Deceased-donor-initiated kidney-exchange chains are performing well in Italy

 Here's a new report from Italy on initiating kidney exchange chains with a deceased donor.*  In Italy to date, 34 deceased donor initiated chains generated 84 transplants (34 from deceased donors  and 50 from living donors), including 56 among incompatible pairs and 28 to candidates on the waitlist.

Furian L., Di Bella C., Maggiore U., Fiaschetti P., Partelli S., Feltrin G. Integrating Deceased and Living Donation: Long-Term Outcomes of the Italian Deceased-Donor-Initiated Kidney Exchange (DEC-K) Program AJT_ 26/7S1, Volume 26, Issue 7, S1. The cover date will be July 2026. 

"Integrating deceased and living donation through deceased-donor (DD)-initiated chains can expand kidney transplant access in small paired exchange pools. The Italian DEC-K program allocates a DD kidney to initiate a chain (chain-initiating kidney, CIK) among incompatible living-donor (LD) pairs, ultimately returning a LD kidney to the national waiting list (WL). We report the first long-term national results of this donor organ allocation model.
 

"Methods: All DEC-K chains performed in Italy (2018-2025) were retrospectively analyzed. Recipients were stratified by kidney source (CIK vs LD).

...
"Results: Thirty-four DEC-K chains generated 84 transplants (34 DD and 50 LD), including 56 among incompatible pairs and 28 to candidates on the WL. Donor withdrawal occurred once. Four chains were terminated early after CIK transplantation due to newly developed contraindications to donation. At a median follow-up of 60 months, 1- and 3-year graft survival was 100% in both groups, while patient survival was 97.1% for CIK and 98.0% for LD. Three CIK and one LD recipients died with functioning graft (suicide, sepsis, urothelial carcinoma, and acute myocardial infarction, respectively). One CIK recipient experienced graft loss after 40 months due to chronic rejection. Adjusted eGFR trajectories were comparable between CIK and LD (P = 0.48). Chain-ending kidney recipients, with 4 graft loss overall (1 antibody-mediated rejection and 3 vascular thrombosis), showed outcomes comparable to LD (P = 0.64 for eGFR; P = 0.57 for graft survival).
 

"Conclusions: The DEC-K program proved feasible, safe, and effective in expanding transplant opportunities for incompatible and hard-to-match patients."

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* Some earlier posts on deceased donor initiated chains:

Sunday, April 3, 2022

Kidney Paired Donation Chains Initiated by Deceased Donors

Monday, November 22, 2021

A naturally occurring deceased-donor-initiated kidney exchange chain, by Maghen and Veale

Sunday, August 23, 2020

More on Deceased donors as non‐directed donors in kidney exchange chains

Tuesday, August 7, 2018

Deceased donor chains: Market design language is entering transplantation

Monday, April 11, 2016

Using deceased donor kidneys to start living donor kidney exchange chains

 

Conversations about computing, a podcast by a16Z

  Here's the announcement of a forthcoming series of podcast interviews that looks interesting.:

Announcing First Principles: Rare conversations with the pioneers behind key computing technologies
a16z crypto editorial 

 Here's the trailer:

Financial Times quick review of four new econ books

 The FT has brief reviews of four new economics books:  Moral Economics, The Common Good Economy: A New Compass,  We Need to Tax Billionaires, and Money: The Inside Story

The price of good intentions  Four new books that examine the morals, markets and money behind modern capitalism. by Tej Parikh

Here are the remarks about the one of the four that I'm most familiar with:

      "At a time when public outrage can shape policy decisions faster than ever before, Nobel Prize-winning economist and Stanford professor Alvin Roth makes a compelling case for evidence over instinct in Moral Economics: What Controversial Transactions Reveal About How Markets Work (Basic Books £25/Basic Venture $35). Roth, whose pioneering work in market design transformed systems for kidney donation, examines some of the most contentious exchanges in modern society, including prostitution, organ sales, drugs and medical aid for the dying.

"In the process, Roth delivers some eye-opening hard-truths to those who might think moral intuition ought to underpin all regulation and law. He shows why most policy decisions involve unavoidable moral trade-offs, and how bans of activities deemed objectionable can result in transactions being pushed underground (where they become harder to regulate). He also makes the case for treating markets in distasteful services as moral tools, not failures.

“My goal is not to tell you what to think, but to help you think,” Roth writes in the introduction. He largely succeeds. This is an entertaining and mind-opening read from start to finish. Some may find the discussions about morally “repugnant” topics somewhat offensive — but that’s the point."
 

 

A rogue's gallery of transplant heroes (following ATC2026)

 After my talk yesterday at the American Transplant Congress, I had lunch with a table of transplant heroes, Joe Tector, Peter Friend, Juliana Bastos, Mike Rees and Gustavo Ferreira.

 

 

 

 

 

 

Medical aid in dying (and Moral Economics) on Freakonomics Radio

 The latest episode of Freakonomics looks at the controversies and philosophies involved in the growing legalization of medical aid in dying (MAID).  Stephen Dubner interviews people with multiple perspectives, and offers a personal insight of his own.

"DUBNER: I have a sister who died last year, it was a pretty rotten death, honestly, and she wanted to hasten it. We couldn’t physically orchestrate it. And it really made me see this issue in a new way. It just seemed, you know, I don’t want to say the scales fell from my eyes, but I’d never encountered it first-hand. And it made me think that almost anyone who did encounter it first-hand might have a reckoning, might be in favor of it. But I don’t know, maybe that’s just me. Do you have any sense of how broad the support is for it generally?

ROTH: We’re an aging population, so I think not only do more people have a reason to contemplate their own death, but more people know a peer who’s died, and certainly parents have died, and relatives, you know, siblings and friends. So I would think that anyone who’s seen an agonizing death should at least give some thought to whether we should be legalizing medical aid in dying." 

You can listen or read the transcript at this link:

Who Gets to Choose a “Good Death”?
New York is the latest state to legalize medical aid in dying. Stephen Dubner speaks with the governor who signed the law, a Nobel Prize-winning economist, a death doula — and an ethicist who thinks the very idea is wrong.

 "SOURCES:
Kathy Hochul, governor of New York.
Suzanne O'Brien, death doula, founder of Doulagivers Institute.
Al Roth, economist at Stanford University.
Daniel Sulmasy, physician, philosopher, director of the Kennedy Institute of Ethics at Georgetown University.

RESOURCES:
Moral Economics: From Prostitution to Organ Sales, What Controversial Transactions Reveal About How Markets Work, by Al Roth (2026).
"New York Moves to Allow Terminally Ill People to Die on Their Own Terms," by Grace Ashford (New York Times, 2025).
The Good Death: A Guide for Supporting Your Loved One through the End of Life, by Suzanne O'Brien (2025).
The Future of Assisted Suicide and Euthanasia, by Neil Gorsuch (2009).
EXTRAS:
"Make Me a Match (Update)," by Freakonomics Radio (2023).
 

 

Starzl Lecture: "The Economics of Kidney Exchange," Sunday at the American Transplant Congress in Boston

 I'll be speaking Sunday at the American Transplant Congress, on kidney exchange.  It will be hard to squeeze in all the recent developments in my half hour, including current controversies.

State-of-the-Art Speakers:  Transplantation’s leading luminaries and innovative thinkers will share inspiring research and insights at ATC 2026.  
 
Alvin E. Roth, PhD: 
Thomas E. Starzl State-of-the-Art Lecture: The Economics of Kidney Exchange

Sunday, June 21: 11:00 AM ET 

 

 

 

When people rely on A.I. to avoid ethical challenges

 HBS puts the spotlight on a paper by Alex Chan.

When AI Gives Advice, Employees Rarely Ask Why   Featuring Alex Chan. By Ben Rand

"People increasingly trust AI to make decisions—but research by Alex Chan finds they avoid evaluating the algorithm's rationale if it causes moral discomfort. How can organizations encourage employees to think more critically? "

 

Here's the paper:

Preference for Explanations: Case of Explainable AI
By: Alex Chan   Harvard Business School Working Paper, No. 26-028, November 2025.


Abstract
Participants acted as loan officers deciding whether to approve real $10,000-loans issued by a private U.S. lender using an AI’s default-risk predictions. When explanations revealed that the AI penalized non-White or female borrowers, participants were more likely to override the AI’s profit-maximizing recommendation. When their bonuses depended on repayment, however, they sought predictions but avoided explanations, consistent with willful ignorance; this effect disappeared when explanations were framed as purely financial or demographics were hidden. A secondary experiment reveals a novel bias: participants failed to reason contingently and undervalued explanations even when these complemented private information and improved decision accuracy.