Monday, October 31, 2016

Public appeals for organ donors by patients in Canada

The Ottawa Sun has the story: After Eugene Melnyk, transplant surgeons OK public appeals for living organ donors

"Eighteen months after a donated liver from a stranger saved the life of Ottawa Senators owner Eugene Melnyk, his case has helped prompt Canadian transplant officials to accept that public pleas for living organ donors are ethical, legal and even beneficial, under the right circumstances.

Melnyk was one of two high profile cases in 2015 (the other was the family of twin girls from Eastern Ontario, the Wagners) in which public pleas were made for a liver donor. Hundreds of people answered the call to donate parts of their livers to save Melnyk’s life. His eventual transplant was a success and both Melnyk and his anonymous donor — who was described only as a Senator’s fan — recovered. Little Binh Wagner also recovered from a successful liver transplanted from an anonymous donor (her twin sister received part of their father’s liver).

The cases raised ethical questions about the fairness of public pleas that tend to favour those with more compelling stories over others legitimately waiting for an organ transplant. They also highlighted the fact that there is no national policy on organ solicitation, a gap the Canadian Society of Transplantation, the Canadian National Transplant Research Program and the Canadian Blood Services hope to close with guidelines released this week.

The guidelines acknowledge that ethical questions remain, but note that the gap between supply and demand of organs and the availability of public platforms to easily make such pleas means those questions are going to continue.

Dr. Atul Humar, medical director of transplant at the University Health Networks in Toronto where Melnyk’s and Binh Wagner’s transplants were performed, said public solicitations are increasing, mainly because of easy access to social media and a shortage of organs to transplant. Earlier this year, Gianna-Lynn Favilla, an eight-year-old Russell girl, received a life-saving liver transplant after the family made a desperate public plea on her behalf. The donor was a neighbour and the father of Gianna-Lynn’s best friend.

At the end of 2014, 4,514 patients (3,473 for a kidney and 507 for a liver) were waiting for an organ in Canada. During the same year, 2,356 transplant procedures were performed and 278 patients died while on the waiting list."
"The issue has caused some soul searching among transplant officials in Canada and around the world. Some institutions have refused to transplant organs obtained from public solicitation and the practice is banned in Australia. Recently, European transplant officials came to a similar conclusion as the Canadian guidelines: “As long as donor shortage persists, we should not condemn patients, who do not have a live kidney donor, or only have a very slim chance of finding a suitable donor when they decide to publicly solicit for a live donor.”

Sunday, October 30, 2016

Tissue transplants and tissue banks

Solid organ donation gets more press, but tissue transplants and medical devices made from human tissue are big business. Here's a profile of a Virginia organ and tissue bank:
Hearts, lungs and kidneys recovered by LifeNet Health get the most attention, but tissue is the larger player, By Elizabeth Simpson, The Virginian-Pilot

"[Tissues] are used in a wide variety of ways: to reconstruct breasts after cancer treatment. To repair joints in knees and ankles. To treat wounds of diabetics suffering from foot ulcers. To bridge bones in spinal fusion surgeries.

Douglas Wilson, LifeNet Health’s executive vice president, puts it into perspective this way: In one month, LifeNet provides solid organs for 40 to 60 patients, most of whom live in Virginia. But in terms of tissue transplants, some 40,000 patients a month across the globe receive LifeNet bioimplants.

That branch powers the growth of LifeNet, a nonprofit in the burgeoning Princess Anne bioscience corridor with operating revenue that topped $200 million last year. Solid organ recoveries went from 385 in 2011 to 467 last year, and tissue transplants from 389,000 to 462,000.

LifeNet is one of 58 organ procurement organizations in the country, and one of more than 100 accredited tissue banks. By law, companies can’t sell human tissue, but they can charge fees for recovery, processing, storing and distributing tissue.

And LifeNet fiercely guards its techniques. In 2014, the organization took a rival tissue transplant company to court, saying it used LifeNet’s patented technology to preserve tissue grafts and bone.

A federal jury awarded nearly $35 million to LifeNet, a finding that was appealed by the New Jersey-based LifeCell Corp., but upheld by a federal appeals court last month.

Wilson expects the growth in the tissue transplant field – which includes both for-profits and nonprofits – to continue, considering a few trends:

More older people will experience worn-out knees, hips, tendons and spinal discs. Obesity rates will fuel more diabetes cases with ulcers that require tissue transplants. And there’s the explosive field of regenerative medicine, which focuses on replacing and regenerating human cells.

“We’re sending tissue to every state and 30 countries,” Wilson said. “Allografts are used in almost every hospital in the U.S.”

When technical specialist Craig Wolf came to work at LifeNet 28 years ago, he was one of 44 employees. The number now? Nearly 900. The company has 600 products, 60 patents and branch offices in Washington and Florida."

Saturday, October 29, 2016

Organ donation in Wales (where registration is now opt out)

Here's an early, optimistic report:
Organ donation rates have risen since the 'opt-out' system was introduced in Wales

"There has been a rise in the number of organs being donated by people in Wales since the new “opt out” law was put in place last year.

New figures from the Organ Donation Annual Report 2016 have revealed a 7% increase in the number of deceased donors donating in Welsh hospitals, up from 60 in 2014-15 to 64 in 2015-16.

Similarly, the number of donors after brain death increased by 13% to 36, while the number of donors after circulatory death remained the same at 28."
I can't actually find the full year figures through the end of their fiscal year, but here is
Organ Donation and Transplantation Activity Data: WALESAnnual data for financial years 2011/12 to 2014/15 and data for 2015/16 - first 3 quartersDate published: January 2016

Friday, October 28, 2016

NBER Market Design meeting at Stanford: Oct 28-9

Market Design Working Group Meeting
Michael Ostrovsky and Parag Pathak, Organizers
October 28-29, 2016
Koret-Taube Conference Center
Stanford University
366 Galvez Street
Stanford, CA
Friday, October 28

8:30 am
Continental Breakfast
9:00 am
Darrell Duffie, Stanford University and NBER
Haoxiang Zhu, Massachusetts Institute of Technology and NBER
Size Discovery
Ahmad Peivandi, Georgia State University
Participation and Unbiased Pricing in CDS Settlement Mechanisms
10:30 am
11:00 am
Hugo Hopenhayn, University of California at Los Angeles and NBER
Maryam Saeedi, Carnegie Mellon University
Bidding Dynamics in Auctions
12:30 pm
2:00 pm
Christina Aperjis, Power Auctions LLC
Lawrence Ausubel, University of Maryland
Oleg Baranov, University of Colorado Boulder
Thayer Morrill, North Carolina State University
Efficient Procurement Auctions with Increasing Returns
Tibor Heumann, Princeton University
Ascending Auctions with Multidimensional Signals
3:30 pm
4:00 pm
John Hatfield, University of Texas at Austin
Scott Duke Kominers, Harvard University
Hidden Substitutes

Paul Milgrom, Stanford University
Deferred Acceptance Auctions Without Substitutes
5:30 pm
6:30 pm
Il Fornaio Restaurant
520 Cowper Street
Palo Alto, CA

Saturday, October 29

8:30 am
Continental Breakfast
9:00 am
Gabriel Carroll, Stanford University
Ilya Segal, Stanford University
Robustly Optimal Auctions with Unknown Resale Opportunities
Songzi Du, Simon Fraser University
Robust Mechanisms Under Common Valuation
10:30 am
11:00 am
Shengwu Li, Stanford University
Obviously Strategy-Proof Mechanisms
Marek Pycia, University of California at Los Angeles
Peter Troyan, University of Virginia
Obvious Dominance and Random Priority
12:30 pm
2:00 pm
Benjamin Roth, Massachusetts Institute of Technology
Ran Shorrer, Pennsylvania State University
Making it Safe to Use Centralized Markets: Epsilon-Dominant Individual Rationality and Applications to Market Design
Michal Feldman, Hebrew University of Jerusalem
Nicole Immorlica, Northwestern University
Brendan Lucier, Microsoft Research
Tim Roughgarden, Stanford University
Vasilis Syrgkanis, Microsoft Research
Efficiency Guarantees in Large Markets
3:30 pm
4:00 pm
David Delacretaz, University of Melbourne
Scott Duke Kominers, Harvard University
Alexander Teytelboym, University of Oxford
Refugee Resettlement

Tommy Andersson, Lund University
Lars Ehlers, Université de Montréal
Assigning Refugees to Landlords in Sweden: Stable Maximum Matchings
5:30 pm

Thursday, October 27, 2016

Re-auction of Kenneth Wilson's, 1982 Nobel medal for Physics

The Nobel Prize medal awarded to physicist Kenneth G. Wilson in 1982 is up for auction, again. (Apparently its hard to pick an appropriate reservation price...)

Here's the current auction page:
Nobel Prize Awarded to Physicist Kenneth G. Wilson in 1982 -- One of the Kingpins of Quantum Physics, OCTOBER 2016 AUCTION ENDS THURSDAY, OCTOBER 27TH, 5PM PACIFIC
Minimum Bid:$95,000

Here's the previous auction (from the same auction house), which apparently didn't draw any bids:
Minimum Bid:$450,000
Final prices include buyers premium.:$0
Number Bids:0

Update: this auction apparently didn't draw any bids either:
Current Bidding
Minimum Bid:$220,000
Final prices include buyers premium.:$0
Number Bids:0

Auction closed on Thursday, October 27, 2016.

Wednesday, October 26, 2016

Matching patients to clinical trials

There are lots of clinical trials that a patient might be eligible for, but with many constraints on eligibility it isn't trivial to match patients to trials. has a story:
 Providers turn to technology to match patients to clinical trials

"Clinical trial recruitment has long been one of the most challenging areas of drug development, with the potential to add significant costs and delays. And as the medical field gains a greater understanding of cancer pathways and genomics, finding patients for these trials has become only more complex.

Now a number of technology companies are aiming to solve that problem by helping providers identify clinical trials for patients who might qualify.
"At any given time, there are as many as 180,000 ongoing clinical trials, each with its own specific inclusion and exclusion criteria. Meanwhile, physicians have only 15 minutes, in many cases, to explore these options with a patient"

HT: Itai Ashlagi

Tuesday, October 25, 2016

Los Altos High School STEM Week. Oct 25-27

Here's the program for the Los Altos High School STEM week.
I'll be speaking Wednesday morning.

Monday, October 24, 2016

New York City high school admissions, signaling 'demonstrated interest,' in The Atlantic

High school admissions in NYC may end with a (well designed) deferred acceptance algorithm, but the process starts long before students and some schools submit their preference lists. The Atlantic writes about how it is hard to form preferences over high schools, and to signal them to the schools through 'demonstrated interest'...

Broken Promise of New York City's High-School Admissions System
Its high-school fair is designed to give attendees a leg up in the application process—but that’s not always the case
(The URL is more informative than the headline: )

Sunday, October 23, 2016

Raj Chetty at the LSE: How Can We Improve Economic Opportunities for Low-Income Children?

Lionel Robbins Memorial Lecture Series

How Can We Improve Economic Opportunities for Low-Income Children?

Date: Monday 24th, Tuesday 25th and Wednesday 26th October 2016
Time: 18:30 - 20:00
Venue: LSE Old Theatre
Speaker: Professor Raj Chetty
In this series of lectures, Raj Chetty will discuss findings from the Equality of Opportunity Project, which uses big data to develop new answers to this important and timely policy question. The presentation will show how children's opportunities to climb the income ladder vary substantially depending upon where they grow up.It will then identify factors that contribute to this geographic variation in opportunities for upward mobility. The talks will conclude by offering policy lessons for how social mobility and economic opportunity can be increased in the next generation.
Lecture 1: The Geography of Intergenerational Mobility
(Chair: Prof. Steve Machin, CEP Director)
Lecture 2: Policies to Improve Upward Mobility
(Chair: Prof. Robin Burgess, IGC & STICERD, LSE)
Lecture 3: Upward Mobility, Innovation, and Economic Growth
(Chair: Prof. Henrik Kleven, CEP, IGC & STICERD, LSE)
About the speaker: Raj Chetty is a Professor of Economics at Stanford University. His research combines empirical evidence and economic theory to help design more effective government policies. His work on tax policy, unemployment insurance, and education has been widely cited in media outlets and Congressional testimony.
This event is free and open to all with no ticket or pre-registration required. Entry is on a first come, first served basis
For more information on how to attend, please visit the LSE Events office webpage at:

Saturday, October 22, 2016

Airbnb faces regulatory headwinds in NY

The FT has the story:
Airbnb faces fight for survival in New York City
Governor set to sign legislation likely to end start-up’s business in Big Apple

"The online service, which connects owners of homes and flats with tourists and other renters in cities around the world, has often clashed with regulators which accuse the company of facilitating illegal hotel businesses and reducing affordable housing stock.

In New York, hotel unions and New York City officials have been particularly vociferous on the company’s failure to comply with a 2010 accommodation law that banned short-term rentals in Manhattan, but which is rarely enforced.

On Wednesday, Airbnb said that it wanted to pay taxes in New York, estimating that it could generate about $90m a year in the state under its new registration scheme. The company also proposed a new “three strikes” rule that would permanently ban hosts who broke the 2010 law more than three times.

The company has already reached agreements on collecting and remitting taxes with many other cities, including Paris, its largest market. In New York City, Airbnb hosts 46,000 flats and homes.

Like other such Silicon Valley start-ups that have disrupted traditional business models, Airbnb has been forced, often through confrontation, to become more responsive to local regulators and interest groups as it expands."

And, after the governor signed the bill,
Airbnb Sues Over New Law Regulating New York Rentals
"Hours after Gov. Andrew M. Cuomo of New York signed a bill that would impose steep fines on Airbnb hosts who break local housing regulations, Airbnb filed a federal lawsuit contending the new law would cause it “irreparable harm.”

The heightened battle in New York follows lawsuits that Airbnb has filed against its hometown San Francisco and in Santa Monica, Calif., which have both moved to fine the company for illegal listings.

The company, which operates in a regulatory gray area around the globe, is also fighting tough battles in Amsterdam and Barcelona, Spain, which penalizes hosts who list illegal rentals, and in Berlin, which has banned most short-term rentals."

Soros on refugee resettlement as a matching problem

 George Soros on refugees, earlier this summer:
This is Europe’s Last Chance to Fix Its Refugee Policy
Foreign Policy Magazine, Jul 19, 2016

"Fifth, once refugees have been recognized, there needs to be a mechanism for relocating them within Europe in an agreed way. It will be crucial for the EU to fundamentally rethink the implementation of its stillborn resettlement and relocation programs; a tentative step in this direction was taken last week in new proposals put forth by the European Commission. The union cannot coerce either member states or refugees to participate in these programs. They must be voluntary; a matching scheme could elicit preferences from both refugees and receiving communities so that people end up where they want to be and where they are welcome. EASO has begun to develop such a matching scheme."

A somewhat shorter summary of his whole argument is here:
Saving Refugees to Save Europe

Friday, October 21, 2016

China, transplants, and executed prisoners: is the situation getting clearer?

A recent meeting in China cautiously suggests that there may be some concrete change in the practice of transplanting organs from executed prisoners:
Doctors hail China’s pledge to stop harvesting inmate organs

"Doctors from the World Health Organization and the Montreal-based Transplantation Society who were invited to the conference by China praised Chinese officials for reforms they have made in the transplant system, including a ban put in place last year on using organs from executed inmates.

"Doubts persist that China is accurately reporting figures or meeting its pledge given its severe shortage of organ donors and China’s long-standing black-market organ trade. By its own figures, China has one of the lowest rates of organ donation in the world, and even the system’s advocates say it needs hundreds of additional hospitals and doctors.

"While China suppresses most discussions about human rights, government officials and state media have publicly talked about their commitment to ending a practice opposed by doctors and human rights groups due to fears that it promotes executions and coercion.
"Others offered praise for Chinese officials, but stopped short of saying whether they could confirm China had stopped using executed inmates’ organs.

“It’s not a matter for us to prove to you that it’s zero,” said Dr. Francis Delmonico, a longtime surgeon and a professor at Harvard Medical School. “It’s a matter for the government to fulfill what is the law, just as it is in the other countries of the world that we go to.”

"China is believed to perform more executions than any other country, though the government does not disclose how many.

"The former vice minister of health, Dr. Huang Jiefu, publicly acknowledged in 2005 that China harvested executed inmates’ organs for transplant, and a paper he coauthored six years later reported that as many as 90 percent of Chinese transplant surgeries using organs from dead people came from those put to death.

"Huang has also responded to a report earlier this year that a Canadian patient apparently received a kidney from an executed inmate by announcing that the doctor and the hospital in question were suspended from performing more transplants."

Thursday, October 20, 2016

Normative Ethics and Welfare Economics at HBS, and Behavioral Ethics, also at HBS (at the same time:)

There are two (competing) conferences on ethics at Harvard this weekend, one on Friday and Saturday and the other on Friday, both at HBS.

I'll be speaking at this one:

2016 Normative Ethics and Welfare Economics Conference
October 21-22, Harvard Business School
Organizers: Itai Sher and Matt Weinzierl

All sessions will take place in the Chao Centerroom 340
Transportation to the HBS campus from the Hyatt Regency Cambridge Hotel will be provided.
Oct 21

A Harvard University shuttle bus will depart the Hyatt at 8:00 am




Opening Remarks


Population Ethics

Partha Dasgupta and Johann Frick
Discussant: Glen Weyl

Birth and Death
Socially Embedded Preferences, Environmental Externalities, and Reproductive Rights



Reasons and Preferences

Justin Snedegar and Itai Sher
Discussant: Caspar Hare

Overlapping Reasons

Comparative Value and the Weight of Reasons



Public Reason

Matt Weinzierl and Sean Ingham
Discussant: Lucas Stanczyk

A Dilemma for Theories of Public Reason
A Welfarist Role for Nonwelfarist Rules: An Example with Envy



Forbidden Transactions

Michael Sandel and Al Roth
Discussant: Stefanie Stantcheva



Dinner for Speakers & Discussants

Location TBA

Transportation will be provided
Oct 22

A Harvard University shuttle bus will depart the Hyatt at 8:00 am



Business Ethics




Behavioral Economics and Welfare Economics

John Doris, Julia Haas, and Dan Benjamin
Discussant: Ben Lockwood

Moral Psychonomics
Reconsidering Risk Aversion


1:30 - 3:00


Matthew Adler and Hilary Greaves
Discussant: Jerry Green

Justice, Claims and Prioritarianism: Room for Desert?



Closing Panel

Marc Fleurbaey, Dan Hausman, Greg Mankiw, Tim Scanlon
Moderator: Nathan Hendren


It turns out that there is a lot of interest in ethics at Harvard, and so there is another ethics conference at the same time, also meeting at HBS:

Symposium - "Behavioral Ethics: Philosophical and Psychological Perspectives" Featuring Peter Singer


Friday, October 21, 2016 (All day)

See also: Ethics


Spangler Auditorium, Harvard Business School

Organizers: Max Bazerman and Joshua Greene
Sponsors: Edmond J. Safra Center for Ethics, Harvard Business School, Center for Public Leadership at Harvard Kennedy School
This symposium will integrate psychology and philosophy to explore a goal state for ethical behavior, why we fail to achieve that goal state, and what society can do create more ethical behavior.
Event Participant Bios

9:30 a.m. - 10:00 a.m.
Danielle Allen and Max Bazerman

10:00 a.m. - 12:00 p.m.         
What does the greatest good look like in contemporary society?
Peter Singer, "What is the Most Good We Can Do?"
Joshua Greene, TBD
Steven Pinker, “Measuring and Defining Progress”

12:00 p.m. - 1:00 p.m.           
Lunch Break

1:15 p.m. - 2:45 p.m.             
Why don’t we get there?
Mahzarin Banaji, "The Difficulty with Discretion"
Fiery Cushman, “Is Non-Consequentialism a Feature or a Bug?”
Michael Norton, "Spreading the Wealth (and Health): Evidence for a Universal Desire for Greater Equality"
3:00 p.m. - 4:30 p.m.
What can be done to change behavior (nudging and beyond)?
Francesca Gino, “To Do or Not To Do: Motivating Ethical Behavior”
Iris Bohnet, "Gender Equality by Design"
Max Bazerman, "Prescriptions for Creating Greater Good"

4:30 p.m. - 4:45 p.m.             
Closing Statement
Max Bazerman

Wednesday, October 19, 2016

Foreign students recruited to Canadian Universities

Inside Higher Ed reports on concerns that universities' eagerness for high tuition payments is leading to unqualified students are being recruited:
Corruption in Higher Ed: Canada in the Crosshairs
It is overwhelmingly evident that there is a remarkable and callous disregard for academic ethics and standards in a scramble by Canadian universities to sign up foreign students.

"It is overwhelmingly evident that in the last two decades we have witnessed first-hand a remarkable and callous disregard for academic ethics and standards in a scramble by Canadian universities and colleges to sign up foreign students, who represent tens of millions of dollars to their bottom lines.
We have been in a school auditorium in China and listened to the school owner tell prospective parents that the Grade 12 marks from the Canadian provincial school board program can be manipulated to secure admission for their children into Canadian universities. This, while the Canadian teachers sat oblivious to the presentation in Chinese.
In hundreds of our own interaction with students who completed the Canadian provincial school board’s curriculum in China and who achieved grades of 70% and higher in their English class have been unable to achieve even a basic level of English literacy in the written tests we have administered.   But when the largest country of origin for incoming international students and revenue is China - the Canadian universities admitting these students salivate over the dollars and focus less on due diligence.
We were once asked by a university on Canada’s west coast to review 200 applications from Saudi Arabia, in order to identify the two or three Saudi students who were actually eligible for conditional admission to that university's undergraduate engineering program. But the proposal was scuttled by the university's ESL department that wanted all 200 to enroll in its language courses. It insisted on and managed conditional admissions for all 200. It’s common at Canadian universities for the ESL program “tail” to wag the campus “dog” when it comes to admissions. In fact, recent Canadian government regulations have been proposed to crack down on this practice as it is an affront to academic integrity."

Tuesday, October 18, 2016

Organ donation rates in Canada

"Despite the progress, Canada lags behind "top-tier" countries such as the U.S. and Spain, where deceased donation rates exceed 30 donors per million population. Canada's rate currently stands at 18.2 donors per million population, up from 14.1 for that measure in 2006.

Spain fostered a culture of donation over three decades and Canada is now embarking on creating one, said Dr. Peter Nickerson, vice-dean of research at the University of Manitoba and a medical adviser to CBS.

About 21 per cent of donations come after cardiac death, said Kimberly Young, director of donation and transplantation at CBS. Before those programs were implemented, most deceased organ donations occurred after catastrophic brain injury. Now organs can be donated after the heart stops.

Young also acknowledged the hundreds of Canadians who've chosen to become living donors, many without ever knowing the recipient.

The living donation rate hasn't increased in the past decade, Young said. One of the reasons it hasn't decreased, as in some countries, is due to the national paired kidney donation program. It pairs compatible donors, including those in different parts of the country. Doctors consider kidney donations the best treatment for end-stage kidney disease.

Lung transplants are in the top tier of comparable wealthy countries, thanks to pioneering research at lung retrieval centres such as Toronto General Hospital, Nickerson said. Likewise, liver donation rates are high. Heart access is relatively equal, he said.

There have also been significant improvements in access to transplants among those who have the hardest time finding a donor match because of a highly sensitive immune system. "

Monday, October 17, 2016

Who Gets What and Why, in Korean

Here is the Korean translation of my book Who Gets What and Why:
Who Gets What-and Why in Korean
Eun Jeong Heo tells me that the title in Korean is "Matching: a strong drive to uncover hidden markets"

Eun Jeong points me to these two URL's where you can buy the book:

Sunday, October 16, 2016

Two papers on repugnance and payments for body parts

Here's an NBER paper by Nicola Lacetera, which includes this in the acknowledgments: "I dedicate this paper to the memory of my friend Julia Fletcher, whose life could have been longer if a bone marrow match were found for her."

Incentives and Ethics in the Economics of Body Parts

Nicola Lacetera

NBER Working Paper No. 22673
Issued in September 2016
NBER Program(s):   HE      PE 

Research shows that properly devised economic incentives increase the supply of blood without hampering its safety; similar effects may be expected also for other body parts such as bone marrow and organs. These positive effects alone, however, do not necessarily justify the introduction of payments for supplying body parts; these activities concern contested commodities or repugnant transactions, i.e. societies may want to prevent certain ways to regulate a transaction even if they increased supply, because of ethical concerns. When transactions concern contested commodities, therefore, societies often face trade-offs between the efficiency-enhancing effects of trades mediated by a monetary price, and the moral opposition to the provision of these payments. In this essay, I first describe and discuss the current debate on the role of moral repugnance in controversial markets, with a focus on markets for organs, tissues, blood and plasma. I then report on recent studies focused on understanding the trade-offs that individuals face when forming their opinions about how a society should organize certain transactions.


And here's another, by Julio J. Elias, Nicola Lacetera, and Mario Macis

Efficiency-Morality Trade-Offs in Repugnant Transactions: A Choice Experiment

Julio J. EliasNicola LaceteraMario Macis

NBER Working Paper No. 22632
Issued in September 2016
NBER Program(s):   HE   LE   PE 
Societies prohibit many transactions considered morally repugnant, although potentially efficiency-enhancing. We conducted an online choice experiment to characterize preferences for the morality and efficiency of payments to kidney donors. Preferences were heterogeneous, ranging from deontological to strongly consequentialist; the median respondent would support payments by a public agency if they increased the annual kidney supply by six percentage points, and private transactions for a thirty percentage-point increase. Fairness concerns drive this difference. Our findings suggest that cost-benefit considerations affect the acceptance of morally controversial transactions, and imply that trial studies of the effects of payments would inform the public debate.

Saturday, October 15, 2016

A look into how transplant centers are monitored (and organs are allocated)

Here's a press release saying that the University of Pittsburgh's iconic transplant center has been taken off probation by UNOS. The reason they were on probation is interesting:
University of Pittsburgh Medical Center released from probation

"The Board had placed UPMC on probation in June 2015. Its lung transplant program had an unusually high number of instances where they accepted lung offers for one transplant candidate, then transplanted another candidate at the program. This inappropriately limited opportunity for consideration of other candidates identified on the match run."

Friday, October 14, 2016

A kidney donor at 18 who is now a medical student feels he didn't give sufficiently informed consent (and some reactions)

Here's the story in the Washington Post: At 18 years old, he donated a kidney. Now, he regrets it.

"Five years after the surgery, when I was 23 and getting ready to go to medical school, I began working in a research lab that was looking at kidney donors who had gone on to develop kidney failure. For that research, I talked to more than 100 such donors. In some cases, the remaining kidneys failed; in others, the organ became injured or developed cancer. The more I learned, the more nervous I became about the logic of my decision at age 18 to donate.
"And then in 2014, a study looking at long-term risks for kidney donors found that they had a greater risk of developing end-stage renal disease. Another study that same year raised the possibility that they may face a heightened risk of dying of cardiovascular disease and all-cause mortality (although this point remains controversial).
"Other studies and surveys, though, suggest that the risk, while greater, isstill fairly small.
"The truth is, it is hard to get good numbers about what happens to donors. Hospitals are required to follow them for only two years post-donation, which does not catch such long-term complications as chronic kidney disease, cardiovascular issues or psychiatric issues. There is no national registry for kidney donors or other large-scale means of tracking long-term outcomes."

Response to living kidney donation regret Washington Post news story

CATEGORIES // General InterestUNOS News
Response to living kidney donation regret Washington Post news story
A recent news story appearing in the Washington Post talked about an 18 year old living kidney donor's concerns and regret for that donation.  In a response to that, TRIO board member, Josh Morrison, offers his own thoughts on that concern based on his altruistic living kidney donation.  Photo is of Josh and his unrelated recipient, John, whose story is shared in Josh's article linked below (along with a link to the original 'regret' story).

Here's a different take on nondirected donation (and the resulting chains...)
These six people donated their kidneys to complete strangers and saved 140 lives in the process — here’s why

Thursday, October 13, 2016

Nondirected donor kidney exchange chains come to the UK

In the U.S., many kidney exchange transplants now occur in chains begun by nondirected donors. Rule changes in Britain may allow transplants to increase this way too

Progress is being made in kidney exchange in the UK. The Mirror has the story:
Kidney 'triple transplant chain' rule change brings hope to thousands and has already saved 48 people

"Rule changes last year mean more healthy kidneys are available – bringing fresh hope to ­thousands of patients on the waiting list.

"From April 2015, it became possible for a stranger to give up a kidney and spark a series of donations. We have discovered that for each of 16 such donations, three people received a transplant.

"Previously, the chain was limited to two people who were in the National Living Donor Sharing Scheme, set up to allow pooling of organs from willing donors not a match for their own sick loved ones.

"Under triple transplant chains, a stranger’s kidney is allocated to the first recipient, a patient who is enrolled in the sharing scheme.

"In turn, the first recipient’s friend or relative, who wants to donate to their loved one but cannot because they are not a match, donates to another patient in the scheme, the second recipient.
"Any adult can ­volunteer to be ­considered an altruistic donor. You must be over 18 in England, Northern Ireland and Wales, and over 16 in Scotland.
The 16 Brits who gave their kidneys to patients they did not know first had several months of physical and psychological tests at their local transplant centre to ensure they were able to safely donate, and to confirm which recipients would be a suitable match."