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.

######

*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."

Multi-hospital kidney exchange in Brazil

An article in Floha de S. Paulo, tells of the first inter-hospital kidney exchange in Brazil:

 Transplante renal pareado amplia opção para pacientes que têm doador, mas não podem receber o rim  by Claudia Collucci

English translation:
Paired kidney transplant expands options for patients who have a donor but can't receive the kidney

https://www1.folha.uol.com.br/equilibrioesaude/2026/06/transplante-renal-pareado-amplia-opcao-para-pacientes-que-tem-doador-mas-nao-podem-receber-o-rim.shtml

Article summary: 

For the first time in Brazil, two transplant centers in different cities carried out a paired kidney donation — swapping incompatible living donors so each recipient gets a compatible kidney from someone else's donor instead. The initiative was led by Hospital das Clínicas at USP's medical school (HCFMUSP) in São Paulo and Santa Casa de Juiz de Fora in Minas Gerais.

The surgeries happened simultaneously at both hospitals — a donor from São Paulo traveled to Juiz de Fora to donate to the Minas Gerais recipient, while the donor from Minas Gerais went to Hospital das Clínicas in São Paulo to donate to the São Paulo patient. 

the two hospitals use an internationally developed (U.S.-built) platform that cross-references immunological traits, body size, and donor kidney quality to identify the best-matching combinations — this is functionally the same kind of algorithm we've been discussing with NKR.

Brazil has no specific regulation for paired kidney donation under its National Transplant System, so the procedure currently proceeds only as research. 

 

HT: Dr. Gustavo Ferreira 

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Earlier:

Thursday, January 22, 2026

Kidney exchange in Brazil (a clinical trial)

Here's a video in which Mike Rees, the founder of the Alliance for Paired Kidney Donation (APKD) describes how (with the help of a grant from Stanford Impact Labs) the APKD is helping Brazilian transplant docs get kidney exchange going there. 

 Earlier:

Tuesday, February 27, 2024  Stanford Impact Labs announces support for kidney exchange in Brazil, India, and the U.S.

 Thursday, October 10, 2024  Kidney exchange in Brazil, continued (with pictures)

 

Program for the Workshop on Game Theory and Economic Applications, São Paulo, July 26-August 2

 Here's a high level overview of the program, which begins today.

And here's the detailed day by day program. 

 I'm expecting to speak on Wednesday, which looks to be a busy day:

 

 

4th International Workshop on Game Theory and Economic Applications, São Paulo, July 26-August 2

 My old friend, colleague and coauthor Marilda Sotomayor is presiding over a big game theory conference in São Paulo this coming week.

 Here are the first paragraphs of the announcement from the University of São Paulo:

USP brings together six Nobel laureates in Economics in an event on Game Theory

 The Faculty of Economics, Administration, Accounting and Actuarial Sciences of the University of São Paulo (FEAUSP) will host, between July 26 and August 2, 2026, the 4th International Workshop on Game Theory and Economic Applications (IWGTEA). The event, consolidated as one of the most important in the area, is organized by the renowned professor emeritus of FEAUSP, Marilda Sotomayor, a world authority in Theory of Matching Markets.

The workshop will bring together six Nobel laureates in Economics. In person, FEAUSP will receive Paul Milgrom (Nobel 2020), Roger Myerson (Nobel 2007) and Alvin Roth (Nobel 2012). Laureates Robert Aumann (Nobel 2005), Robert Wilson (Nobel 2020) and Eric Maskin (Nobel 2007) will participate online. It will be a rare opportunity to translate how seemingly abstract mathematical ideas influence markets, governments, and everyday decisions.

In addition to the Nobel laureates, the body of keynote speakers includes important names such as Gabrielle Demange (Paris School of Economics), Ehud Kalai (Northwestern University), Hervé Moulin (University of Glasgow) and the Brazilian Aloísio Araújo (IMPA/FGV). There will also be a plenary session with Professor Marilda Sotomayor, who shared with Alvin Roth, in 1990, the authorship of the book "Two-Sided Matching: A study in game-theoretic modeling and analysis".


 

Nobel Prize in Economics Alvin Roth and professor Marilda Sotomayor (FEAUSP)
Photo: personal archive
 

Unlike traditional congresses, the IWGTEA is structured as a "workshop and school", focusing on the training of new researchers. "The idea is aimed at the interaction of students with the most renowned researchers in game theory", explains Professor Marilda Sotomayor. According to her, the main objective is to provide students with direct contact with the minds that shaped the modern economy. The expectation is that the workshop will attract 250 participants with more than 100 students from different parts of the world. 

... 

 Conference location: Av. Prof. Luciano Gualberto, 908 - Butantã, São Paulo - SP, 05508-010 

Schedule: https://www.iwgtea.fea.usp.br/