Monday, May 31, 2010

Money and medicine in Britain's National Health Service

The London Times reports NHS bars woman after she saw private doctor

"A WOMAN has been denied an operation on the NHS after paying for a private consultation to deal with her severe back pain.
Jenny Whitehead, a breast cancer survivor, paid £250 for an appointment with the orthopaedic surgeon after being told she would have to wait five months to see him on the NHS. He told her he would add her to his NHS waiting list for surgery.
She was barred from the list, however, and sent back to her GP. She must now find at least £10,000 for private surgery, or wait until the autumn for the NHS operation to remove a cyst on her spine. "

The managing of waiting lists for scarce resources is a tough business.

Sunday, May 30, 2010

Kidney exchange at VA hospitals

It's exciting to see kidney exchange growing. The issues that the Veterans Affairs hospitals face reflect the progress in the last few years at other kinds of hospitals and kidney exchange networks.

Paired kidney exchange attracts VA: Growing practice may be allowed at four hospitals that do transplants

"Sometime in the next month, more than 600 veterans waiting for kidney transplants at VA hospital transplant centers in Pittsburgh and three other locations across the country could have a new option for finding an organ match.
William Gunnar, national director of surgery for the Veterans Health Administration, said he is reviewing the idea of letting the four VA hospitals that do kidney transplants -- in Pittsburgh, Nashville, Iowa City and Portland -- join the still novel but growing practice known as paired kidney exchange."
"Kidney transplant administrators at all four VA hospitals said they would like to take part in paired kidney exchanges after discussing it for four years, and are hoping for a favorable review from the central office.
"It's a no-brainer," said Mohan Ramkumar, kidney transplant program medical director at VA Pittsburgh Healthcare, which has 194 people on its waiting list and does about 40 transplants annually. "The more transplants you can do, the more money you save from dialysis, and the more people you help."
"I don't know if it will do a tremendous amount to cut down on our waiting list, but it could help. It would be one more option," said Dr. Ramkumar.
Last year, of the roughly 17,000 kidney transplants done nationally, 304 of them were the result of paired exchanges. But that's up from just 74 in 2006, according to The United Network for Organ Sharing, an organization that oversees the nation's organ and transplant network. Experts expect those figures to continue to grow rapidly as the concept takes hold."
"The VA used to have 20 hospitals that did kidney transplants. But when Medicare in 1973 started paying for all kidney transplants, veterans chose private hospitals for transplants, and the VA closed its programs.
When Medicare started charging co-pays for its services in the 1990s, veterans asked the VA to do kidney transplants. In 2001, the VA chose three hospitals to restart their programs, with Pittsburgh joining them a year later."
"Though most of the nation's kidney transplant centers already are members of at least one of the various paired kidney exchange consortium -- which orchestrate exchanges between different hospitals -- the VA has moved more cautiously.
"There have been some accusations over the years that this ethically and legally borders on potentially selling organs," said Dr. Gunnar.
A 2007 federal law specifically said that paired kidney exchanges was not selling organs, which would be a violation of the National Organ Transplant Act, but Dr. Gunnar said a legal opinion was still needed to move forward.
Ethically, a big issue for paired kidney exchanges is dealing with altruistic donors not tied to a specific transplant recipient, said Judy Kazmar, kidney transplant coordinator for the Portland VA hospital, which has 152 people on its waiting list and does about 30 transplants a year there.
"We're pretty conservative here. And with donors, we need to know, what's their motive for donating?" Ms. Kazmar said. "I think paired donations is a good idea, but it has a lot of logistics to it to work out."
If the VA does decide to go ahead with paired exchanges, one idea would be to start with its own pilot program of sorts.
"I think a consortium among ourselves would be best to start with, and then look at joining a larger consortium or national program," said Anthony Langone, kidney transplant medical director for the Nashville VA hospital, which has about 200 people on its waiting list and does about 30 kidney transplants a year.
The VA also is debating how to pay the thousands of dollars to pre-screen potential donors -- some of whom might not donate -- and how to assign long-term, post-surgical care to donors who aren't veterans, said Dr. Thomas.
"We as a nation have done badly dealing with long-term care for living donors," he said. "We want to make sure we get it right." "

Saturday, May 29, 2010

Veil travails

French cabinet approves veil ban
" The French cabinet has approved a draft law to ban the wearing of full-face veils in public spaces, opening the way for the text to go before parliament in July.The bill calls for $185 fines and, in some cases, citizenship classes for women do not comply with the ban.
Addressing the cabinet meeting on Wednesday, Nicolas Sarkozy, the French president, said: "Citizenship should be experienced with an uncovered face. There can be no other solution but a ban in all public places."...
"The bill includes a new offence - inciting to hide the face - with anyone convicted of forcing a woman to wear such a veil risking a year in prison and a $18,555 fine."
"The bill is set to go before parliament in July and is widely expected to become law."

Friday, May 28, 2010

Design of financial clearinghouses: Over the counter derivatives markets

The Bank for International Settlements' Committee on Payment and Settlement Systems has, in a followup to the recent financial crisis, issued two reports.

The first concerns clearinghouses-- Central Counterparties (CCPs). Here is the summary, and the report. From the summary:

"Over the past several years, public and private sector entities have undertaken a coordinated effort to improve the post-trade infrastructure for OTC derivatives transactions. The recent financial crisis demonstrated the need to further enhance the safety and transparency in the OTC derivatives markets. As a result, authorities in many jurisdictions have set out several important policy initiatives encouraging greater use of CCPs for OTC derivatives markets. The CPSS and the Technical Committee of IOSCO support these positive developments.
A well designed CCP can reduce the risks and uncertainties faced by market participants and contribute to the goal of financial stability. Nevertheless, because of the complex risk characteristics and market design of OTC derivatives products, clearing them safely and efficiently through a CCP presents unique challenges that clearing listed or cash-market products may not. "

Some of the challenges seem to be in making the products well defined...

These apply also to Trade Repositories, which are meant to be simple registers of what positions are held. Again, here's the summary and the report.

Promoting young faculty at Harvard

The Chronicle reports At Harvard, Tenure Isn't Just for Old People Anymore (and the issue, they surmise, is two career households).

"For decades, assistant professors at Harvard University knew better than to get too comfortable. After all, they probably wouldn't be staying there very long.
Unlike the typical university, Harvard didn't have a tenure track. Instead, most young scholars spent several years capitalizing on the university's famous name and resources, then moved on to a tenured job somewhere else. Meanwhile, Harvard usually reserved tenure for senior stars with established reputations whom it lured away from other universities.
In the last several years, however, Harvard has changed. Of the 41 people to whom the university offered tenure last year, half started as junior scholars there. The university had been finding it harder to persuade senior faculty members to pick up their families and move, even to storied Cambridge, so it has developed a tenure track and begun grooming those coming up through the ranks."...

"Plucking senior scholars from other campuses worked well for Harvard when the desired scholars had spouses or other partners who didn't work. "It used to be that if you were Harvard, you crooked your finger and people came," says Susan Carey, who heads the university's psychology department.
But over the last couple of decades, as dual-career couples became the norm, Harvard's offers were less compelling. Many senior scholars were unwilling to move if it meant spouses had to give up their jobs.
"The old days when the guy came home and said, 'Honey, we're moving to Cambridge, pack up,' just don't exist anymore," says Lizabeth Cohen, chairwoman of the history department. "We were investing huge amounts of time in senior searches and not getting the yield to make it worth it." "

Thursday, May 27, 2010

Spousal Hiring

In The Intricacies of Spousal Hiring, David Bell, a former Johns Hopkins dean writes

"My experience in the dean's office confirmed my impressions as to the need for spousal hiring. Johns Hopkins simply could not have built its faculty without a willingness to create positions for spouses and partners.
In case after case, that willingness was, by far, the single most important factor in recruitment. We could increase a salary offer by tens of thousands of dollars a year; provide lavish research accounts; promise a scandalous number of sabbatical leaves—none of it mattered if it meant that a candidate still faced the prospect of a long-distance commute or a major professional sacrifice by a spouse."

Wednesday, May 26, 2010

Paul Milgrom on spectrum auctions in India and Germany

Paul Milgrom writes on Success in Spectrum Auctions in India and Germany, in which he played an active role consulting to bidders.

Organ sales in China

MSNBC reports Organ trafficking trial exposes grisly trade: Chinese man accused of selling black market body parts
"China in 2007 banned organ transplants from living donors, except spouses, blood relatives and step or adopted family members, but only launched a national system to coordinate donation after death last year.
Its efficiency has yet to be proved. Nearly 1.5 million people in China need organ transplants each year, but only 10,000 can get one, according to the Health Ministry.
The defendants in the two Beijing trials face up to five years for their role as go-betweens between donors and buyers, which could "damage society and moral values", the Procuratorial Daily reported. They are still waiting for their verdict.
But at least two of them say they are being unfairly hounded for playing a vital role in helping both the sick and poor.
"I believe I was helping people, not harming others," the paper quoted defendant Liu Qiangsheng as saying.
Liu says he got into the business after selling half his own liver in 2008 to help pay for this father's medical bill. A friend of the recipient, who was waiting in despair for a liver, asked him to find another organ provider.
"I saved the life of the person who received my liver. He was only in his 30s. I do not regret it," he said.
His partner, Yang Shihai, had also sold one of his own kidneys, the paper reported.
"The donors were free. They were not controlled by us. They sold their organs voluntarily," it quoted Yang saying.
Middlemen specialized in faking documents allowing donations between strangers have helped raise transplants from living donors to 40 percent of donations, from 15 percent in 2006, the official China Daily reported last year.
However the majority of organs for transplant are still harvested from executed criminals, the paper said. Beijing hopes the new system will end both live transplants and taking organs from prisoners, which makes senior officials uncomfortable.
"(Executed prisoners) are definitely not a proper source for organ transplants," Vice Minister Huang Jiefu told China Daily."

An incongruous note: In the middle of the story was an ad saying "Buy 1 Get 1 Free." (It turned out to be an ad for eyeglasses...)

Tuesday, May 25, 2010

Kidney exchange at Northwestern

Tomorrow (Wednesday) afternoon I'll be giving the Nancy L. Schwartz Memorial Lecture at Northwestern, and I'll talk a lot about kidney exchange.

So it's a good time to mention a big exchange chain that was completed last month entirely at Northwestern Memorial Hospital, which has one of the biggest living donor transplant programs in the country: Sixteen Patients, Eight Kidney Transplants, Three Days... One Life Changing Event .

This was an innovative non-simultaneous altruistic donor chain, conducted over three days (with 3 transplants done the first day, 3 the second, and 2 the third.)

Here's a page containing (scroll down) a May 19 video interview with the non-directed donor, and two of the transplant docs, John Friedewald and Joseph Leventhal.

Some of my earlier posts on the revolution caused by non-simultaneous chains are below:

(John Friedewald, the Northwestern transplant nephrologist interviewed about the story at the top of this post, is the chair of the UNOS Kidney Paired Donation Work Group charged with organizing a pilot national program...)

Monday, May 24, 2010

Predicting behavior in games: a competition

Sometimes an experimental design is meant in part to solve a market design problem. That's the case with the call for entries reproduced below. You are invited: Enter and win:)

The market design issue is twofold. Scientific publishing gives a lot of incentives for reporting positive results about interesting problems, but can have the effect of suppressing negative results (the "file-drawer effect") or sometimes promoting false positives. It is also hard for researchers to report how models perform on representative random samples of problems, both because this requires relatively big and costly experiments, and because randomly chosen problems (some of which are, by themselves, boring) may not be as rewarding to examine as are problems carefully selected to showcase the virtues of a particular model.

The competitions we're proposing are an attempt to ameliorate both incentive problems. The hosts of the competition will run the necessary experiments on random samples of games, and invite researchers to submit models to predict the observed behavior. (Researchers can test their model on a first random sample of games for which the experimental results are reported before the competition, and they are invited to predict results for a second random sample of games that will not be published until all the models are submitted.) So the competition is cheap to enter (the random sampling experiments are already taken care of), and the entries are submitted before their authors know how well they will perform.

Here's the call for a competition to predict behavior in market entry games. And here is a version just sent out by email:

Ido Erev, Eyal Ert, Al Roth and Games Editorial Office invite you to participate in the choice prediction competitions that will be conducted as part of the special issue of the journal Games ( on “Predicting Behavior in Games” ( Below is the call to participate in the first competition which focuses on market entry games.
The first “Games” competition: Predicting behavior in market entry games.
The first competition focuses on the prediction of behavior in repeated 4-person market entry games. The organizers first ran (in March 2010 at Harvard) an experimental study of (40) games that were randomly selected from a well-defined space of market entry games. The raw experimental results of this study, referred to as the “estimation experiment,” are presented in the competition’s website (
In addition, the competition website includes the rules of the competition, and a link to a paper that summarizes the results of the estimation experiment and explores the value of several baseline models (
The site explains that the goal of the participants in the competition is to predict the results of a second experiment. This study, referred to as the “competition experiment,” will be run by the organizers in May 2010 (but the results will be kept confidential until 2 September 2010). The competition experiment will use the same method as the estimation experiment, but will study different games (drawn from the same space of games) and different subjects.
To participate in the competition you will have to email us a computer program (in MATLAB, Visual Basic, or SAS) that reads the parameters of the games (the incentive structure) as input, and predicts the main results as output. The program should be an implementation of your favorite model. To develop and/or estimate your model you are encouraged to analyze the data of the estimation experiment, and to build on the baseline models that were posted in the competition website.
The submitted models will be ranked based on the mean squared deviation between the predictions and the results of the competition experiment. The prize for the winners will include an invitation to publish a paper that describes the winning model in Games, and an invitation to a special workshop.
The submission deadline for this competition is 1 September 2010. You are allowed to submit one model as a first author and to co-author up to three additional submissions.
Best regards,

Ido Erev, Eyal Ert and Al Roth
Guest Editors
Games Special Issue "Predicting Behavior in Games"

Sunday, May 23, 2010

Gifts of kidneys and gifts of gratitude

The ethics column in today's NY Times Sunday Magazine begins with this query:
"Last fall, a stranger donated a kidney to my husband. We offered her a gift after the operation, which she declined. Recently she wrote us that her house is in foreclosure, and she needs money. We obviously have no legal responsibility to respond, but what is our ethical responsibility? I wish it were legal to sell organs; it would be much cleaner in many ways. NAME WITHHELD "

The column's author and resident ethics guru, Randy Cohen, offers this response:
"You’ve no moral obligation to send money to the organ donor. She admirably — heroically — provided her kidney as a gift. An essential quality of a gift is that it comes with no strings, with no reciprocal obligations. Otherwise, it would be a sort of disguised sale. United States law prohibits the sale of organs, wisely, in my view. To permit such transactions is to allow those with money to harvest the organs of those without. Even if you prefer that system of organ allocation — many honorable people do — it was not what you and the donor agreed to.

That said, it is a fine thing to echo generosity, to respond to the subsequent and unanticipated travails of someone who has done so much for you. You need not put yourself in dire financial peril to send this woman money, but if you choose to help her, that would be estimable.

Perhaps it is my suspicious nature, an occupational hazard, but I see at least the possibility that she might have known about her money trouble for some time, and the hope of alleviating it may have been part of her motivation to donate a kidney, a desperate and pitiable measure. If you believe that she planned to psychologically pressure you into, in effect, paying for a kidney, you should decline to collaborate in cloaking an organ sale as a gift."

Update: my colleague Greg Mankiw, reflecting on his favorite textbook, summarizes the article this way.

Do two rights make a wrong?

via Greg Mankiw's Blog by Greg Mankiw on 23/05/10

Users of my favorite textbook know that it includes, in Chapter 7, a case study on whether kidneys should be traded in a market. Today's NY Times has a related article.

The paper's so-called "Ethicist" is dealing with this situation:

1. Person A receives a kidney transplant as a donation from person B.
2. A short time later, person B is having financial troubles and her home may go into foreclosure. Person A is considering her giving some money to help out.

So what does the "Ethicist" say about all this? Apparently, both of these gifts are noble acts, worthy of the highest praise and admiration. Unless, that is, there is some reason to think they are linked together. In that case, the reallocation of resources (kidney, cash) would be a despicable market transaction.

I suspect that few economists would concur. Indeed, the essence of market transactions is a kind of reciprocal altruism, enforced by contract. It might be nice if the world could work using pure altruism alone, but that seems highly unrealistic. The sad truth is that under the Ethicist's code of conduct, we have more deaths and more foreclosures than necessary, all in the name of fairness.

Saturday, May 22, 2010

Scalping world peace as NY ticket resale laws expire

The NY Times reports on Scalping World Peace, Outside Radio City
"The appearance of the Dalai Lama at Radio City Music Hall has inspired a certain chant on the Avenue of the Americas.

“Tickets for the Dalai Lama, tickets,” intoned a not-particularly-spiritual-seeming 55-year-old scalper from Brooklyn, standing on the corner of 50th Street on Friday afternoon. “Anyone selling tickets? Tickets.
“It’s difficult to bargain with Dalai Lama fans,” Richie said later. “They don’t even know what ‘orchs’ are,” meaning orchestra seats. “They’re always looking for cheap seats. They have no concept of premium seating.” "

This is taking place in an unsettled legal environment: The Times reported last week
Legal Ticket Scalping Law to Lapse as Albany Debates a New Provision, and here's yesterday's Daily News: Gov. Paterson reenacts 1920s ticket scalping law, serving notice to StubHub, Ticketmaster and others

Usury in the middle ages

From Walsh, Adrian “The Morality of the Market and the Medieval Schoolmen,” Politics, Philosophy & Economics 2004; 3; 241-259

“Exploring the evils of usury exercised the minds of a great many medieval philosophers, writers and artists. Consider Dante’s Inferno. As Dante descends into the depths of Hell, he discovers usurers (along with sodomites) in the smallest and most terrifying ring (Round 3 of Circle VII) of the Inferno. Dante inquires as to the nature of the sins of the usurers and is told that their sins are classified as a kind of violence towards God because usury was an attack on the natural use for money given by God and it implied contempt for God’s bounty.
Dante’s views are typical of the moral condemnation of his society for those who made a living out of interest. The practice of usury was not only subject to moral disapprobation; theological and legal injunctions against the practice were in force during the period over much of Europe. In 1274 Gregory X, in the Council of Lyons, ordained that no community, corporation or individual should permit foreign usurers to hire houses, but that they should expel them from their territory; and the disobedient, if laymen, were to be castigated with ecclesiastical censures. In 1311 the Council of Vienne declared all secular legislation in favour of usury null and void, and branded as heresy the belief that usury was not sinful. Anti-usury laws, although subsequently subjected to numerous modifications, persisted across Europe for over 500 years until the time of the Napoleonic Code. After the Napoleonic Code had allowed the taking of interest, the Church too decided to abandon the old usury doctrine. It was quietly buried (although not revoked) in 1830, when the Church issued instructions to confessorsnot to disturb penitents who lent money at the legal rate of interest without any title other than the sanction of Civil Law."

Friday, May 21, 2010

Market orders, programmed trading and loss of thickness

I haven't yet read a convincing account of the one-day stock market crash and rebound on May 6, but here's an early (May 9, NY Times) story that makes a case that a lot of conventional market tools could have interacted to produce a bad outcome: Thursday’s Stock Free Fall May Prompt New Rules.

"The S.E.C., which oversees the nation’s equity markets, requires a suspension in trading only in the event of a broad market collapse, defined as a drop of at least 10 percent in the Dow Jones industrial average, which is based on the share prices of 30 large American companies.
Other countries, like Germany, impose similar circuit breakers on trading in shares of any individual company that has a similar drop, but the S.E.C. has never done so. A former S.E.C. official said the possibility had been discussed in recent years, but “I don’t think there was quite the urgency to deal with it.”
The S.E.C. and the Commodity Futures Trading Commission said in a joint statement on Friday that the issue now had their attention.
“We are scrutinizing the extent to which disparate trading conventions and rules across various markets may have contributed to the spike in volatility,” the statement said. “This is inconsistent with the effective functioning of our capital markets and we will make whatever structural or other changes are needed.”
Early this year, the S.E.C. also began a broad review of equity markets, including whether computerized trading is properly regulated.
The heads of several of the largest electronic exchanges said Friday that they would support industrywide rules for breaking free falls.
But there are other ideas to keeping computerized markets in check. Lawrence E. Harris, a finance professor at the University of Southern California, said regulators should simply require all sellers to specify a minimum price below which they do not want to complete the sale of their shares. Market orders, placed at the best available price, can be too risky in the fast-moving age of electronic trading.
On Thursday, some sellers placed orders that were not fulfilled until prices had plunged as low as a penny a share. If sellers had placed “limit orders” instead, those transactions would not have happened, Professor Harris said.
“Electronic exchanges in most other countries only accept limit orders,” said Professor Harris, a former S.E.C. chief economist. “Without any mechanisms to stop the market, we just had stocks falling through the ice.”
But Rafi Reguer, a spokesman for the electronic exchange Direct Edge, said retail investors liked market orders because limit orders could be rejected, forcing the seller to try again, in some cases at a lower price.
“Sometimes what people value is the certainty of execution,” Mr. Reguer said.
Experts also note that the value of limit orders can be subverted if investors routinely set unrealistically low limits, to avoid the inconvenience of having their orders rejected.
The BATS Exchange, a large electronic exchange based near Kansas City, rejects orders if the price would be more than 5 percent or 50 cents away from the last completed transaction.
During the market panic on Thursday, between 2:40 and 3 p.m., BATS prevented more than 47.6 million orders from executing — more than 95 percent of all orders during that period, according to Randy Williams, a spokesman for the company. "

And here's a May 19 NY Times story on the SEC's new rules: New Rules Would Limit Trades in Volatile Market
"The Securities and Exchange Commission said Tuesday that it would temporarily institute circuit breakers on all the stocks in the Standard & Poor’s 500-stock index after the huge market gyrations on May 6.
The circuit breakers will pause trading in those stocks for five minutes if the price moves by 10 percent or more in a five-minute period. The trial run will begin after a 10-day comment period and will last through Dec. 10, the commission said. The circuit breakers will apply both to rising and falling stock prices.
But in a separate report, the S.E.C. and the Commodity Futures Trading Commission said that they had not been able to pinpoint the cause of the sharp market decline that shook investors and markets two weeks ago.
Generally, the agencies said, the drop was caused by traders stepping back from the market and refusing to buy or sell, in both the stock and futures markets. The government found that there was also a heavy reliance by investors on automated orders to sell at the market price once stock prices had declined by a certain amount. Further, there were different rules on different exchanges about when trading is automatically slowed or stopped. "

Thursday, May 20, 2010

College admissions fraud, at Harvard

The Globe weighs in: Trust-based admissions process leaves elite colleges open to fraud
"The former Harvard College senior accused of duping one of the world’s most selective universities seems to have exploited an application system at elite colleges that is largely based on trust and where admissions officers verify credentials only when they suspect that something is awry.
As questions mount about how 23-year-old Adam B. Wheeler could have pulled off such a sophisticated charade — doctoring transcripts and College Board scores and submitting fake letters of recommendation on official-looking letterhead — neither Harvard admissions officials nor a university spokesman would discuss its admissions process.
Nor would they say whether policies will change as a result of the alleged scam by Wheeler, who pleaded not guilty in Middlesex Superior Court in Woburn yesterday to 20 counts of larceny, identity fraud, and other charges and was ordered held on $5,000 cash bail.
Admissions officials at other colleges said the sheer volume of applicants makes it impractical to independently verify every document submitted unless they discover inconsistencies."

The Crimson takes up the story, with an account of how the fraud(s) came to light: Former Harvard Student Indicted For Falsified Applications, Identity Fraud
"A former Harvard student was indicted Monday for falsifying information in his applications to Harvard and for several scholarships.
Adam Wheeler, 23, was indicted on 20 counts of larceny, identity fraud, falsifying an endorsement or approval, and pretending to hold a degree. Wheeler was allegedly "untruthful" in his applications to the University and in scholarship applications, according to a statement released Monday by Middlesex District Attorney Gerry Leone.
As a senior in September 2009, Wheeler allegedly submitted fraudulent applications for the Harvard endorsement for both the United States Rhodes Scholarship and the Fulbright Scholarship.
His application packet included fabricated recommendations from Harvard professors and a college transcript detailing perfect grades over three years. Wheeler's resume listed numerous books he had co-authored, lectures he had given, and courses he had taught, according to authorities.
Wheeler's transgressions came to light when a Harvard professor noticed similarities between Wheeler's work and that of another professor during the application review process for the Rhodes Scholarship. The professor then compared the two pieces and voiced concerns that Wheeler plagiarized nearly the entire piece.
Wheeler’s file was referred to University officials, who decided—upon discovering the falsified transcript—to open a full review of Wheeler’s academic file

Wednesday, May 19, 2010

More on payments for egg donors

Payment Offers to Egg Donors Prompt Scrutiny
" a study in the most recent issue of The Hastings Center Report, a leading bioethics journal, found that the compensation being touted in ads aimed at young women often exceeded industry guidelines. The study is the latest development in a long-running debate over how much — or even whether — egg donors should be paid. "...
"Last fall, California adopted a law requiring egg donor advertisements to include specific warnings about health risks. The state already bans the sale of eggs for research purposes, in accordance with guidelines issued by the National Academy of Sciences.
In contrast, New York’s Empire State Stem Cell Board decided last year that state research money could be used to pay women up to $10,000 for donating eggs."
Kim Krawiec over at Faculty lounge has an update on the extra problems facing egg donation in Israel: What Religion Is Your Egg?

Tuesday, May 18, 2010

Organ donor registry mishap in Britain

The Telegraph reports: Organs removed without consent after IT blunder

"The records of 800,000 people were affected by an error that meant their wishes about the use of their organs after death were wrongly recorded.
An investigation has found that 45 of those for whom wrong records were stored have since died – and in approximately 20 cases organs were taken where consent had not been given.

Donors can give permission for any of their organs to be taken, or provide more specific agreements. A glitch in the system more than a decade ago removed the distinctions expressed by people.
Many donors have strong views about what can be taken. Often consent is not given for eyes to be removed, while some people who agree to donate organs are uncomfortable with the idea of their body tissue being used in research.
Joyce Robins, from the pressure group Patient Concern said: "This Government has got an absolutely dreadful record when it comes to data, but it is absolutely horrific that such sensitive details were handled in such a careless way."
The NHS is about to contact approximately 20 families who allowed organs to be taken from their relations after being misinformed about what consent had previously been given.
It is illegal to remove organs without prior consent from the person who died or their next of kin. A view is sought from relations before decisions are taken. In the cases where errors were made, it is understood that families were asked for permission, but their decisions were based on misinformation about the wishes of their relations.
After detecting the fault last year, NHS Blood and Transplant, which holds the organ donation register, was able to correct 400,000 of the flawed records. But 400,000 more people will shortly be contacted to be told that the wrong information may be held about them, and asked to provide consent again.
Until fresh consent is obtained, organs will not be taken from any of those people in the event of death. "

Monday, May 17, 2010

Deceased organ donation, misc. links

Number of Americans willing to donate organs rises, but still not keeping pace with need: Survey reveals pervasive donation myths "The online survey of 5,100 U.S. adults, which was supported by Astellas Pharma US, Inc., also uncovered some pervasive myths regarding donation. For example, the majority (52 percent) of respondents were open to the idea that doctors may not try as hard to save their lives if their wish to be organ donors is known, and 61 percent are open to the idea that it is possible for a brain dead person to recover from his or her injuries. In addition, 8 percent believe that organ or tissue donation is against their religion."
"Additional survey findings include: More than three-fourths of adults (78 percent) correctly realize there are more people who need organ transplants in the U.S. than the number of donated organs available. 61 percent of adults would donate the organs or tissue of a family member if they died suddenly without indicating their wishes. The number of African Americans who wish to donate all their organs and tissue has increased to 41 percent versus 31 percent in 2009 – encouraging news as African Americans comprise nearly 35 percent of the national kidney transplant waiting list."

Why New Yorkers Don’t Donate Organs. Susan Dominus writes in the NY Times: "When I started thinking about writing about New York State’s exceptionally low number of registered organ donors — 13 percent of people 18 and older — I remembered that I had never signed up on the official registry to designate myself a donor. So I went online, assuming I would be able to click somewhere quickly, and was delighted at the prospect. ...
"Except that it was nowhere near as easy as getting broccoli delivered to my door. I had to print out a form and mail it....What, specifically, did I want to donate, it wanted to know: Bone and connective tissue? Heart with connective tissue? Pancreas with iliac vessels? ...
"Were I not writing about the subject, I would quite likely have avoided it forever — which puts me in good (or, I should say, equally flawed) company, said Elaine Berg, president of the New York Organ Donor Network. In her opinion, the snail-mail process is a major barrier to increasing New York’s low rate of registration. All but 5 of the 49 states that have organ donor registries — Vermont is the holdout — allow for an electronic signature. That enumerated list of donation options is another hurdle. “It even turns me off,” Ms. Berg said. “It becomes a visual.” Only four states rank lower than New York on the recently released national report card from Donate Life America, a national advocacy group. ...
"But the department maintains that the enumerated list is the best way to meet the requirements of the legislation governing the registry, which was established in 2000 but became binding in 2008. The law states that “the registry shall provide persons enrolled the opportunity to specify which organs and tissues they want to donate.” So let them, Ms. Berg said. As many other states do, give would-be donors a blank space in which they can specify, or give them two options: “All” and “Everything except (blank).” As a journalist, I’m all for full disclosure, except for full disclosure about the gory details of a gesture I’d like to make regarding my organs in the event that I end up brain-dead on a respirator. It’s amazing how a matter of marketing can mean so much for a matter of life and death. In the downstate region of New York, which includes the city, Long Island and the five counties immediately north of the city, Ms. Berg said, 8,000 people are waiting for organs. In the downstate region, about 600 people die a year under circumstances conducive to organ donation (the typical qualifying donor is a middle-aged stroke victim); in these emergency circumstances, New York has around a 50 percent consent rate — much better than the 13 percent on the official registry, but still below the 67 percent rate nationally. And yet cynicism plays in: New Yorkers are more likely than the average American to think doctors put less effort into saving the lives of organ donors, Donate Life America reports. "

Should Laws Push for Organ Donation? discussion and commentary of a proposed NY law to shift to presumed consent. Interesting followup discussion by Alex Tabarrok at MR: Presumed Consent and Organ Donation

Informal money transfer networks: "hawala"

The informal money transfer system known as Hawala (or hundi) is in the news with the arrest of three Pakistani men in New England who are believed to have provided funds to the Times Square bomber. The Boston Globe reports Possible ties to murky finance system examined
"An informal money-exchange network known as “hawala’’ — a centuries-old system that operates outside conventional banking networks — is at the center of the investigation into three Pakistanis arrested Thursday in Massachusetts and Maine with alleged ties to the suspect in the failed Times Square bomb plot, law enforcement officials said yesterday."
"Hawala, which originates from the Arabic word for change or transform, is a practice that predates modern banking systems and has been around for centuries. There are believed to be thousands of hawala brokers operating in the United States, and they are not necessarily operating outside US laws if they register with the US Department of Treasury. Many don’t, however, operating more like black-market, cash-based versions of Western Union.
Relying on an informal network of brokers who use designated couriers, the networks are used to transfer money in relatively small amounts in and out of developing nations where modern financial systems are scarce, such as in South Asia, the Middle East, and Africa. Transactions often can be completed within 24 hours and at a lower cost than a traditional wire transfer or bank draft that could take as long as a week and require official paperwork.
Hawaladars, as the brokers are known, often operate out of cash-intensive businesses such as restaurants, convenience stores, or gas stations, the officials said."

The informal nature of the transfers, which circumvent banks and regulated record keeping, and the fact that the broker on one end doesn't know the customer on the other end, have made the hawala system a concern for law enforcement involving money laundering. Here's a report from Interpol: The hawala alternative remittance system and its role in money laundering

Sunday, May 16, 2010

Piracy and anti-piracy: recent developments

Russian Destroyer Frees Hijacked Oil Tanker (May 6, 2010)

"Cmdr. John Harbour, a spokesman for the European force, said Thursday that the Russian warship had freed the tanker, the Moscow University, after its crew members locked themselves into the rudder compartment of the ship."

Saturday, May 15, 2010

South Africa's president on monogamy, polygamy, infidelity, and AIDS

Zuma’s Frank Talk Starts AIDS Dialogue in South Africa
"During a 45-minute interview on Thursday, Mr. Zuma, who has three wives and a fiancée, talked about his personal relationships with startling directness and laid out his belief that a polygamous marriage in which H.I.V. is openly discussed is safer than a monogamous union in which a man has hidden mistresses. "

Ernst Fehr in New Scientist

Ernst Fehr: How I found what's wrong with economics

Least expected line: "However, as a former Austrian national wrestling champion, Fehr doesn't give up easily."

Friday, May 14, 2010

Job prospects for new law graduates

The WSJ reports: Bar Raised for Law-Grad Jobs: Employment Prospects Dim as Firms Retrench, Derailing Career Paths for Many

"Many 2009 law graduates who were offered jobs just started work this year. And many graduates hired in 2010 won't start until 2011. So even when the economy picks up, firms would first have to absorb their backlog of recent hires."


"Law firms had an average of 16 summer internship positions to offer this year, about half the number of the previous year, according to a March report by the National Association for Law Placement Inc.
Employers last year offered 69% of summer interns a full-time job, down from about 90% in the previous five years."

Thursday, May 13, 2010

Market design seminar tomorrow (Friday May 13 2010)

If you're not on Peter Coles' distribution list, here's the announcement.

Hello Market Design Community:

The speakers in Friday’s HBS Market Design Workshop (the last of the semester!) are

** IAN KASH, "An Auction Design for Sharing Wireless Spectrum," Harvard Center for Research on Computation and Society

** SCOTT KOMINERS, "Concordance Among Holdouts" [with E. G. Weyl], Harvard Business Economics

We’ll meet tomorrow, Friday May 14, from 3-5PM in HBS Baker Library Room 102. The workshop features an informal format for presenting early-stage work, and is intended to encourage the Boston area market design community to meet and interact. Sushi will be provided.

Thanks, and we look forward to seeing you.

Peter Coles / Ben Edelman / Al Roth

College admissions after May 1

The Chronicle of Higher Education reports Good Seats Are Still Available at many colleges.
"On Wednesday, the National Association for College Admission Counseling released its annual "Space Availability Survey," listing the colleges and universities that still have openings for this fall's first-year class. As we move past May 1, the traditional deadline for students to submit enrollment deposits, the survey is a good reminder that the admissions calendar isn't the same at every college." has a similar story from the perspective of the colleges: The Early Word on Yield. That story offers some interesting perspectives on the business of finding and recruiting students, e.g.:
"Across the state, Mike Frantz, vice president of enrollment at Robert Morris University, is also looking at vastly different yields for different programs. ...Over all, the university is thrilled "beyond our wildest dreams" because those numbers for the year -- in which overall yield is 17.6 percent, down less than a point -- come from a much larger applicant pool and more admittances. Applications were up 40 percent. The key, Frantz said, was that the college bought names of prospective students at the beginning of their senior year in high school. In the past, Robert Morris stopped buying new names when students reached their junior year, a common practice, feeling that potential students would be identified by then. "But the vast majority of our new applicants, and many of our new students, came from these pools, whose names aren't being purchased traditionally," he said."

Wednesday, May 12, 2010

The market for divorce

Tyler Cowen at MR links to a NY Times story about a divorce themed trade fair in Italy: Divorce Trade Fair Shows Changing Italian Culture
It notes that until recently divorce was a repugnant transaction in Italy. "Italy ratified divorce only in 1974 in a referendum, and critics complain that Italian legislators have not kept up with changing times. "

A much more aggressive component of the market for divorce is reported by the Times of London in a story from Japan. Sex, lies and splitting up: Want to dump a troublesome husband, or unsuitable boyfriend? Just call Osamu Tomiya and his team of splitter-uppers...

The article focuses on "Osamu Tomiya — a member of a peculiarly Japanese profession, part-private investigator, part-prostitute, known as wakaresase-ya — the “splitter-uppers”.
The function of the wakaresase-ya is the direct opposite of a dating agency: with great ingenuity, and the right fee, they will prise apart human relationships. Do you have a troublesome ex-boyfriend who won’t leave you alone? A beloved son who is getting engaged to an unsuitable girl? A dead-loss employee who refuses to take the hint and retire? All of these difficult situations can be resolved by the splitter-uppers.
The broken-hearted ex will be visited by the girl’s “new boyfriend”, a muscular gangster-type who explains why he would be wise to nurse his broken heart alone. The undesirable daughter-in-law-to-be will be lured into a drunken one-night stand with a handsome and mysterious man who appears from nowhere — photographs of their tryst will find their way to her fiancĂ©. The stubborn employee will find himself confronted with evidence of gambling debts, or nights in massage parlours — and resign to avoid embarrassment. In each case, the dirty work — of threatening, seducing and investigating — has been done by a splitter-upper.
But most common of all are complications surrounding marriages. In Japan, the idea of a “no-fault” divorce has never caught on and when a marriage breaks down, it is helpful to be morally in the right. When it comes to maintenance, division of common property and custody of children, the betrayed partner is at a great advantage over the betrayer. And this is where the splitter-uppers come in.
For a wife who wants shot of her husband, it would be disastrous just to own up to a long-term lover and throw herself on the mercy of the courts. Instead, she hires someone such as Mr Tomiya, a 40-year-old former sushi chef, to set up the honeytrap that will put her husband in the wrong and enable her to go before the judge as the injured party, with photographs to prove it."

Tuesday, May 11, 2010

Misc. organ transplant commentary and news

The Times of London reports on how one deceased donor can donate many organs: How one organ donor can save the lives of nine people
There is a worrying shortage of organ donors — and gaining consent from grieving relatives is a delicate task

A living donor is unhappy with the way they have been treated: The Hypocrisy of OPTN's Committee Goals "UNOS has had the OPTN contract since 1986 (yet they cared so little for us they didn't even collect LD social security numbers til 1994); they've had policy to collect follow-up data on living donors since 2000 (but the transplant centers were 50-80% non-compliant), yet it wasn't until 2005 they decided it should be "clinically relevant and validated". And since 2005, independent researchers, UNOS officials and SRTR personnel have all criticized UNOS' data collection as 'woefully inadequate', and worthless as far as any meaningful analysis goes. "

A columnist quotes Adam Smith in support of making compensation for donors legal: Dying people shouldn’t be beggars "It is not from the benevolence of the butcher, the brewer or the baker that we expect our dinner, but from their regard to their own interest. ... Nobody but a beggar chooses to depend chiefly upon the benevolence of his fellow-citizens."
—Adam Smith, "Wealth of Nations"

A living donor is declined by a hospital: Kidney Donation Canceled Because Donor and Recipient ‘Bonded’ and THE MATCH (UN)MAKERS: Why did Einstein halt life-saving transplant? both report a hospital's decision not to accept a donation from a donor who had met his potential recipient via the website. The WSJ piece says, by way of of explanation: "As the WSJ has reported, hospitals may be reluctant to agree to this kind of altruistic donation, fearing that donors may have been paid or that participants won’t make it through the rigorous psychological evaluation process, or because the practice sidesteps the official organ waiting lists."

Alex Tabarrok at MR reports on Changing Views on Organ Prohibition and reports that the anthropologist Nancy Scheper-Hughes, who has studied black markets for organs, is in favor of careful trials of ways to ethically compensate organ donors.

California, New York mull changes to organ donor laws
"A California bill may soon create a living donor registry -- the first for any state.
Spurred by Apple co-founder and transplant recipient Steve Jobs, the bill has gained support from major politicos, including California Gov. Arnold Schwarzenegger, and is expected to land on his desk this summer.
Meanwhile, on the East Coast, a far more sweeping transplant bill would make every person an organ donor who doesn't opt out. This would create an organ donation system in New York similar to the ones used in several European countries, but the measure is already facing opposition."
The California bill seems to be aimed primarily at promoting kidney exchange...

Monday, May 10, 2010

Surrogacy, payments, and parental rights in Britain

Couples who pay surrogate mothers could lose right to raise the child: High court could refuse recognition to people who flout law by paying disproportionate fees to a surrogate mother overseas.

"Childless couples who acquire a baby using a surrogate mother abroad risk not being recognised as its parents in Britain if they flout British law by paying fees, fertility lawyers have warned.
Such payments, which can be as high as £30,000, could lead to those who have made them being refused permission by the high court to become the child's legal parents, specialist solicitors say.
The Human Fertilisation and Embryology Act 1990 allows couples entering into deals with a surrogate mother overseas to pay her only what is allowed here – "expenses reasonably incurred", such as compensation for time off work, medical bills and living expenses."
""The risk couples face if they pay a disproportionate amount in expenses is that the high court may refuse to authorise those expenses. That could result in the parental order application failing and in turn they would have no status as parents under English law," said John Randle, a leading surrogacy lawyer."
"International surrogacy is hugely controversial. "It's unethical and exploitative because the trade is all one-way," said Breedagh Hughes, a Royal College of Midwives spokeswoman, on the ethics of childbirth. "It reduces babies to the level of commodities." "

"Jonathan, a 32-year-old nurse, tells how he and his civil partner, Colin, 33, a financier, spent $150,000 (£98,000) on surrogacy to become the parents of Harriet, who was born in California last year. They live in London.
"We began discussing having a child in 2006, when we were deciding to become civil partners. I was feeling broody, and had always wanted to have my own biological child. We opted to pursue surrogacy in California because we would get legal custody there of the child before it was born and the surrogate would have no legal relationship to the baby.
"My sperm was introduced to eggs left by an egg donor: they were fertilised in an IVF clinic in Los Angeles and two of the embryos were implanted into the surrogate. She simply carried the child for nine months.
An agency in LA found both the egg donor and the surrogate. We never met the egg donor or knew who she was, but knew her medical history, results of her genetic tests, what she looked like and so on. We did meet and get on well with the surrogate, who was called Jennifer. She had two daughters of her own and had been a surrogate once before. There was no coercion. We had a contract, and Jennifer specified things in that like that she wanted back massages and a big hotel room for her family to stay in when she was giving birth.
Agencies in California quote a price of $100,000 to $150,000 to do everything relating to a child. The whole process wasn't too difficult, and cost us about $150,000. We paid the embryologist $60,000, though that included the harvesting of the donor's eggs, the IVF and the transfer of the embryos into the surrogate. It was $40,000 for the surrogate and $10,000 for the egg donor, plus $10,000 to the agency, who supplied the donor and the surrogate. Then there was $10,000 for our lawyer, $5,000 for the medical and psychological screening and another $5,000 for medication for both the donor and the surrogate, to ensure they were in cycle at the same time.
"Bringing Harriet into the UK nine months later was incredibly difficult, though, and we engaged lawyers to help us. She had to come in as an immigrant on a US passport on a six-month tourist visa. When we later filled in a form to get her British citizenship, we put 'not known' in the section headed 'mother'. She now has dual nationality and is legally ours under Californian law. If we do apply, it could be an issue that we paid well over the 'reasonable expenses' limit – that is, we paid a fee. That's illegal in this country, but allowed under Californian law.
"We shouldn't have to seek a parental order. She was conceived and born in California as our child, and her birth certificate says who her parents are, so the courts here should respect Californian law.
Having to apply for a parental order, where there'd be an assessment of Harriet's welfare and Colin would have to prove that he's no danger to her, is an inequity. Anybody else can go out, get drunk, get pregnant, bring up a child appallingly and face no intervention or legal barriers.
I resent people saying that British couples who resort to surrogacy are buying babies abroad. We didn't buy Harriet: she's not picked off a shelf. She's not a 'designer baby'.
We had our own child and had a great team to help us. All we did was rent a woman to carry her. We paid for the services of an embryologist and an incubator who walks and makes good babies – but we didn't buy a baby. She's my daughter biologically, and she's our baby.
A lot of heterosexual couples in the UK spend a lot of money having many cycles of IVF at £5,000 a time – is that not buying a baby?" "

HT: Nick Feltovich

Sunday, May 9, 2010

Organ donation and surrogacy: a Mothers' Day story

Donor gives more than just kidney to Northbrook family
"A little more than 6½ years ago, Fink, then 43, started dialysis after her kidneys failed. Soon after, the Northbrook resident learned the devastating news: her life expectancy made it unlikely she'd live beyond March of this year. But after she found a kidney donor through a Web site -- and after that donor's wife agreed to be a surrogate mother for Fink and her husband -- Gail is not only alive, she is thriving. So are her twin 2½ year-old sons."

Happy Mothers' Day out there.

Saturday, May 8, 2010

China’s Arranged Remarriages

The NY Times reports on China’s Arranged Remarriages among widows and widowers whose spouses died in the devastating earthquake that destroyed towns in Sichuan on May 12, 2008.
It is an unusual demographic event, which created a thick pool of potential (re)marriage partners.
"Coaxing earthquake survivors into remarriage has become a community obligation. Unlikely volunteers have joined in the matchmaking efforts, from former in-laws to the leaders of the local Communist “work units” to which every family in this part of rural Sichuan is still assigned. Behind them is the Chinese government. The state, which has long seen fit to intervene in the most private aspects of people’s lives, including reproductive rights, has avidly promoted — and in some cases even arranged — what it dryly calls “restructured families.”
By the end of 2008, less than eight months after the earthquake, 614 survivors from Beichuan alone had already remarried, according to Wang Hongfa, a local civil-affairs official. (The number across Sichuan’s earthquake zone, though not made public, is estimated to be well into the thousands.) That so many earthquake survivors have already remarried is not surprising in itself; but in many cases, these are widows marrying widowers, two survivors striving to get back onto solid ground. "

Gifted programs for pre-kindergarten in NYC

I like the first paragraph of this story: More Pre-K Pupils Qualify for Gifted Programs

"The number of students qualifying for gifted kindergarten programs in New York City public school districts rose by 10 percent this year, and those qualifying for the elite citywide program jumped by a third, raising the possibility that parents and their children have begun to master an admission process that was retooled three years ago."

Friday, May 7, 2010

School choice in NYC, a problem facing large school systems

The most demanded schools are very hard to get into, even for very well qualified students, some of whom can have trouble matching: For Many, High School Match Game Continues.

"Although most of the city's 86,000 eighth graders were matched with a high school this year, every year thousands of students don't get in anywhere and it doesn't matter whether they have good grades, test scores and attendance records. They have to apply all over again, with a much more limited list of schools to choose from."

The full process in NYC, in which in the initial round students can list no more than 12 programs to apply to, is described in this paper: Abdulkadiroglu, Atila, Parag A. Pathak, and Alvin E. Roth, "Strategy-proofness versus Efficiency in Matching with Indifferences: Redesigning the NYC High School Match,'' American Economic Review, 99, 5, Dec. 2009, pp1954-1978.

And the following paper uses the fact that the proportion of unmatched students doesn't go to zero as the school system gets large, so in a very large school system like NYC, the number of initially unmatched students won't be tiny. (That doesn't mean that allowing longer lists wouldn't help.)

Kojima, Fuhito, Parag A. Pathak, and Alvin E. Roth, " Matching with Couples: Stability and Incentives in Large Markets," working paper, April 28, 2010.

Thursday, May 6, 2010

Same sex spouses versus Defense of Marriage Act

The clash between repugnant and protected transactions will have its day in court, starting today: Gay Couples Challenge Defense Of Marriage Act

"Six years after Massachusetts became the first state in the nation to legalize gay marriage, a group of married same-sex couples will be in federal court in Boston on Thursday, arguing that their marriages should also be recognized by the federal government. "...

"Bush, Ritchie and 17 other plaintiffs argue that the federal government can't just ignore some marriage certificates and recognize others. Their lawyer, Gary Buseck with Gay and Lesbian Advocates and Defenders, says DOMA violates the equal protection clause of the Constitution because it is discriminatory.
When Congress passed the law in 1996, Buseck says, members "simply had a knee-jerk reaction that we have to bar the doors of the federal government in every conceivable way from the invasion of married gay people. I mean, they let it all hang loose."
Indeed, in heated congressional debate over DOMA in 1996, supporters argued the stakes couldn't be higher. One of DOMA's authors, former Republican Rep. Bob Barr, proclaimed, "The flames of hedonism and the flames of self-centered morality are licking at the very foundations of our society."
Barr, now a libertarian, has since called for DOMA's repeal, saying it violates states rights. President Obama also supports repeal. But his administration is in the awkward position of having to defend the law in court. As a Department of Justice official put it, we "can't pick and choose which federal laws [to] defend based on any one administration's policy preferences."
So, while government lawyers go out of their way in their legal papers to call DOMA “discriminatory,” they’re also arguing Congress did have good reason to want to preserve the status quo."

Here's my earlier post: When a protected transaction meets a repugnant one: The MA suit over the Defense of Marriage Act

Compensation for bone marrow donors: opposing views

In November I wrote about a lawsuit to overturn the ban on compensation for bone marrow donors: Compensating donors: how about bone marrow? . Commentary in support of the lawsuit suggested that perhaps bone marrow had been unintentionally included in the more general ban on compensation for organ donors.

More recently, some of the organizations connected with bone marrow have come out against compensation: Leading Transplant and Transfusion Organizations Join Forces in Effort to Keep Bone Marrow Donation Voluntary .

"Voicing concern about the potential impact on patient and donor safety, nine leading international health organizations have formed a coalition to oppose compensating people who provide bone marrow for transplantation.

"The organizations — each a leader in the field of transplantation and transfusion therapies — have joined forces in the face of a lawsuit aimed at overturning current U.S. law regarding bone marrow donation. The Institute for Justice is seeking to reverse the National Organ Transplant Act of 1984, as it applies to the prohibition on compensating bone marrow donors. ...

"The coalition includes the NMDP, America’s Blood Centers, AABB (formerly American Association of Blood Banks), the American Society for Blood and Marrow Transplantation, American Society of Histocompatibility and Immunogenetics, the American Society of Transplantation, International Society of Cellular Therapy, The Transplantation Society, and the World Marrow Donor Association.
They oppose changing the current law, citing these reasons:
Protecting Recipient and Donor Safety
A complete and truthful health history is critical to ensure that individuals are eligible to donate and that donated cells are free from infectious diseases. There is a substantial body of experience that people wanting to sell their body parts are more likely to withhold medical details and information that could harm patients.
Maintaining Altruistic Motivations
Studies have shown that compensating donors would deter those who are willing to donate for purely altruistic reasons. The eight million members of the Be The Match Registry® — in addition to the five million volunteer donors on international registries — are proof that people do not need material incentive to save a life. Current law already allows donors to be reimbursed for out-of-pocket expenses and lost wages. The NMDP and other organizations maintain funds expressly for this purpose.
Avoiding the Creation of Markets in Marrow Donation
Compensation has the potential to create markets for marrow, which could have detrimental effects for both donors and patients. Sellers influenced by possible financial gain could ignore the health risks associated with donation or be coerced by third-party organizations that would profit from a marrow sale. In addition, markets put physicians in the morally dubious position of carrying out medical procedures solely so that sellers may profit.
”The creation of markets is likely to elicit criticism from groups that oppose treating the human body and its parts as property,” said Art Caplan, professor of bioethics at the University of Pennsylvania. “To risk potentially undermining support for marrow donation by allowing donor compensation is irresponsible and short-sighted.”
Ensuring Patients’ Access to Treatment
While the Institute for Justice’s lawsuit alleges compensation might increase patients’ access to bone marrow, the opposite is true.
Changing the U.S. law to allow compensation for marrow donors would set a precedent that could hurt the current voluntary systems for organ and blood donation, potentially undermining some patients’ access to safe organ transplants and blood transfusions. If donors were compensated, the United States would no longer conform to international standards for the use of volunteer donors in cell therapies. Thus, patients in the United States may be unable to have access to the worldwide search process. This would restrict Americans’ chances of finding a match and lives may be lost. "

Wednesday, May 5, 2010

Kidney exchange time series

What is this sequence? 2, 4, 6, 19, 34, 27, 74, 121, 240, 304...

It is the number of "Non-Biol,unrel: Paired Exchange" kidney transplants in the OPTN database, i.e. the number of kidney transplants in which the donor was not a blood relative or married to the recipient, arranged by kidney exchange, in the years 2000-2009, by year. (Kidney exchange is also called paired kidney donation, kidney paired donation--KPD, and paired kidney exchange.)

Note the accelerating upward trend: the number of transplants through kidney exchange has grown by a factor of 9 since a comprehensive integration of living and deceased transplantations through both cycles and chains was proposed in 2004. For logistical reasons, the New England Program for Kidney Exchange (NEPKE) and the Alliance for Paired Donation (APD) initially started with exchanges between just two pairs. But soon larger exchanges and chains started to be commonplace, and today a nonnegligible part of the most recent growth is due to non-simultaneous chains.

The best practices seem to be spreading from hospital to hospital pretty well, organized by growing regional and other networks that coordinate exchanges. Sometimes there's some mis-coordination. There is still talk of a national exchange, although medical and other politics at a national level have so far raised some obstacles that need to be overcome.

In some moods I'm surprised that it has come so far so fast. In other moods I'm frustrated at how very slowly things have progressed. There's still lots of room to grow, and the need for kidney transplants keeps growing faster than the supply.

update: the OPTN data report requires a number of clicks once you get to their website, it is from the report "Living Donor Transplants By Donor Relation U.S. Transplants Performed : January 1, 1988 - February 28, 2010 For Organ = Kidney.
Starting from the web page , I choose “national data,” then choose category transplant, organ kidney, then click on Living Transplant by Donor Relation…

Tuesday, May 4, 2010

Moral judgments about economic transactions: Luke Coffman

Lucas (Luke) Coffman defended his dissertation yesterday. He's an eclectic experimenter, and one of his papers looks at the assignment of credit or blame, and how that is influenced by the presence of intermediaries. For example (to pick a Harvard-centric one), is Harvard viewed differently if it hires janitors directly at a low wage than if it contracts with a janitorial services company that employs the janitors?

The baseline condition of one of his experiments is easy to describe: one participant (who you can think of as Harvard) is endowed with $10, which he can divide with a second participant (who you can think of as a janitor), or instead can sell the right to divide the $10 to a third participant (who you can think of as the janitorial services company). Luke then elicits a judgment of the transaction from a fourth party, who is able to punish the first party by reducing his payoff. The results are clear: for a given (low) amount delivered to the “janitor,” punishments are considerably reduced if it is delivered indirectly, through a third party, rather than directly.

Luke designed and conducted many careful controls to better understand what is going on, and rule out plausible alternative hypotheses. (For one thing, choosing to use an intermediary doesn’t seem to fool anyone; people correctly anticipate that using an intermediary will be bad for the lowest paid member of the group, but they nevertheless find it less blameworthy.) One way to think about his results is that they suggest that fairness judgments may be very narrowly framed, and confined more than we had any reason to suspect to very direct interactions, so that intermediated interactions are judged differently than direct interactions.

Luke will be an assistant professor of economics at The Ohio State University next year.

Welcome to the club, Luke.

Monday, May 3, 2010

Angel donors and angel flights in a NEPKE kidney exchange chain

One man's gift of a kidney brings hope to four people*: A NEPKE simultaneous chain, starting with a non-directed donor at Dartmouth.

My close colleague Jerry Green flew two of the kidneys in this exchange, first one from Lebanon, NH to Philadelphia, and then one from Philadelphia to Boston, as part of the Angel Flights program. (He's a private pilot, and his wife Pam accompanies him on these trips as his turbulence control officer...).

*Update: that link doesn't work anymore, but here's the story

The slave trade had sellers as well as buyers

In a NY Times oped, Ending the Slavery Blame-Game, Henry Louis Gates Jr. writes about the slave trade.

"While we are all familiar with the role played by the United States and the European colonial powers like Britain, France, Holland, Portugal and Spain, there is very little discussion of the role Africans themselves played. And that role, it turns out, was a considerable one, especially for the slave-trading kingdoms of western and central Africa. These included the Akan of the kingdom of Asante in what is now Ghana, the Fon of Dahomey (now Benin), the Mbundu of Ndongo in modern Angola and the Kongo of today’s Congo, among several others.
For centuries, Europeans in Africa kept close to their military and trading posts on the coast. Exploration of the interior, home to the bulk of Africans sold into bondage at the height of the slave trade, came only during the colonial conquests, which is why Henry Morton Stanley’s pursuit of Dr. David Livingstone in 1871 made for such compelling press: he was going where no (white) man had gone before.
How did slaves make it to these coastal forts? The historians John Thornton and Linda Heywood of Boston University estimate that 90 percent of those shipped to the New World were enslaved by Africans and then sold to European traders. The sad truth is that without complex business partnerships between African elites and European traders and commercial agents, the slave trade to the New World would have been impossible, at least on the scale it occurred."

Sunday, May 2, 2010

Prizes as a spur to innovation: a White House memo

A March 2010 White House memo "Guidance on the Use of Challenges and Prizes to Promote Open Government," promotes the use of prizes by agencies of the U.S. government.

"[I]t is Administration policy to strongly encourage agencies to:
• Utilize prizes and challenges as tools for advancing open government, innovation, and the agency’s mission;
• Identify and proactively address legal, regulatory, technical, and other barriers to the use of prizes and challenges;
• Select one or more individuals to identify and implement prizes and challenges, potentially in partnership with outside organizations, and to participate in a government-wide "community of practice" led by the Office of Management and Budget and the Office of Science and Technology Policy; and
• Increase their capacity to support, design, and manage prizes, potentially in collaboration with external partners.
To support agencies in the execution of prizes that further the policy objectives of the Federal Government, the Administration will make available a web-based platform for prizes and challenges within 120 days. This platform will provide a forum for agencies to post problems and invite communities of problem solvers to suggest, collaborate on, and deliver solutions. Over the longer term, the General Services Administration (GSA) will also provide government-wide services to share best practices and assist agencies in developing guidelines for issuing challenges. Additionally, GSA will develop, as expeditiously as possible, a contract vehicle to provide agency access to relevant products and services, including technical assistance in structuring and conducting contests to take maximum benefit of the marketplace as they identify and pursue contest initiatives to further the policy objectives of the Federal Government. "

See also a discussion of prizes in a McKinsey report called “And the winner is …” Capturing the promise of philanthropic prizes .

Saturday, May 1, 2010

Herodotus on repugnance

Apparently it all depends on what you're used to.

From The History of Herodotus , III.38 (Written 440 B.C.E, Translated by George Rawlinson):

"Darius, after he had got the kingdom, called into his presence certain Greeks who were at hand, and asked- "What he should pay them to eat the bodies of their fathers when they died?" To which they answered, that there was no sum that would tempt them to do such a thing. He then sent for certain Indians, of the race called Callatians, men who eat their fathers, and asked them, while the Greeks stood by, and knew by the help of an interpreter all that was said - "What he should give them to burn the bodies of their fathers at their decease?" The Indians exclaimed aloud, and bade him forbear such language. "

cited by John O'Neill