Auction markets for compute capacity as a pathway to building AI

 Dr. Silvia Console Battilana who partnered with Paul Milgrom to found the auction consulting firm Auctionomics, writes about markets for compute capacity as an aid to developing AI.

The Missing Market We Need To Win The AI Race
By Silvia Console Battilana,Forbes Councils Member.
for Forbes Business Council COUNCIL POST | Membership (fee-based) 

"In 2025, the global artificial intelligence market was valued at nearly $300 billion. By 2034, it’s projected to grow to almost $2.5 trillion. Demand for AI services is soaring and AI providers are racing to keep up. Behind them, suppliers of “compute”—the chips and data centers that power AI—are scrambling to expand capacity.

"So, what can the compute market do to enable this growth?

 ...

"There’s another drag on AI growth, and it’s one that I’ve seen before in my work designing markets for radio spectrum, energy and other limited resources: inefficient use of existing capacity. I believe the key to unleashing AI’s potential is not just to build more, but to use what we already have more productively.​

...

"Speeding up our AI highways will require addressing problems with existing compute markets. And one of the primary issues is that we treat all demand for compute the same. Some large compute jobs, including training runs for new AI models, are like tractors that move slowly and take up multiple lanes. These jobs require large quantities of compute but can be completed anytime. They could run overnight without losing value. Real-time AI queries and time-sensitive regressions, on the other hand, are like race cars. Their value depends entirely on speed. If they’re late, they’re worthless.

...

"We can build more lanes on the highway, but in my experience, that tends to be more costly than adding traffic lights and congestion pricing. A well-designed market should create incentives to guide when different compute jobs run. Through real-time spot markets, urgent jobs could pay more for capacity exactly when they need it. Through forward-looking futures markets, large but flexible jobs could secure low prices in advance. "

Kidney exchange in Germany can draw on the experience in other countries

 Here's an editorial arguing that as the recently legalized kidney exchange in Germany is implemented, attention should be paid to the controversies that have been encountered and addressed elsewhere, including those about non-directed donors, and the governance and transparency of transplant decisions.

 Benning L, Lu W, Budde K , Josephson, M.  Germany’s move toward kidney paired exchange and non-directed donation: governance lessons from abroad, Kidney International Reports, 2026 

"In 1986 F.T. Rapaport outlined a core idea behind kidney paired exchange: that a registry can coordinate incompatible donor-recipient pairs so that incompatibility becomes a solvable matching problem rather than a barrier to transplantation1. Today, forty years later, Germany is on the verge of making that coordination legally possible. In October 2025, the German federal cabinet approved a draft amendment to the Transplantation Act that would enable kidney paired exchange and non-directed anonymous living kidney donation, while strengthening donor protection and establishing the legal basis for a national program with a central matching function. If operationalized, Germany would move from a restrictive framework for living kidney donation, historically tied to a strict requirement of a close relationship between donor and recipient, toward a governance model that supports kidney exchange and donor chains at scale.

"This moment is internationally relevant because Germany now faces the same policy questions that have shaped kidney paired exchange implementation elsewhere. The impending change creates an opportunity to learn from other countries on key issues, including who should govern a registry, which safeguards ensure legitimacy, how to balance privacy and transparency regarding organ quality, and how to promote access without risking commercialization. Rather than being mere technical considerations, these questions are constitutive for the legitimacy and public trust required for kidney paired exchange to function as a public good. 

"Early debates about living kidney donation repeatedly straddled suspicion and admiration. In the 1970s, living non-related and particularly non-directed donors were sometimes portrayed in medical discourse as psychologically unstable or even pathological, raising concerns about whether such donors should be permitted to proceed2,3. 

...

" History offers two more lessons: (i) Donor protection and respecting donor agency are not mutually exclusive: psychosocial assessment, independent counseling, and rigorous consent procedures can reduce coercion and misunderstanding while still recognizing donors as autonomous agents making a deliberate moral choice. (ii) Public legitimacy is fragile and easily lost: If suspicion dominates, programs risk being viewed as illegitimate or unfair. If, on the other hand, enthusiasm and implementation moves faster than safeguards, programs risk scandal, backlash and, ultimately, lose public support. Germany’s 2012 transplant scandal, involving the manipulation of patient data to improve waiting-list positions, offers a cautionary example of how deficits in transparency and accountability can erode trust in transplantation more broadly and disrupt an entire program4."

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 There are many reviews of the international experience.  Below is a recent one from physicians at Erasmus University in the Netherlands:

Stijn C. van de Laar, Hidde A. de Heus, Annelies E. de Weerd, Matthijs F. Klaassen, Robert J. Porte, Robert C. Minnee Frank J.M.F. Dor, A Comprehensive Review of Strategies to Advance Kidney Exchange Programs and Optimize Effectiveness and Outcomes, Kidney International Reports, Volume 11, Issue 7, July 2026, 106539

"Living donor kidney transplantation (LDKT) offers superior graft survival and cost-effectiveness compared with deceased donor transplantation (DDKT), yet the availability of immunologically compatible living donors limits its reach. Kidney exchange programs (KEPs) can overcome these barriers by matching incompatible pairs through paired exchanges, domino chains, and nonsimultaneous extended altruistic donor (NEAD) chains. This review summarizes the evolution and current landscape of national and international KEPs. We examine operational challenges (cold ischemia time [CIT], logistical coordination, algorithmic fairness, and ethical and regulatory heterogeneity) and explore innovations in matching algorithms, international kidney exchange debates, and machine perfusion technologies. We conclude by proposing strategic priorities to optimize capacity, equity, and outcomes in future kidney exchange efforts. " 

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Earlier: 

Friday, March 27, 2026 Germany legalizes kidney exchange !!

Surrogacy: a political scandal in Germany, and fertility tourism around the world

 Here's a story in the NYT, covering an uproar that's been in the German newspapers for a week or so now.  A leader in the German governing coalition announced on social media that he and his husband had welcomed a new baby into their family, born via surrogacy in the U.S.  But surrogacy in Germany is not legal, so this was a "for me but not for thee" hypocrisy moment there. (In general it's hard to ban effectively something that is legal in other jurisdictions: someone could write a book about that.)

Uproar Over Surrogate Baby Prompts German Official’s Sudden Resignation
Jens Spahn, a top leader of Chancellor Friedrich Merz’s party, resigned his post after announcing that he had a baby by surrogate, which is illegal in Germany.   By Jim Tankersley

"Mr. Spahn, 46, the leader of the party in Parliament, is a former federal health minister who has forged deep ties to the Republican Party under President Trump, including attending the 2024 Republican National Convention.

...

"Mr. Spahn stirred national outcry this week when he announced, on social media and in the tabloid paper Bild, that he and his husband, Daniel Funke, had become fathers to a son via a surrogate in the United States.

"Surrogacy is prohibited under German law. Mr. Spahn had defended that ban throughout his career, including as health minister.

"The birth announcement brought immediate cries of hypocrisy from across the political spectrum, including in Mr. Spahn’s own party. Some regional leaders of the Christian Democrats demanded his ouster. News outlets teemed with outrage. 

...

"Mr. Spahn defended himself, essentially, on a technicality: German law does not punish parents who use surrogates abroad. He told a podcast interviewer he had struggled with the decision but chose to prioritize his family." 

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Here's a related story: German couples in need of surrogacy are not the only ones, and the US is not the only destination.

The Guardian reports:

Rise in overseas surrogates ‘increases risk of stateless babies’
Calls grow for global regulation as rising numbers of westerners use surrogates in countries with different laws  by Jessica Murray and Rachel Hall

"The rise in the use of surrogates abroad is leaving more babies at risk of becoming stateless, experts have said, amid growing calls for urgent global regulation of the practice.

"The warning follows the suspension of a 15-year effort by The Hague Conference on Private International Law (HCCH) to establish a global surrogacy convention, which was paused due to divisions among member states. 

...

"UK surrogacy agencies argue that an outdated legal framework at home is pushing couples to seek surrogates abroad, where regulations to protect surrogates from exploitation can be less robust or do not exist at all. Anti-surrogacy campaigners say the practice is fundamentally abusive in all cases and are pushing for a global ban.

"Prof Michael Hellner, who chaired the HCCH working group, said hugely differing opinions on the ethics of surrogacy between the member states involved meant the project to create a global framework on legal parentage in surrogacy cases had proved impossible.

...

"Experts said statelessness could happen in cases where a country does not automatically grant nationality to a child born there, and where surrogacy is not legally recognised in either the country of birth or the child’s final destination.

"Hellner said the project had proved difficult when some countries were “violently opposed to anything that could be seen as legitimising surrogacy, which they think is a violation of human rights and dignity”. 

...

"Most of these children were born abroad, mostly in the US, Ukraine, Nigeria, Georgia, Colombia and Mexico. British people using surrogates abroad to have babies are forced to apply to the UK family courts for a parental order to become the legal parents of their child and, in some cases, also need to apply for British citizenship for the child." 

Are vouchers appropriate for hard-to-match patient-donor kidney exchange pairs?

 A recent letter from Mayo Clinic transplant providers raises concerns related to bad outcomes when some patient-donor pairs are separated (the donor donates before the intended recipient is matched to a donor), but the intended recipient is hard to match.

Donor Mentoring in Private Kidney Paired Donation Programs: The Need for Transparency and Accountability by Tayyab S. Diwan, Pooja Bhudiraja, Shennen Mao, and Carrie Schinstock, Transplantation 110(7):p e1555-e1556, July 2026. | DOI: 10.1097/TP.0000000000005764 

"it is important to recognize that some KPD organizations, such as the National Kidney Registry, operate as private organizations (POs) with distinct governance structures, priorities, and commercial interests. These objectives may not always fully align with those of transplant centers or the broader transplant community, potentially creating gaps in transparency and accountability within a process that directly affects donors and recipients.

"We recently encountered a concerning example that illustrates the ethical tensions inherent when donor mentors are employed by private KPD organizations. ... During a routine text message check-in, the mentor initiated a discussion promoting voucher donation, emphasizing that voucher donors receive priority within the system.  

...
"The donor described the interaction as uncomfortable and “pushy,” and subsequently contacted our transplant center for guidance. Notably, the communication focused on system-level benefits and prioritization metrics but did not explore critical clinical and ethical considerations specific to this donor-recipient pair.

"The discussion was insufficiently individualized and appeared framed toward a preferred outcome. The donor’s preferences and the potential downsides of voucher donation were not explored. The mentor did not ask how the donor would feel if they proceeded with voucher donation and their intended recipient never received a transplant. The discussion lacked any reference to recipient factors that could influence the advisability of voucher donation, including sensitization or recipient comorbid conditions. There was also no discussion about why KPD was being used. Often the donor can donate directly to a recipient (eg, compatible pair), but may decide to enter a KPD pool temporarily to see whether the recipient could receive a transplant with improved size or HLA matching. Finally, the average wait times for a recipient to receive a transplant after voucher donation were not mentioned.

"This interaction raises concern about whether the mentor’s guidance was fully centered on the donor-recipient pair or instead influenced, even indirectly, by organizational incentives to increase voucher participation. When donor mentors are employed by entities that operationally benefit from particular forms of donation, even well-intentioned communication can create perceived or actual conflicts of interest. Transparency regarding these structural incentives, along with a clear commitment to individualized donor-centered mentoring, is essential to maintaining ethical integrity in these situations.

...

"As stewards of living donor trust, the transplant community must ensure that innovation proceeds with appropriate oversight. Any perception that donor education or support is influenced by business interests risks eroding public confidence in living donation programs, with potentially far-reaching consequences that could discourage future donors." 

#########

 Here's an article on NKR from the NYT that discusses its particular voucher program (and also its finances):

How One Father Created an Organ Empire: The National Kidney Registry has matched thousands of kidney donors with recipients. It has also paid millions of dollars to a company owned by its founder.
By Danielle IvoryGrace Ashford and Robert Gebeloff
Dec. 27, 2025 

 "One of N.K.R.’s most innovative policies, many doctors said, is known as voucher donation: Donors can choose to give their kidneys immediately, in exchange for organ vouchers their loved ones redeem later.

"This arrangement has helped N.K.R. expand its pool. But vouchers add risk for donors giving on behalf of hard-to-match patients. They might go through surgery months or even years before their loved ones get a match. Matches are especially unlikely, doctors said, for “very highly sensitized” patients who carry antibodies likely to reject a transplant.

...

" many doctors said that given N.K.R.’s relatively small size, these rare patients would be better served waiting for a match before their loved ones donate.

"“We definitely recommend that they not go with a voucher,” said Dr. Miklos Molnar, the medical director of the kidney transplantation program at the University of Utah, which works with N.K.R.

"Dozens of highly sensitized patients who are also on kidney dialysis have waited a year or more after their loved ones donated, according to N.K.R. quarterly reports since 2022. At least three waited more than four years, and one for seven years.

"Doctors told The Times that they knew of some patients who became too sick or died before they redeemed their vouchers."

######## 

Here's a a discussion of the earliest exploration of unpaired donation that I know of:

Sunday, September 13, 2020

A proposal for non-simultaneous kidney exchange in pairs and chains and with deceased donors...

  

Exam schools, gifted programs, and "giftedness"

 Are some children more gifted than others, and can they be identified in ways that aren't irreparably confounded with socioeconomic status? Those questions are part of what lies behind long-standing controversies about public schools that require entrance exams (typically high schools), and interventions for gifted children at earlier ages.   

Below are two recent stories that tackle those questions from different parts of the life cycle, i.e. from exam-school admissions to adult achievements. 

Here's a NYT story about admissions:

An Elite N.Y.C. Public School Admitted 777 Students. Only 3 Were Black.  New York’s specialized high schools give disproportionately few seats to Black and Hispanic students, continuing a pattern that has drawn criticism. By Matthew Haag  July 14, 2026

"About 62 percent of the students in the city’s public schools are Black or Hispanic. But at its eight most prestigious high schools, about 10 percent of the students in the incoming freshman class are expected to be Black or Hispanic, roughly the same as last year. About 80 percent of the seats went to Asian and white students.

"At Stuyvesant High School in Manhattan, often considered the most selective of the city’s specialized high schools, three of the 777 offers were made to Black students, and 21 were for Hispanic students, together representing a nearly one-third decline from the previous freshman class. One Black student was admitted to Staten Island Technical High School.

"While only 5 percent of high school students attend a specialized school, the annual release of the admission results has stirred debate and scrutiny for decades, especially as the profile of students in those schools stands in stark contrast to the rest of the school system, the nation’s largest. Gaining entrance to the schools has been perceived as a path out of poverty and a gateway to the nation’s top colleges and, perhaps, a flourishing career.

...

"Critics have called the one-day, high-stakes test racially discriminatory, saying it does not capture a student’s intelligence or capabilities. Supporters say it is a fair, rigorous and meritocratic assessment."
...

"“It’s not how we do admissions for colleges, for law school, for business school, for medical school,” Mr. Restler said. “How on earth do we do it for these specialized high schools?”

"Yiatin Chu, a public school parent and the co-founder of Parent Leaders for Accelerated Curriculum and Education, a group that has supported gifted and talented programs, said that the entrance exam was a “race-blind, income-blind test."

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And here's an article from New Scientist on adult achievement:

We’re finally learning what happens to gifted children in adulthood
A spate of new studies is revealing the lifelong impact of being marked as exceptional during childhood – and the results suggest we may need to revise how we view giftedness
By David Robson, 15 July 2026

 " a spate of studies is providing answers and revealing the fascinating lifelong impacts of being marked as exceptional at a young age.

"Far from growing into troubled adults, many gifted individuals appear to flourish later in life. Long-term studies suggest they are more likely than average to achieve professional success and, contrary to popular stereotypes, often enjoy better mental health. Scientists are also starting to understand what makes gifted brains so exceptional, finding that they are better integrated and can process information more efficiently, which raises the question of whether we should view giftedness as another form of neurodiversity. While that is still an open debate, what is becoming increasingly clear is that many of our assumptions about extraordinary minds – and the lives of those who possess them – may need revising.

...

“Despite their exceptional talent, identifying gifted children is challenging, especially when accounting for differences in socioeconomic backgrounds. Even though genetics play a large role in intellectual development, family circumstances heavily influence performance on traditional intelligence tests, particularly in early childhood. Children growing up in working-class families tend to develop a smaller vocabulary in their first years, for instance, which may increase the likelihood that teachers or psychologists ignore their learning potential.”  

Declaring death is sometimes difficult (not just in connection with organ donation)

 I've written about the determination of death prior to deceased-donor organ donation, but it turns out that there are other hard cases. Submersion in icy water is one, hence the rule  "they aren't dead till they're warm and dead."

 Medpage Today has the story:

Declaring Death Is Not So Simple
by Judy Melinek, MD 

" Hypothermia -- especially in children rescued from drowning -- can deliver us patients in a state of suspended animation, all their metabolic systems so slowed by cold that advanced cardiovascular life support and emergency medicine training teaches that "they aren't dead till they're warm and dead." Get that patient warmed to normal human body temperature, then check again for signs of life."

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Earlier: 

Monday, July 6, 2026  When is someone dead? (dead enough to donate organs?)

 

MAID in France

 After a multi-year legislative struggle, France's  Assemblée Nationale legalized medical aid in dying for some patients.

Le Monde has the story:

What's in France's assisted-dying law?
The law adopted on Wednesday establishes the right to assisted suicide or euthanasia for patients experiencing constant suffering from serious and incurable illnesses, under strictly regulated conditions.
By Béatrice Jérôme 

"With this bill, we are facing death head-on," declared French President Emmanuel Macron on March 10, 2024. More than two years later, the Assemblée Nationale cast a definitive vote on Wednesday, July 15, on the bill establishing a right to assisted dying. With the adoption of the law, France joins 11 other countries where people with severe illnesses can obtain a lethal substance on medical prescription, based on criteria varying from one legal system to another.

"The "French end-of-life model," a phrase Macron used in 2023, originated from the president's own initiative. However, its design resulted solely from the work of MPs after four rounds of readings, the Sénat having rejected the bill three times. Supporters have praised the bill as "balanced" and "secure," offering safeguards to ensure that recourse to assisted dying remains "an exception." Its critics, however, argue that the "safeguards" provided are not sufficient for preventing "abuse."

##########

 The Catholic Courier summarizes some of the opposition to the bill:

France’s bishops criticize vote legalizing ‘assisted dying’
Caroline De Sury/OSV News | 07.16.2026

"PARIS (OSV News) — France’s bishops are strongly criticizing a “radical choice” made by French lawmakers to legalize “assisted dying.”

"A watershed vote by the National Assembly July 15 legalized assisted dying, including euthanasia and assisted suicide in certain cases.

"Cardinal Jean-Marc Aveline of Marseille and president of the bishops’ conference, lamented that “members of parliament have enshrined in French law the possibility of causing death.” 

...

"For the bishops, one of the greatest dangers of the law stems from the fact that the principle that death can constitute a medical response to suffering has now become part of the legal heritage of the country. The choice to die can then be asserted as a right that could be extended to others.

“Experience in other countries shows that the criteria for access to assisted dying always tend to broaden, to the detriment of palliative care,” they noted.

"Meanwhile, “the effects of such legislation are not yet fully measured, but they are already taking shape,” the bishops warned. “Our relationship to vulnerability, old age, disability, and illness will change,” they added.

“The poorest are likely to be the first to pay the price: not wanting to be a burden on their children or grandchildren, elderly people in precarious situations may feel pressured to die,” the prelates warned.

"Catholic care facilities could face legal action for refusing euthanasia, assisted suicide on their premises
For the bishops today, the most immediate and concrete concern is that, if the law goes into effect, care facilities — foremost among them Catholic institutions — could face legal action if they refuse to allow euthanasia or assisted suicide to take place on their premises. As it stands, the law will require the head of the facility or department to authorize outside practitioners to perform the lethal procedure.

"The bishops have therefore announced that they will “closely monitor the referrals to the Constitutional Council” that were announced prior to the vote. 

...

"On July 14, while France was celebrating Bastille Day — the country’s biggest national holiday — Prime Minister Sébastien Lecornu surprised many by announcing that he would appeal to the Constitutional Council to submit the text of this law — to which he is personally opposed — for review. He justified this final recourse by citing the lack of agreement between the two chambers, the National Assembly and the Senate. A few days earlier, Senate President Gérard Larcher had announced his intention to take the same step.

"The Constitutional Council may approve the entire bill, strike down certain provisions, or issue interpretive reservations before the law is promulgated by Macron. The referral requested by the prime minister will focus in particular on the absence of a conscience clause allowing healthcare facilities — such as the Catholic nursing homes run by the Little Sisters of the Poor — to be legally authorized to refuse to provide such “assisted dying” services on their premises.

"Pending the outcome of the appeal, the bishops of France have reiterated their call to Catholics in France to “bear witness that another path is possible — one of faithful presence and attentive care that alleviates physical or psychological suffering, without ever abandoning anyone.”