-5:30 Eduardo Azevedo (w/ David Mao, Jose Montiel Olea, and Amilcar Velez)

“A/B Testing with Gaussian Priors”

5:30-6:10 Ran Shorrer (w/ Yannai Gonczarowski and Scott Kominers)

“To Infinity and Beyond: Scaling Economic Theories via Logical Compactness”

Chair: Al Roth

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Day 2: Saturday, September 24, 2022

SESSION 5

8:00-8:40 Thayer Morrill (w/ Peter Troyan)

“Desirable Rankings: A New Method for Ranking Outcomes of a Competitive Process”

8:40-9:20 Lars Ehlers (w/ Christian Basteck)

“Strategy Proof and Envy-Free Random Assignment”

9:20-10:00 Itai Ashlagi (w/ Jacob Leshno, Pengyu Qian, and Amin Saberi)

“Price Discovery in Waiting Lists: A Connection to Stochastic Gradient Descent”

Chair: Rakesh Vohra

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BREAK: 10:00-10:30

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SESSION 6

10:30-11:10 Josue Ortega (w/ Thilo Klein)

“Improving Efficiency and Equality in School Choice”

11:10-11:50 Aram Grigoryan

“Transparency in Allocation Problems”

11:50-12:30 Inácio Bó (w/ Rustam Hakimov)

“Pick-an-Object Mechanisms”

Chair: Federico Echenique

Economists as Engineers: Public lecture at Iowa State University tomorrow

 
I'll be travelling today to Ames Iowa, to give a public lecture tomorrow evening at Iowa State University (and to attend a market design conference there on Friday and Saturday)

"This event will be recorded and available for two weeks on the Lectures website at https://www.lectures.iastate.edu/recordings/available-recordings "

Investment Incentives in Truthful Approximation Mechanisms by Akbarpour, Kominers, Li, Li and Milgrom

Computationally intractable optimization problems often allow approximate solutions that are 'close enough' to the optimal solution.  But these approximation algorithms can radically change the incentives to the participants, or not.  Here's a paper on frontier of market design and computer science, from the KIT — Paris — ZEW Workshop on Market Design from June 2022.

Investment Incentives in Truthful Approximation Mechanisms, by Mohammad Akbarpour, Scott Duke Kominers, Kevin Michael Li, Shengwu Li, and Paul Milgrom.   May 16, 2022

"Abstract: We study investment incentives in truthful mechanisms that allocate resources using approximation algorithms instead of exact optimization. In such mechanisms, the price a bidder pays to acquire resources is generally not equal to the change in other bidders’ welfare—and these externalities skew investment incentives. Some allocation algorithms are arbitrarily close to efficient, but create such perverse investment incentives that their worst-case welfare guarantees fall to zero when bidders can invest before participating in the mechanism. We show that an algorithm’s guarantees in the allocation and investment problems coincide if and only if that algorithm’s “confirming” negative externalities are sufficiently small. Algorithms that exclude confirming negative externalities entirely (XCONE algorithms) thus have the same worst-case performance for the allocation and investment problems."

 

A "confirming" negative externality is an investment that doesn't change the investor's allocation but imposes a negative externality on the market.

Crowdsourcing organ transplant ethics

 In Slate, an upbeat article about the ethical issues associated with deceased organ allocation and (before that) access to dialysis, and the benefits and difficulties with crowdsourcing the solutions.  

The Kidney Transplant Algorithm’s Surprising Lessons for Ethical A.I.  A more democratic approach to A.I. is messy, but it can work.  BY DAVID G. ROBINSON

This article is adapted from Voices in the Code: A Story About People, Their Values, and the Algorithm They Made, out Sept. 8 from Russell Sage Foundation Press.

" in the world of organ transplants, surgeons and data scientists have an unusual habit of being brutally honest about the human lives behind their work—of inviting others into the impossible choices their field confronts. For better and worse, the organ transplant system is itself a real-life laboratory of more inclusive, accountable techniques for building and using A.I.—approaches that are now being proposed in U.S. and EU legislation that could cover courtrooms, hiring, housing, and many other sensitive domains.

...

"Where did this culture of moral humility—one that’s now shaping the design of a high-stakes A.I. system—come from?

"Collaborative decision-making about hard ethical choices in kidney medicine began before the digital revolution. It began before there were many kidney transplants. "

After the development of dialysis there were..."just a handful of dialysis machines, ...Whom to save? Scribner and his team were inundated with pleas from dying patients and their doctors.

"Faced with this quandary, Scribner and his colleagues chose to do something extraordinary: They shared their moral burden with the Seattle community they served. Rather than pretending that their technical expertise gave them special moral standing, they chose to be morally modest, and to widen the circle. The doctors still decided who was medically eligible for dialysis. But then, they established a second committee, a group of seven laypeople chosen by the local medical society, who would make the non-medical decision of how to allocate the few available slots among the many eligible patients. The committee members were given some basic education about kidney medicine, but weren’t told how to make their moral choices.

“They Decide Who Lives, Who Dies” was the headline of a 1962 Life magazine article about this new group. Its members, who were anonymous, were photographed in shadow. A clerical collar can be seen on one. The lone woman of the group, a homemaker, clasps a pair of reading glasses in her folded hands. The article reported that the committee’s approach was based on “acceptance of the principle that all segments of society, not just the medical fraternity, should share the burden of choice as to which patients to treat and which ones to let die.”

"The Life story described some biases that played out on the committee—they favored male breadwinners who had children to support—and it triggered widespread revulsion. A pair of scholars wrote that the committee was judging people “in accordance with its own middle-class suburban value system: scouts, Sunday school, Red Cross. This rules out creative nonconformists … the Pacific Northwest is no place for a Henry David Thoreau with bad kidneys.” The original Life story never mentioned race, but later reporting suggested the committee had been biased in favor of white applicants. The committee only ran for a few years. Other dialysis facilities used different rationing strategies—including first-come, first-served—and in 1972 Congress passed an extraordinary law to provide dialysis at public expense through Medicare to all patients who needed it. That proved to be a humane, if extremely costly, escape route from the rationing problem that Scribner once faced.

"Along with all its faults, I think the Seattle committee also gave us much to admire. It was profoundly, even uncomfortably, honest about the hard choices at the center of kidney medicine. It refused to pretend that such choices were—or ever could be—entirely technical. And it tried, albeit clumsily, to democratize the values inside a complex, high-tech system. The Seattle physicians and their lay colleagues were rationing a scarce supply of dialysis treatments. But even after Congress provided dialysis for everyone, the shortage of transplantable kidneys was destined to spark similar questions, ones we still face today."

HT: Tom Riley

Canadian Blood Services to start paying Canadian plasma donors

 CBC news has the story, which seems to mark a turning point in a long struggle with repugnance for paying donors.

Canadian Blood Services signs agreement with private company to boost national plasma supply.  Some advocates calling for the resignation of Canadian Blood Services leaders over agreement. by Stephanie Dubois 

"Canadian Blood Services (CBS) is partnering with a private healthcare company to boost Canada's national blood plasma supply, the organization announced Wednesday.

...

"CBS has signed an agreement with Grifols, a company headquartered in Spain, which specializes in producing plasma medicines, the national blood collection organization said in a news release.

...

"Grifols will help CBS meet national targets for plasma supply by both collecting paid-for plasma and by turning Canadian plasma into immunoglobulins —a form of specialized medications called plasma protein products– for Canadian patients. 

...

"Health Canada says on its website there's currently "not enough plasma collected in Canada to meet the demand," and most of the plasma products distributed by CBS and Héma-Quebec are purchased from U.S. manufacturers and made from U.S. paid-donor plasma. "

Non-directed organ donors and NLDAC financial support

For some years I've been a member of the advisory group of the National Living Donor Assistance Center (NLDAC) which is authorized to offer federally funded financial support (for travel, and now also for lost wages and childcare expenses) to needy donors whose recipients also cannot afford to offer such support. As kidney exchange has grown, so have the number of non-directed donors, who don't have a particular recipient in mind. In a recent email, NLDAC has defined how these donors can qualify for financial assistance.

"Defining Non-Directed Donors

"Eligibility for NLDAC depends primarily on the recipient's household income. This is because the Organ Donation and Recovery Improvement Act requires NLDAC to assess the recipient's ability to reimburse their donor before providing reimbursement with federal funding. Most donors have a particular recipient in mind, and that person is allowed to reimburse their expenses, if they are willing and able to do so. NLDAC provides reimbursement when the recipient cannot afford to provide it. Some donors do not have a recipient to ask for help, though. A non-directed donor is a living donor with no intended recipient. These donors can apply to NLDAC without recipient information because there is no identified recipient. Non-directed donors are eligible for NLDAC regardless of their eventual recipient's information, as long as the donor meets the residency requirements and applies on time. 

"Let's consider some examples:

"Tina heard on the news that there are 5,000 people waiting for a kidney transplant in her state. She called a transplant center and asked that they give her kidney to anyone who needs it, if she is approved to donate. Tina is a non-directed donor because she has no intended recipient. 

"Anthony read about a stranger's search for a living kidney donor on Facebook. Though he doesn't know the person, he would like to be evaluated as a potential donor for them. He is a directed donor because he has an intended recipient, even though he doesn't know them personally. 

"Jacqueline wants to donate to a member of her church without revealing her identity to the recipient. She is a directed donor because she has an intended recipient, though she wants to remain anonymous. 

"Esther wanted to donate to her husband, but they are not a good match. Through kidney paired donation, she donates to a stranger, and the stranger's loved one donates to her husband. Because Esther has an intended recipient who received a transplant through her donation, she is a directed donor. 

"Devin was being evaluated as a potential living donor to his uncle when his uncle received a deceased donor transplant. Devin decided he was still willing to donate even though his uncle no longer needed his organ, and asked the transplant center to give his kidney to anyone on the waitlist. Devin is now a non-directed donor because he does not have an intended recipient anymore. 

"Which of these donors can apply to NLDAC without their recipient's information? Tina and Devin, because they are donating without an intended recipient. Anthony, Jacqueline, and Esther can apply with their intended recipient, and NLDAC will keep the donor and recipient's information private. Esther would apply with her originally intended but incompatible recipient, her husband."

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All my posts on NLDAC:  https://marketdesigner.blogspot.com/search?q=nldac&max-results=20&by-date=true

A milestone and a stepping stone: 1 million U.S. organ transplants

 Here's the story from the AP, about the 1,000,000th transplant in the U.S., a milestone reached last Friday:

US counts millionth organ transplant while pushing for more By LAURAN NEERGAARD September 9, 2022

"The U.S. counted its millionth organ transplant on Friday, a milestone that comes at a critical time for Americans still desperately waiting for that chance at survival.

"It took decades from the first success — a kidney in 1954 — to transplant 1 million organs

...

"Yet the nation’s transplant system is at a crossroads. More people than ever are getting new organs — a record 41,356 last year alone. At the same time, critics blast the system for policies and outright mistakes that waste organs and cost lives.

"The anger boiled over last month in a Senate committee hearing where lawmakers blamed the United Network for Organ Sharing, a nonprofit that holds a government contract to run the transplant system, for cumbersome organ-tracking and poor oversight."

Depreciated currency

I'm flying home today from Argentina, where I took part in the TTS2022 international transplant conference.   I had to change dollars to pesos, which is made more complicated by the fact that Argentina has experienced persistently very high inflation.  But I feel on much more solid ground than if I had been in Venezuela, where inflation has wreaked havoc.

 David Klinowski recently finished a postdoc at Stanford and moved to Pitt. As a souvenir, he gave us this peacock, made by an artist from depreciated Venezuelan currency, which happens to have pictures of birds.  Persistent inflation has made this one of the high value uses of these old bills.

Here's a snippet of inflation data from the IMF: 

Venezuela: Inflation rate from 2012 to 2022 (compared to the previous year)

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In contrast to Venezuela, inflation in Argentina could be worse--it's less than 100% a year--double digits rather than 5 digits--although it's still among the highest in the world:

Argentina: Inflation rate from 2004 to 2027(compared to the previous year), with 2014-16 missing (and estimated going forward)

TTS2022 Awards--Congratulations

 Today at TTS2022, prizes will be awarded.  One that I know is very well deserved, is to Dr. Vivek Kute, for his extraordinary achievements in kidney transplantation in India. Congratulations to all the prize winners.

I've followed Dr. Kute's work over the years in multiple posts.

The First 52 Global Kidney Exchange Transplants: today at TTS2022 in Buenos Aires

 Tomorrow at TTS2022 in Buenos Aires, Mike Rees will present

The First 52 Global Kidney Exchange Transplants: overcoming multiple barriers to transplantation by MA Rees, AE Roth , IR Marino, K Krawiec, A Agnihotri, S Rees, K Sweeney, S Paloyo, T Dunn, M Zimmerman, J Punch, R Sung, J Leventhal, A Alobaidli, F Aziz, E Mor, T Ashkenazi, I Ashlagi, M Ellis, A Rege, V Whittaker, R Forbes, C Marsh, C Kuhr, J Rogers, M Tan, L Basagoitia, R Correa-Rotter, S Anwar, F Citterio, J Romagnoli, and O Ekwenna.  

Introduction: Many barriers currently stand in the way of achieving international kidney exchange including: financial, regulatory, logistical, cultural, immunological and legal barriers. 

Methods: The Alliance for Paired Kidney Donation serves patients in 15 countries. Ten of these countries have participated in Global Kidney Exchange (GKE) transplants in which either living donors, their kidneys or recipients have traveled internationally to achieve successful living donor kidney transplantation (LDKT). In all cases, barriers were present that prevented LKDT in the donor or recipient country of origin.

Results: Between January of 2015 and February of 2022, GKE has produced 11 chains and 4 cycles that has provided LDKT for 17 international patients from 10 countries to be transplanted, as well as 35 LDKT for patients in the United States (US). GKE chains lengths have ranged from 1 to 11; cycles were length 2 or 3. Eight GKE transplants overcame immunologic barriers, 4 financial barriers, and 5 both immunologic and financial barriers. GKE has involved 19 US transplant centers across 18 states and 38% of recipients were minorities. For US recipients 11% had blood type (BT)-A, 57% BT-0, 17% BT-B, and 14% BT-AB; for international recipients 41% had BT-A, 53% BT-O and 6% BT-B. The PRA was 0-20% for 23 patients, 21-79% for 14 and > 80% for 15 (10 international). International pairs were funded by a combination of self-pay, insurance and philanthropy. Transplanting 35 US patients saved US healthcare payers $7-10M vs. dialysis. International recipients have 100% 3-year patient and graft survival and all international donors are alive and have normal creatinine and blood pressure.

Conclusion: GKE overcomes financial and immunological barriers to transplantation. Savings from avoided dialysis offers scalability. Our program ensures transparency of international pair selection, emphasis on donor safety, and assurance of longterm immunosuppression for recipients as prerequisites for sustainability.

Access to transplantation around the world, at the International Congress of The Transplantation Society (TTS 2022) in Buenos Aires

I'm attending the 29th International Congress of The Transplantation Society (TTS 2022) | Buenos Aires - Argentina, and will speak in the first plenary session, on Access and Transparency in transplantation around the world.  I'll be the third of three speakers:

Plenary on access and transparency

 Monday, September 12, 2022 – 09:40 to 11:10

Transplantation in a moving world: Migrants, refugees & organ trafficking

Dominique Martin, Australia

Short Biography

Steps towards increasing deceased donation worldwide

Beatriz Dominguez-Gil, Spain

Short Biography

Transplant sufficiency in an unequal world

Alvin E. Roth, United States

Short Biography

Organ donor joke from the Edinburgh fringe

 “My dad suggested I register for a donor card. He’s a man after my own heart.” 

That's a joke by Masai Graham, who won the most popular joke vote this year at the Edinburgh fringe, with 52% of 2,000 votes for another one-liner: “I tried to steal spaghetti from the shop, but the female guard saw me and I couldn’t get pasta.”

Here's the Guardian with more:

Pasta one-liner wins best joke award at Edinburgh festival fringe. West Midlands comedian Masai Graham, who works as a part-time care worker, wins title for second time. by Harriet Sherwood 

Kidney exchange launched between the U.S. and Italy

 Here's the announcement from Italy (in Italian), on the site of the Centro Nazionale Trapianti, the National Transplant Center: 

Al via programma di trapianti incrociati di rene tra Italia e Usa, firmato l'accordo, 

Google translate: "The pilot phase will cover the first three cases and will be limited to  three hospitals : for Italy, the kidney transplant center of the  Agostino Gemelli Polyclinic in Rome will participate, directed by Professor Franco Citterio, present at the signing of the agreement, while for the USA the  University of Toledo Medical Center  and the hospitals of  Thomas Jefferson University in Philadelphia will be involved . Once the operational and management experimentation has been completed, the program will be re-evaluated for a possible consolidation of the protocol and for the progressive expansion to other living kidney transplant centers of the Italian network. 

"The one with the United States is  the second international exchange protocol  activated by our country: since 2018 an agreement has been in force involving France, Portugal and  Spain  and which has resulted in three cross transplants with the latter nation. From 2015 to date, the Italian national crossover kidney transplant program has allowed  77 interventions to be carried out . Overall, 2,043 kidney transplants were performed in Italy in 2021, of which 341 from living donors: of these, 5 were carried out through an exchange between donor and recipient pairs. "

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Here's the announcement from the Alliance for Paired Kidney donation, the U.S. partner (in English):

PILOT KIDNEY EXCHANGE TRANSPLANT PROGRAM LAUNCHED BETWEEN US, ITALY

""The goal of the memorandum of understanding, which was signed at the Ministry of Health in Rome, is to provide for the possible treatment of thousands of patients awaiting kidney transplants in both the U.S. and Italy. The agreement was signed on behalf of CNT by its director, Massimo Cardillo, and by Michael A. Rees, MD, PhD, the CEO of APKD and the surgical director of kidney transplantation at the University of Toledo Medical Center in Ohio.

"The new US-Italy program concerns kidney exchange transplantation, in which incompatible living donor and recipient pairs are matched with other incompatible pairs for kidney transplants. Thanks to the agreement between APKD and CNT, incompatible American and Italian donor-recipient pairs will be able to exchange with each other based on a shared algorithm that will verify the level of compatibility between those on the countries’ transplant waiting lists. In this way, patients with kidney failure, who also have an incompatible volunteer donor, will have a greater chance of receiving the transplant they need.

"In addition to the technical-operational aspects – such as the requirements of the participating hospitals, matching algorithm and overall governance of the transplant process – the agreement provides that the costs related to the transplant procedure are borne by the U.S. insurance coverage for the U.S. recipient and the Italian donor, while the Italian National Health Service will cover the expenses for the Italian recipient and the American donor. Transplant surgeries will take place in the country where the recipient is located.

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A critical role was played by Dr. Ignacio Marino, the transplant surgeon who took time off to be the mayor of Rome and is now at Jefferson Hospital in Philadelphia.

His facebook post yesterday describes some details of the proceedings (first in Italian and then in English:

"The agreement was signed by the Italian National Transplant Centre (NTC), represented by director Massimo Cardillo, and the Alliance for Paired Kidney Donation (APKD), a non-profit organisation that runs one of the largest living kidney exchange programmes in the United States, represented by its CEO, Professor Michael A. Rees, MD PhD, director of the Kidney Transplant Centre at the University of Toledo Medical Center, Ohio. The signing of the protocol was attended by the Italian Deputy Minister for Health Pierpaolo Sileri, who has wholeheartedly supported this innovative project from the outlet."

Drs. Mike Rees and Ignazio Marino

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Update, October 3:

Here's an Italian news article from Sanita24 taking note of the agreement.

Trapianti di rene: attese più brevi grazie all'algoritmo del premio Nobel Alvin Roth  di Paolo Castiglia

G translate of first paragraph: "In no country in the world is there a sufficient number of donors to cover the transplant needs of all patients suffering from end-stage renal failure and who therefore have to resort to dialysis. To address this need, a memorandum of understanding was signed for the launch of an organ donation program in a “cross” mode between different continents, to offer a new possibility of treatment to patients on dialysis."

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Related earlier posts

Tuesday, September 4, 2018

Ignazio Marino on global kidney exchange

Sunday, December 20, 2020

Jefferson University celebrates Dr. Ignazio Marino

Do (some) kidney donors have a right to donate?

 Here's an article that considers whether some potential kidney donors, who have more appetite for risk than some transplant teams, might nevertheless have a right to donate.

Donor Autonomy and Self-Sacrifice in Living Organ Donation: An Ethical Legal and Psychological Aspects of Transplantation (ELPAT) View  , by Nizam Mamode, Kristof Van Assche2, Lisa Burnapp, Aisling Courtney, David van Dellen, Mireille Houthoff, Hannah Maple, Greg Moorlock, Frank J. M. F. Dor, and Annette Lennerling, Transplant International, 35, 2022, https://www.frontierspartnerships.org/articles/10.3389/ti.2022.10131, DOI=10.3389/ti.2022.10131    

ABSTRACT: "Clinical teams understandably wish to minimise risks to living kidney donors undergoing surgery, but are often faced with uncertainty about the extent of risk, or donors who wish to proceed despite those risks. Here we explore how these difficult decisions may be approached and consider the conflicts between autonomy and paternalism, the place of self-sacrifice and consideration of risks and benefits. Donor autonomy should be considered as in the context of the depth and strength of feeling, understanding risk and competing influences. Discussion of risks could be improved by using absolute risk, supra-regional MDMs and including the risks to the clinical team as well as the donor. The psychological effects on the donor of poor outcomes for the untransplanted recipient should also be taken into account. There is a lack of detailed data on the risks to the donor who has significant co-morbidities."

"The donation of a solid organ for transplantation by a person who is alive at the time represents a unique event in healthcare, since the donor will gain no physical benefit from undergoing major surgery, which has a low but nevertheless significant rate of major complications and death (1, 2). Living donors are usually highly motivated individuals, whose appetite for risk differs substantially from that of the healthcare team (3). This may lead to conflicts between the clinical team and potential donors-some examples are given in Figure 1. Were the decisions of the clinical teams correct? This article explores the issues raised by these cases and others, and considers the principles which might help to guide decision-making. It is an overview aimed at healthcare professionals, and is not intended to be an in-depth ethical review."

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And here's a news story from People.com about just such a donor, who exercised his right to donate:

When His Patient Couldn't Find a Kidney Donor, This Doctor Gave His: 'It's a Feeling That's Hard to Describe'  "I was always in awe of people who donated organs. It fascinated me. And I soon decided that I didn't just want to talk the talk," said Dr. Aji Djamali    

By Johnny Dodd 

"Djamali, a nephrologist who chairs the department of medicine at Maine Medical Center Department, was wheeled into an operating room and surgeons removed his kidney. Within minutes another team went to work transplanting the organ into Jartz, who had been diagnosed with polycystic kidney disease (PKD) — an inherited disorder that causes the kidneys to enlarge and stop working — seven years earlier. (The two men met when Jartz was Djamali's patient at the UW Health Transplant Center in Madison, Wisconsin.)

"For Djamali, who was back at work two days later (Jartz was discharged after five days), being able to donate an organ was the culmination of a dream that began decades earlier while in medical school.

...

"Looking back on the experience, Djamali struggles to find the words to properly convey what it feels like to give a part of his body to another person.

"It's a feeling that's hard to describe," he says. "It's like watching your child being born. It's just this sensation of freedom, elation and happiness."

"But, of course, there was another reason why he did it. The veteran physician knew that the story of his actions might spur someone else to perform a similar act.

"Half of the reason was to help John," says Djamali, who is in touch with Jartz on a daily basis. "But the other reason was to encourage people to help others, to inspire them to consider stepping up and helping the 90,000-plus patients across the nation who are on waiting lists to get a transplant."

Three living kidney donors talk about their experience

 Tonight at 6pm Eastern, three donor stories from the National Kidney Donation Organization (NKDO)

Click Here to Register

Kidney exchange in China?

 Here's a video about kidney exchange, proposing that it should be adopted in China. (The author does not reveal his/her identity.)

 https://www.bilibili.com/video/BV1og411D7qu

Decriminalizing drugs at the head of the supply chain--Colombia

 The criminalization of drugs has different consequences on different parts of the supply chain. Here's a harm reduction proposal from Columbia--the Washington Post has the story.

Colombia, largest cocaine supplier to U.S., considers decriminalizing. By Samantha Schmidt and Diana Durán 

"It’s the largest producer of cocaine in the world, the source of more than 90 percent of the drug seized in the United States. It’s home to the largest Drug Enforcement Administration office overseas. And for decades, it’s been a key partner in Washington’s never-ending “war on drugs.”

"Now, Colombia is calling for an end to that war. It wants instead to lead a global experiment: decriminalizing cocaine.

"Two weeks after taking office, the country’s first leftist government is proposing an end to “prohibition” and the start of a government-regulated cocaine market. Through legislation and alliances with other leftist governments in the region, officials in this South American nation hope to turn their country into a laboratory for drug decriminalization.

“It is time for a new international convention that accepts that the war on drugs has failed,” President Gustavo Petro said in his inaugural address this month."

Paul Milgrom on auctions for water rights

 ZME Science (in Romania) interviews Paul Milgrom about water shortages (in California):

Could auctions help California make better use of its water? This leading economist believes so.  by Mihai Andrei  

"“People get confused when they think about auctions, they think about bidding for a piece of art or something like that,” Milgrom told ZME Science in an interview. “What economists mean when we talk about auction is a process of decentralized resource allocation using prices. It means that we’ve got people who have knowledge about what they need and how valuable things are to them, and we take account of that information to allocate resources specifically, we make bids, and those things are converted to determine prices.”

“If you’re not using an auction you either mean you’re not using prices to guide the resource allocation or you’re not using individual bids. If you don’t use that information, you’re gonna have waste.”

"Waste also means opportunity, and the opportunity Milgrom sees would be transferring water use from those who value it less to those who value it more (and are willing to pay more for it).

...

“In California, less than 5% of water is reallocated, even in the most severe drought,” Milgrom says

“The prices adjust [water gets more expensive], but the reallocation doesn’t adjust even when there is insufficient water. The prices are responsive, but the value of trade isn’t very responsive. So why doesn’t the market work, and what can we do to fix it?”

“It’s not what you expect in a market. What you would expect in a well-functioning market is that the water allocation would increase more to adapt to sending more water into higher value uses and less water into less-value uses. So we’d expect more trading to go on. The fact that it didn’t suggests there’s a problem with the market.”

...

"Designing a large-scale market for water isn’t without precedent. In Australia, a much larger proportion of water is being traded (about 50%); with a roughly similar standard of living, and similar environmental challenges, people in Sydney use about half that amount. But while Australia can serve as an inspiration for California, the same system can’t be replicated exactly.

“We can’t apply the Australian model to California because there are different property rights regimes, the rights are defined differently. They also don’t take into account return flows, which California water law does.”

...

"“I’m cautiously optimistic,” Milgrom says, drawing from his experience with auctioning broadcast spectrum space. “Part of what’s making me optimistic that this is the right time is the progress in measurements and hydrological models.”

Crowd control of misinformation, by limiting fast forwarding, by Jackson, Malladi and McAdams in PNAS

 Here's a paper in PNAS about limiting the spread of misinformation by changing the network of information flows:

Learning through the grapevine and the impact of the breadth and depth of social networks by Matthew O. Jackson, Suraj Malladi, and David McAdams

"Abstract: We study how communication platforms can improve social learning without censoring or fact-checking messages, when they have members who deliberately and/or inadvertently distort information. Message fidelity depends on social network depth (how many times information can be relayed) and breadth (the number of others with whom a typical user shares information). We characterize how the expected number of true minus false messages depends on breadth and depth of the network and the noise structure. Message fidelity can be improved by capping depth or, if that is not possible, limiting breadth, e.g., by capping the number of people to whom someone can forward a given message. Although caps reduce total communication, they increase the fraction of received messages that have traveled shorter distances and have had less opportunity to be altered, thereby increasing the signal-to-noise ratio."