Tuesday, July 17, 2018

Compensation for plasma donors--calls for a ban in Canada

At the same time as there are calls for decriminalizing drug use in Canada (see yesterday's post), there are calls for bans on compensating plasma donors. (Repugnance is a big topic..)

This post collects some thoughts on compensation for plasma donors, following my participation in the recent Plasma Protein Forum.

Much discussed there is the rash of recent legislation and proposed legislation in Canada to ban compensation for donors (a sort of repugnance event...).

E.g.
B.C. joins 3 other provinces in banning payment for blood and plasma
Alberta, Ontario and Quebec already have laws prohibiting profit from blood donations

Senator introducing bill to ban payments for blood donation
"“The point of this bill is better safe than sorry,” Wallin said.

“Canadian blood donors are not meant to be a revenue stream.”


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One perplexing feature of this debate is that Canada already buys lots of plasma from the U.S., where it is supplied by paid donors. No one seems to be suggesting that should be changed.


(Here are my posts to date on plasma in Canada.)
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In related notes, China seems to be ramping up it's "source" plasma collection (obtained at the source via plasmapheresis, as distinct from "recovered" plasma obtained from whole blood donations), with collection of about 7 million liters in 2017.  My understanding is that Chinese law forbids the importation of blood products except for albumin.

See this Lancet editorial from 2017:
"China,  a  country  that  holds  the  questionable  honour  of  being a world leader in liver disease, is now also the highest consumer  of  serum  albumin,  using  300  tonnes  annually,  roughly  half  of  the  worldwide  total  use,  according  to  an  article  in  the  Financial  Times. 
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In Brazil, compensation of plasma donors is forbidden (along with compensation of organ donors) in the Constitution, article 199
"(4) The law establishes the conditions and requirements to allow the removal of human organs, tissues, and substances intended for transplantation, research, and treatment, as well as the collection, processing, and transfusion of blood and its by products, all kinds of sale being forbidden."



Monday, July 16, 2018

New calls for decriminalizing drug use in Canada


Here's the story in the Washington Post:

Toronto medical official calls for decriminalizing drugs as opioid overdoses skyrocket in Canada

"With opioid-related overdoses and deaths reaching record levels in Canada, the top medical official in Toronto is calling for the decriminalization of all drugs as part of a strategy to treat illicit drug use as a public health and social issue, not a criminal one.

"In a report released Monday, Eileen de Villa, Toronto’s chief medical officer, urged the city’s board of health to pressure the federal government to eliminate legal penalties for the possession of drugs and to scale up “prevention, harm reduction and treatment services.”

"The report also recommended assembling a task force “to explore options for the legal regulation of all drugs in Canada,” which she hopes would destroy an illegal drug market contaminated with fentanyl — a synthetic opioid 100 times more potent than morphine — and other drugs like it.

“When we criminalize people who take drugs, we inadvertently contribute to the overdose emergency,” de Villa said. “It pushes people into unsafe drug use practices and creates barriers for people to seek help.”
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Here's the Toronto report:
A Public Health Approach to Drug Policy
Date: June 28, 2018
To: Board of Health
From: Medical Officer of Health

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See also the Global Commission on Drug Policy's 2016 report:
ADVANCING DRUG POLICY REFORM: A NEW APPROACH TO DECRIMINALIZATION

Sunday, July 15, 2018

Kidney exchange is fragmented in the U.S.


Market Failure in Kidney Exchange

Nikhil AgarwalItai AshlagiEduardo AzevedoClayton R. FeatherstoneÖmer Karaduman

NBER Working Paper No. 24775
Issued in June 2018

Abstract: "We show that kidney exchange markets suffer from traditional market failures that can be fixed to increase transplants by 25%-55%. First, we document that the market is fragmented and inefficient: most transplants are arranged by hospitals instead of national platforms. Second, we propose a model to show two sources of inefficiency: hospitals do not internalize their patients’ benefits from exchange, and current mechanisms sub-optimally reward hospitals for submitting patients and donors. Third, we estimate a production function and show that individual hospitals operate below efficient scale. Eliminating this inefficiency requires a combined approach using new mechanisms and solving agency problems."

Here's a key sentence:
"The three largest multi-hospital platforms together only account for a minority share of the kidney exchange market. 62% of kidney exchange transplants are within hospital transplants that are not facilitated by the NKR, APD or UNOS. Moreover, over 100 hospitals performed kidney exchanges outside these three platforms during this period."

Saturday, July 14, 2018

Jason Furman buys books when they're on sale

Here's a recent book review of my (2015) book that caught my eye, posted by Ismail Ali Manik, which begins with this tweet:
 Random Book recommendation — Who Gets What and Why: The New Economics of Matchmaking and Market Design

You might want to read the book yourself, and in any event there is an interesting selection of quotes, and then links to a bunch of videos, at the link above.

Friday, July 13, 2018

One kidney donor's journey

I recently heard the following story, by email from a recent kidney donor, who has given me permission to share it. It's lightly edited to preserve her privacy and mine, but I can't resist noting that her first name is Hope.

"Dear Professor Roth,

"Seven weeks ago today, I donated a kidney to a stranger in Minnesota.  Mayo Clinic sent me his email address this afternoon, just in case I want to contact him.  I'm not sure yet if I want to initiate communication but I certainly can't stop thinking about it.  It made me think about the Freakonomics episode I heard three years ago that started everything.  You know the one...

"When I heard the episode, I knew right away I wanted to become a living kidney donor.  I was 49 at the time. I never had children and my life felt incomplete.  Moreover, I lost my mother to cancer after a long battle, when I was just 14 years old.  I daydreamed about helping a child who had a sick parent so she doesn't have to go through what I went through. 

"My wife's cousin needed a kidney shortly after the episode aired.  I asked her if it was ok if I stepped up.  I played her the Freakonomics episode and she approved.  I reached out to her cousin Rick.  It turns out a few people volunteered and he got a direct match.  I felt defeated, which sounds selfish after such good news.  Then I heard a follow up episode that united a donor with his recipient.  Stephen Dubner was crying... I was crying... I called Mayo Clinic the next morning and signed up for testing.

"The rest is a long story and I know you are a busy man so I'll skip most of it.  I ended up being part of a pair, instead of an altruistic donor.  There was a man who worked with my wife that needed a kidney.  He once saved her life with the Heimlich maneuver so it was pretty poetic that I could save his.  He received his kidney from a bridge donor and I gave mine to someone on the diseased donor list.  So I got to save two lives!  I'm doing great.  I went back to work a couple of weeks ago.  I have no regrets and I hope I can inspire others to do something selfless and extraordinary in their lifetime. 

"I hope others have written to you.  I'm sure you see the statistics and know the impact of what you created with paired kidney donation.  I just wanted to make sure you hear some personal stories.  Life changing stories..."

A subsequent email exchange clarified some details:

"Hi Al!  I did all of my testing in May of 2016 to be a non-directed donor. I tested positive for Valley Fever and had to wait 90 days to be retested. The 2nd test was negative and I was approved but I was getting married in October so we put a hold on the donation. Mark came into the picture after that. He didn’t know about paired donation. We got him to switch to Mayo and we became a pair. He had lots of complications so I had to wait a long time. When he was finally approved, so much time had passed that I had to do most of the testing all over again. It took awhile to find me a match because I’m AB+. 

So a false positive Valley Fever test got Mark a kidney. 

I met Mark the day of his surgery. My wife and I were the first faces he saw. He was there the day of mine. He brought me flowers and a card from his kids. 

My team at Mayo Clinic were there for me the whole time. There was never any pressure and changing from non-directed to paired was seamless. They never discussed Mark. He had his own team. I was allowed to chicken out at any time. But I’ve never been so sure of anything in my life."
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And here are my posts linking to the Freakonomics shows that gave people so much of Hope.

Thursday, June 18, 2015

and this one (from huffingtonpost.com):

Saturday, May 6, 2017

Thursday, July 12, 2018

A television interview on kidney exchange in Mexico (video)

Here's a short video that ran on Mexican tv, with a one minute introduction in Spanish, and then 11 minutes in English with Spanish subtitles. Curiously, the recording ends abruptly just as I started to talk about the 1974 paper of Shapley and Scarf...:)





Here is an earlier post about my recent visit to Mexico:

Tuesday, May 22, 2018


Forbes Health Forum in Mexico City, May 23

Thursday, May 31, 2018

Kidney exchange takes another step forward in Mexico: Pro-Renal

Wednesday, July 11, 2018

The June issue of the newsletter of the ACM E-commerce group is devoted to market design. You can read them at the links below:

June, 2018



HT: Scott Kominers