Kidney exchange in Mississippi (endorsed by celebrities)

 Mississippi Today has the story:

‘Kidney chains’ could save lives and billions of healthcare dollars, advocates say.  by Pat Boone, Robert Hays and Steve Young 

"Editor’s note: Entertainer Pat Boone, Pro Football Hall of Fame quarterback Steve Young and actor Robert Hays of “Airplane” fame signed on as authors of a guest essay provided by US Blood Donors.org for Mississippi Today on “Kidney Chains.”

"This guest essay, though, written from a national perspective is of special importance to MT Ideas since Mississippi is among the states with the highest number of kidney disease-related deaths per 100,000 adjusted for age, according to the National Center for Health Statistics.* 

"Hundreds of thousands of dialysis patients in the United States could receive lifesaving kidney transplants sooner if one simple idea became widely known: “kidney chains”— sequences of living-donor transplants that allow one donor to save multiple lives. 

The goal is simple: Make “kidney chains” a household phrase. 

Kidney chains allow living donors who are incompatible with their intended recipient to help initiate a sequence of transplants that can save multiple lives. The concept builds on Nobel Prize-recognized work** in market design and has already enabled thousands of lifesaving kidney transplants. 

 

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*Figure from the NCHS 

 

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** The video link is to the last three minutes of this 15 minute talk from 2014

Thursday, September 18, 2014  Kidney exchange at Google Zeitgeist 2014: 15 minute video

 

Controversial markets, black markets, and market design (in Brazil)

 Below is a Youtube video of all the talks given at the 4th International Workshop on Game Theory and Economic Applications at the University of São Paulo last Wednesday.

My talk, whose title was "Controversial markets, black markets, and market design"  is introduced at minute 2:24 (and for some of you the link below should start up there). The talk before mine is by Bob Wilson, and the one after by Paul Milgrom, but the video camera was on all the time, so you have to scroll to get to the actual talks.)

 

My talk begins with some general discussion of how market design and engineering economics are related to game theory. Then I introduce kidney exchange as the talk's main example, and discuss some of the accompanying controversies, including those currently being encountered in Brazil.

Congressional Republicans find IVF repugnant (by stealth, in an election year)

 Public rhetoric and parliamentary maneuvering display opposite positions on IVF in an election year.

G.O.P. Kills Bid to Expand I.V.F. Access in the Military
In a notable shift, Republican senators voted unanimously against a proposal to expand the military’s coverage of fertility treatments. By Annie Karni

"Republicans in Congress have quietly blocked a proposal to expand military health coverage of in vitro fertilization treatment for service members and their families, heeding the calls of anti-abortion groups to limit access to a fertility option that President Trump vowed to make more widely available.

"The move is a shift from previous years, when there was enough bipartisan support for the idea of broadening the availability of I.V.F. for members of the military that it was included in the annual defense bill that passed both the House and Senate. Speaker Mike Johnson later stripped it out in final negotiations before the legislation became law, but the provision’s initial inclusion indicated that the vast majority of Republicans had been willing to accept it.

"This year, Republican senators banded together to bar the measure from being added to the defense bill in the first place. It illustrated how, while many G.O.P. members of Congress have said they are in favor of I.V.F. access, they have managed behind the scenes to thwart legislative efforts to ensure it."

The New Bazaar on Moral Economics

 Cardiff Garcia interviewed me about Moral Economics, and we began by talking about medical aid in dying, and moved briskly on to other controversial markets such as pornography and prostitution.

   The New Bazaar
Economist Alvin Roth, winner of the economics Nobel in 2012 for his work on market design, joins Cardiff to discuss his new book, Moral Economics: From Prostitution to Organ Sales: What Controversial Transactions Reveal About How Markets Work.

The book is about morally contested markets: transactions that participants would like to engage in but that others think they shouldn't be allowed to, even when it’s hard to identify measurable harms to those objectors. It's also a great way to understand how markets interact with the law, politics, social norms, income inequality, human psychology, and so much more than just monetary exchange.

In this chat, Alvin and Cardiff discuss:
• Medical aid in dying and the economics of “repugnant” markets
• Sex work, trafficking, and the unintended consequences of criminalization
• Plural marriage and the challenge of designing new legal protections
• Sports gambling and the rise of prediction markets
• Kidney exchanges, the transplantation shortage, and the opposition to cross-border exchanges

Throughout the conversation, they confront the trade-offs involved in both allowing controversial markets and trying to ban them.

Related Links

• Moral Economics: From Prostitution to Organ Sales: What Controversial Transactions Reveal About How Markets Work (https://basic-venture.com/titles/alvi...) 

Healthcare in jails

The first stop (post-arrest, pre-trial) for many people caught up in the US criminal justice system  is a local jail.  Many of the people who are jailed have healthcare issues involving, for example, mental illness and/or drug and alcohol addiction.  But jails don't view themselves as healthcare facilities.

So I'm glad to see that Stanford Impact Labs (SIL) is funding

Improving Medical Care for People Affected by Incarceration (IMPACT) 

"Local jails are a critical but often overlooked part of the American healthcare system, processing approximately 7.3 million admissions annually and housing more than 600,000 individuals on any given day. Despite this scale, healthcare quality in jails remains highly variable, and mortality rates have increased over time, with drug and alcohol-related deaths increasing as much as four times from 2000 to 2019 and suicide rates remaining approximately twice the national average.

"Our research project addresses this challenge by identifying and scaling organizational strategies to improve healthcare quality, coordination, and oversight in local jails. Building on the first randomized controlled trial of healthcare accreditation in U.S. jails, our team partnered with 46 jails nationwide to evaluate accreditation through the National Commission on Correctional Health Care (NCCHC). We found that accreditation improved compliance with healthcare quality standards, particularly in training and patient care, and reduced 12-month mortality by approximately 60 percent. These improvements happened without increases in staffing or capital investments, suggesting that organizational improvements and better coordination drive impact.

"The current phase of the project focuses on understanding how jail leaders, including sheriffs, make decisions about improving healthcare quality in local jails. Through our partnership with the National Sheriffs' Association, we aim to identify the factors that influence the adoption and implementation of healthcare improvement strategies, including voluntary healthcare accreditation and other evidence-based approaches. Through this partnership, we plan to translate evidence into sustainable improvements in correctional healthcare systems nationwide. 

 

Team
Marcella Alsan
Professor, Stanford Economics

Meghan Beal
Director, I.G.N.I.T.E., National Sheriffs' Association

Crystal Yang
Professor, Law, Harvard Law School

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Other posts about SIL supported work.

 

Delayed feedback on a controversial talk--and some positive signals of potential for change

 One feature of giving talks to unfamiliar audiences is that you only get noisy feedback on how your talk was received.  This past June, I gave the Starzl Lecture at the American Transplant Congress in Boston. (The ATC is jointly organized by the two big American transplant societies, the AST and the ASTS,*)  I spoke to an audience of about 1500 people (just a guess, but I could see some empty seats in an auditorium set up for 2,000).  My talk included topics, including global kidney exchange, that have raised controversies.  

Afterwards, what seemed like a lot of people came to speak to me, and were enthusiastic about my talk.  But "a lot of people" was fewer than 100. So what about everyone else? (It probably wouldn't be statistically kosher to assume that those who came to congratulate me were a representative sample:)   

Since global kidney exchange has led to some people calling me an organ trafficker, I didn't have any measure of the general sentiment of the meeting.

I got some reassuring news recently when the ATC sent out an email soliciting ideas for talks for next year's meeting, in Seattle.  The email came with a picture from this oat meeting:

 

 So I'm guessing this means that my talk was well received by people responsible for organizing the next meeting.

And, indeed, I'm getting multiple signals that there's an appetite for productive change in the transplant community.  I hope to have more to say about that in the coming year.

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*Acronyms:

ATC American Transplant Congress 

 AST American Society of Transplantation

ASTS American Society of Transplant Surgeons 

American Red Cross Declares Second-Ever National Blood Supply Crisis

 Voluntary donation of whole blood in the US has provided adequate supply for many years, but since Covid it has sometimes come close to a shortage, and now we have a second declared shortage.  This contrasts with blood plasma, which  includes supply from paid donors.

American Red Cross Declares Second-Ever National Blood Supply Crisis, Urges Immediate Blood Donations 

I think the graphic is meant to show that the US is running near empty on blood (not that the shortage is only in Southern states...) 

 

 "The American Red Cross has declared only the second national blood supply crisis in its history after blood donations fell to a four-year summer low, deepening an emergency shortage that threatens the availability of lifesaving blood for patients across the country.

Despite thousands of people answering the call to give, blood donations are not keeping pace with hospital demand — which is up during the summer trauma season. Extreme heat, poor air quality and widespread foodborne illnesses are contributing to lower donor turnout this summer, further straining the nation’s blood supply.

As the nation's largest single provider of blood products, the Red Cross now has less than a one-day national supply of type O positive blood — the most commonly transfused blood type. To help ensure blood is available for patients facing the most critical, life-threatening emergencies across the country, the Red Cross has begun limiting distributions of type O blood to individual hospitals."