Saturday, September 30, 2017

More on kidney transplantation and kidney exchange in Mexico

In La Prensa: Donación de órganos, insuficiente en México

From Google translate:
"Arturo Dib Kuri, director general of Pro-Renal and pioneer of the transplant program in Mexico, reported that the cadaveric donation in Mexico, despite the efforts that have been made to promote it, does not reach more than 400 donations a year, which is totally insufficient for the 13 thousand patients on the waiting list.
"He indicated that, according to INEGI, 120,000 Mexicans suffer from renal insufficiency, which places it as the fifth cause of death in Mexico.

"Érick Vélez, for his part, explained that chronic renal failure is a progressive disease, caused mainly by diabetes and hypertension. He reported that in Mexico there are about 60 thousand people in dialysis treatment, which translates into an economic cost of 250 thousand dollars annually, in a comparison between public, social and private hospitals.

"Meanwhile, Dr. Dib Kuri noted that only 24% of patients manage to access an organ annually through two channels: 1) cadaveric donation and 2) donation among compatible living people.

"Dib Kuri said that 1 in 3 Mexicans who require a kidney transplant, has a family member or close friend willing to donate a kidney voluntarily.

"However, the procedure can not be completed because recipient and donor are genetically incompatible, which generates a great feeling of frustration.

"He said that finding genetically identical or similar beings is extremely difficult, but currently in Pro-Renal uses an algorithm, which can identify highly compatible donors, "almost as if it were a twin brother."

"This is a third way to carry out the renal transplantation called Donation Renal [kidney exchange], a novel alternative that, through technology, allows pairs of patients and their incompatible donors, can identify and find other couples in the same situation , with which they are compatible, said the specialist.

"Such a procedure works thanks to a sophisticated Compatibility Algorithm, which allows the analysis of hundreds of genetic variables to accurately determine the genetic match between individuals, even among unknown, unrelated individuals located in different geographic locations.
"He mentioned that Pro-Renal AC works hand in hand with the Alliance for Paired Kidney Donation, the pioneering organization in the field that has more than 3,500 registered couples and experience of more than 350 transplants performed."

Friday, September 29, 2017

Interviewing in matching markets by Robin Lee and Michael Schwarz

We still know too little about interviewing as a part of matching markets, but here's a paper (that has been around for a while but is now published) that takes an interesting approach.

By:Lee, RS (Lee, Robin S.); Schwarz, M (Schwarz, Michael)
Volume: 48   
Pages: 835-855
DOI: 10.1111/1756-2171.12193

We introduce the interview assignment problem, which generalizes classic one-to-one matching models by introducing a stage of costly information acquisition. Firms learn preferences over workers via costly interviews. Even if all firms and workers conduct the same number of interviews, realized unemployment depends also on the extent to which agents share common interviewing partners. We introduce the concept of overlap that captures this notion and prove that unemployment is minimized with perfect overlap: that is, if two firms interview any common worker, they interview the exact same set of workers.

Thursday, September 28, 2017

Restricting choice to improve matching by Yash Kanoria and Daniela Saban

Congestion, sometimes in the form of search costs, is a big deal in many matching markets.  Here are some interesting thoughts on that...

Facilitating the Search for Partners on Matching Platforms: Restricting Agents' Actions

71 Pages Posted: 22 Jul 2017  

Yash Kanoria

Columbia Business School - Decision Risk and Operations

Daniela Saban

Stanford Graduate School of Business
Two-sided matching platforms, such as those for labor, accommodation, dating, and taxi hailing, can control and optimize over many aspects of the search for partners. To understand how the search for partners should be designed, we consider a dynamic two-sided search model with strategic agents who must spend a cost to discover their value for each potential partner. We find that in many settings, the platform can mitigate wasteful search effort by restricting what agents can see/do. Surprisingly, simple restrictions can improve social welfare even when screening costs are small, and agents on each side are ex-ante homogeneous. In asymmetric markets where agents on one side have a tendency to be more selective (due to smaller screening costs or greater market power), the platform should force the more selective side of the market to reach out first, by explicitly disallowing the less selective side from doing so. This allows the agents on the less selective side to exercise more choice in equilibrium. When agents are vertically differentiated, the platform can significantly improve welfare even in the limit of vanishing screening costs, by forcing one side of the market to propose and by hiding quality information. Furthermore, a Pareto improvement in welfare is possible in this limit.

Wednesday, September 27, 2017

Kidney exchange in Europe: 3rd Workshop of the European Network for Collaboration in Kidney Exchange Programmes (ENCKEP)

 The international participation in this conference is a sign of the growing reach of kidney exchange:

3rd Workshop of the European Network for Collaboration in Kidney Exchange Programmes (ENCKEP)

Thursday, September 28, 2017
9h15 Registration
09h40 Welcome and Introduction

10h10 Ruthanne Leishman (UNOS)

10h55 Lisa Burnapp and Rachel Johnson (desensitisation)

11h15 Coffee break

11h45 Joke Roodnat (Dutch KEP)

12h15 Tommy Andersson (Swedish KEP and STEP update)

13h00 Lunch (at workshop venue)

14h30 Round-table: Barriers to Establishing KEPs
Facilitator: Lisa Burnapp (UK)
Participants: Eyjólfur Ásgeirsson (Iceland)
Haris Gavranovic (Bosnia and Herzegovina)
Balázs Nemes (Hungary)
Axel Rahmel (Germany)
Mikko Salonen (Finland)

16h00 Coffee break

16h30 David Manlove (UK KEP)

17h00 Bart Smeulders (Belgian KEP)

17h20 María Valentín and Francesc Castro" (Spanish KEP)

18h00 Close

Friday, September 29, 2017

09h30 Christian Jacquelinet (French KEP)

10h00 Xenia Klimentova (Portuguese KEP)

10h30 Pavel Chromy / Jiri Fronek (Czech/Austrian KEP)

11h00 Rafal Kieszek (Polish KEP)

11:30 Coffee break

12h00 Discussion: Next handbook, Skype Joris, Global Kidney Exchange, Financial Aspects of KEPs, ...

OCT 12 Drinks & Debate: How can NYC's high school admissions process be more fair? by Chalkbeat

Here's an invitation to a discussion of NYC's highschool admission system, and some of the admissions criteria of particular schools: OCT 12 Drinks & Debate: How can NYC's high school admissions process be more fair?  by Chalkbeat

New York City’s high school system is built on choice, but in reality many of the city’s low-income students of color are shut out of its top schools.
Now, the city is trying to figure out how to give more students a fair shot — and in the process make schools more diverse. Chalkbeat NY has been following this story closely, and now we’re inviting people from across the system to join us in a conversation about what can be done to improve this process.
Catch up with our reporters and connect with others who care about New York City schools at this solutions-oriented panel discussion and networking event. Your $17 ticket donation supports Chalkbeat, and drinks and appetizers are on us! (Two drink tickets for either beer or wine will be provided to guests over 21 years old.)
Happy hour will begin at 6 p.m., followed by a panel discussion at 6:45 with additional time for mingling once the panel wraps.
We look forward to seeing you there!


Amy Basile, Executive Director of High School Admissions
- Monica Disare, 
Chalkbeat NY reporter (moderator)
- Tanesha Grant, 
Harlem-based parent of a 9th grader at Urban Assembly School for the Performing Arts
- Jennifer Jennings, Professor of Sociology and Public Affairs at Princeton who studied New York City's high school admissions process
Holliday Senquiz, 9th grade student at Repertory Company High School for Theatre Arts
- Rhea Wong, Executive Director of Breakthrough NY- Lianna Wright, Executive Director of Enrollment Research and Policy
Here's a related blog post, with some links, that gives the current system a pretty good review:The New York City High School Application Process: Is It Fair to Students? Can It Be Improved?

Tuesday, September 26, 2017

Monday, September 25, 2017

Decriminalization of narcotics in Portugal, an update

Kristof in the NYT on narcotics policy and outcomes in Portugal:
How to Win a War on Drugs: Portugal treats addiction as a disease, not a

"Decades ago, the United States and Portugal both struggled with illicit drugs and took decisive action — in diametrically opposite directions. The U.S. cracked down vigorously, spending billions of dollars incarcerating drug users. In contrast, Portugal undertook a monumental experiment: It decriminalized the use of all drugs in 2001, even heroin and cocaine, and unleashed a major public health campaign to tackle addiction. Ever since in Portugal, drug addiction has been treated more as a medical challenge than as a criminal justice issue.

"After more than 15 years, it’s clear which approach worked better. The United States drug policy failed spectacularly, with about as many Americans dying last year of overdoses — around 64,000 — as were killed in the Vietnam, Afghanistan and Iraq Wars combined.
"The number of Portuguese dying from overdoses plunged more than 85 percent before rising a bit in the aftermath of the European economic crisis of recent years. Even so, Portugal’s drug mortality rate is the lowest in Western Europe — one-tenth the rate of Britain or Denmark — and about one-fiftieth the latest number for the U.S."

Sunday, September 24, 2017

Kidney exchange in Aussie TV

Pablo Guillen watches TV in Sydney, and sent me this link to a show featuring kidney exchange:

Saturday, September 23, 2017

Tributes to Ken Arrow

September 22, 2017

In Remembrance of Kenneth Arrow

Tributes in remembrance of Kenneth Arrow have been posted .
Kenneth J. Arrow, Elected 1951, President 1956

Kenneth Arrow's Contributions to Social Choice Theory by Eric Maskin

Kenneth Arrow's Contributions to General Equilibrium by John Geanakoplos

Kenneth Arrow's Work on Coping with Risk and Uncertainty by Menahem Yaari

Kenneth Arrow on Public Goods, Public Policy, and Environmental Economics by Partha Dasgupta

Friday, September 22, 2017

Broken Chains and Reneging: rare and not very consequential

By:Cowan, N ; Gritsch, HA; Nassiri, N; Sinacore, J; Veale, J
Volume: 17   
Issue: 9   
Pages: 2451-2457
DOI: 10.1111/ajt.14343  Published: SEP 2017
Concerns regarding the potential for broken chains and "reneges" within kidney paired donation (KPD) and its effect on chain length have been raised previously. Although these concerns have been tested in simulation studies, real- world data have yet to be evaluated. The purpose of this study was to evaluate the actual rate and causes of broken chains within a large KPD program. All patients undergoing renal transplantation through the National Kidney Registry from 2008 through May 2016 were included for analysis. Broken chains and loops were identified. A total of 344 chains and 78 loops were completed during the study period, yielding a total of 1748 transplants. Twenty broken chains and one broken loop were identified. The mean chain length (number of transplants) within broken chains was 4.8 compared with 4.6 of completed chains (p = 0.78). The most common causes of a broken chain were donor medical issues incurred while acting as a bridge donor (n = 8), donors electing not to proceed (n = 6), and kidneys being declined by the recipient surgeon (n = 4). All recipients involved in a broken chain subsequently received a transplant. Based on the results, broken chains are infrequent, are rarely due to lack of donor motivation, and have no significant impact on chain length.

Thursday, September 21, 2017

The private equity junior labor market continues to unravel

Eric Budish points me to the annual story, which seems to be published earlier each year, about the race for young talent in private equity:

Private Equity Prowls for Young Bankers Early in Frenetic Ritual
Job offers can ‘explode’ at midnight as buyout firms compete

"Junior analysts a few weeks on the job can now expect a flurry of emails from headhunters for some of the most prestigious private equity firms in the world. The jobs they’re being recruited for can pay more than $200,000 a year and won’t start until 2019. The battle to hire the best of them is fiercer, and more urgent, than ever.

"Buyout firms are tapping junior bankers earlier -- advancing the annual recruiting cycle, the industry’s biggest window of hiring, for the fifth consecutive year after an agreement to hold back fell apart.
"During the most recent cycle, formal interviews started in January...

"That was the earliest recruiting start ever -- about two weeks sooner than the previous year, and a full three months sooner than in 2013, when the major private equity firms stopped cooperating on timing after some broke out to recruit early.
"The majority of the mega-funds fill up their spots within 96 hours...
"Going forward, there’s no telling how much sooner the recruitment schedule will creep. But one effect is becoming permanent, said Grauer: candidates don’t have much work experience to discuss in their interviews anymore.

“I’d like to think we’ve gotten to a point where it doesn’t get earlier,” Grauer said, adding that interviewees today don’t often know what they want professionally in the long term. “The days when they were able to talk about all their transactions are gone.”

Wednesday, September 20, 2017

Hurricanes and price gouging (and watermelon)

Accusations of price gouging don't just concern food and water and plywood and gasoline: nowadays we evacuate by airplane as well. But last minute bookings are always expensive...

Airlines Face Criticism Amid Irma Price-Gouging Complaints
"Florida residents have been logging their compaints about unfair pricing of items like water and gasoline, along with airfares, with the office of Pam Bondi, the attorney general of Florida. There have been more than 7,000 since Monday, the attorney general said on Friday.
In their letter to Transportation Secretary Chao, Senators Blumenthal and Markey wrote:
“Airlines certainly have a right to a reasonable return for services rendered and vagaries in pricing are to be expected; but airlines have no right to impose exorbitant, unfair prices on Americans simply trying to get out of harm’s way.”
Florida Representative Charlie Crist also wrote a letter to Ms. Chao, calling for an investigation of United Airlines after receiving several complaints over airfare increases.
"“If there’s any gouge, it’s just the last minute walk-up airfares that are designed for desperate business fliers,” Mr. Hobica said. “It’s just the computer programs doing what they do when it’s last minute and seats are scarce.”
Delta, the target of the initial viral complaint, has denied changing its pricing structure leading up to Irma’s arrival and has capped its one-way fares out of South Florida at $399 through Sept. 13 (other airlines like JetBlue lowered one-way fares to as low as $99.) "
I've never been able to track down if it's a true story, but I've heard over the years of some hurricane in which people both lined up to buy some essential good at a very high price, and then clapped when the police showed up to arrest the purveyors for price gouging and confiscate the goods.
Stephanie Wang points me to this second or third hand account, where the good in question is ice.

They Clapped: Can Price-Gouging Laws Prohibit Scarcity?

Here are two recent articles, con and pro on raising prices in an emergency (they both have a picture of empty shelves...)

Memo to economists defending price gouging in a disaster: It's still wrong, morally and economically  by 

Price Gouging Can Be a Type of Hurricane Aid
Higher prices can help resources get to the people who need them most.
by Tyler Cowen

Of course, not all accusations of price gouging arise from emergencies. Consider the watermelon. The Jordan Times has the story:
Petra diner closed temporarily for ‘overpricing melon’  Photo of fat bill goes viral, triggers anger, mockery

"AMMAN — The Petra Development and Tourism Region Authority (PDTRA) on Wednesday decided to extend the closure of a tourist restaurant over an over-priced bill of a watermelon.

"A photo of the bill went viral on social media sites, triggering both angry reactions and mockery.

"PDTRA President Mohammad Nawafleh told The Jordan Times on Thursday that the restaurant, whose rent contract had already expired on July 15, will be closed for two months for selling a water melon for an unreasonably high price and serving food items that are not listed on its menu.
"Commenting on the issue, Tourism Expert Sami Hasanat said that such overpricing would harm the “already deteriorating” sector in the Kingdom.

"Authorities have to ensure that prices are always within the “reasonable” levels, as prices would affect the turnout of tourists, added Hasanat, a former MP."

Tuesday, September 19, 2017

Marijuana in California: will the illegal market coexist with the legal market?

"California, which by one estimate produces seven times more marijuana than it consumes, will probably continue to be a major exporter — illegally — to other states. In part, that is because of the huge incentive to stay in the black market: marijuana on the East Coast sells for several times more than in California."

That's from the NY Times article
Legal Marijuana Is Almost Here. If Only Pot Farmers Were on Board

Monday, September 18, 2017

School choice in Chile (deferred acceptance algorithm)

There are new school choice systems being used this year in Chile, based on the deferred acceptance algorithm.

"La ciencia detrás del nuevo sistema--
Algoritmo promete terminar con filas y discriminación en la admisión escolar")

(Google Translate: The science behind the new system--
Algorithm promises to end rows and discrimination on school admission)

Here's a sentence that gives an indication of the old system the new school choice system replaces (courtesy of Google Translate):
"What is changing is the night and the long lines because it is a centralized postulation system that guarantees that all those who register in the agreed term do not have to queue and can apply from home."

Sunday, September 17, 2017

Yemenis selling kidneys in Egypt: Al Jazeera

Al Jazeera has the (nuanced) story:
Desperate Yemenis sell organs to survive
Victims of trafficking rings say the networks operate anonymously in shisha bars and coffee shops in Yemen and Egypt.

"Ali - who is unemployed, divorced and in his early thirties - recently found himself facing a stark choice. He could either sign up to fight with the Houthi rebels on the front lines of the war in Yemen, seek work in neighbouring Saudi Arabia, or sell his organs.

"There are no jobs, and my wife left me for another man," Ali said despondently from his postoperative bed in Yemen's Bani Matar district, southwest of the capital Sanaa.

"After more than two years of war, many working-class Yemenis have turned to selling grocery items and khat - a mild, chewable narcotic - to make a meagre living. Others have opted to sell their organs to survive.
"Ali said that the doctor who performed his operation did not warn him of the potential consequences and there was no postoperative care. Patients are compelled to sign a contract that states, "It is not our responsibility if complications arise after the surgery," he added.

"Once the surgery was done, and I received the money, I was on my own," Ali said.
"A few operations are done in big hospitals with proper medical care; the majority are done in unlicensed or makeshift operation theatres with inadequate equipment or staff, Maqtari added. Only 45 percent of the healthcare facilities in Yemen are fully functional.
"As Yemen's war drags on, the future is anything but certain. But for Adnan Ali, who will soon enter his second marriage with the woman of his dreams and launch a taxi service, there are signs of a brighter future.

"Arrangements are under way for the wedding," he said, "and I am planning to buy a car to run a taxi."

Saturday, September 16, 2017

Sven Seuken appointed Chief Economist of BandwidthX

Here's the press release:

BandwidthX Appoints Sven Seuken as Chief Economist
Prof. Seuken’s appointment underlines the importance of market design in BxMarket

"BandwidthX, the operator of the cloud-based mobile data market, today announces Prof. Sven Seuken as its Chief Economist. Professor Seuken is one of the world's experts in electronic market design. He is a tenured Associate Professor of Computation and Economics at the University of Zurich in Switzerland where he supervises a team of seven PhD students and Postdocs, conducting research on market design topics. At BandwidthX, Professor Seuken enjoys a broad mandate including the design and analysis of market mechanisms and trading rules to drive new efficiencies in BxMarket. The appointment comes at an exciting moment as BandwidthX is expanding its platform across various data networks and global offerings.

"Professor Seuken holds a PhD in Computer Science from Harvard University. Since 2006, he has been conducting research on electronic market design. His main focus lies on designing marketplaces with complex combinatorial constraints. Applications he has worked on include peer-to-peer backup markets, electricity markets, matching markets, spectrum auctions, data markets, financial markets, cloud computing markets, and bandwidth markets.  Prof. Seuken has received several awards, including a Google Faculty Research Award, a Microsoft Research PhD Fellowship, and a Fulbright Fellowship."
"BandwidthX operates an advanced connection management service and a cloud-based marketplace where both Mobile Operators and Network Service Providers can define their value for data capacity in real time and are automatically matched when their values align. BxMarket gives the Mobile Operators incremental data capacity at lower cost, while allowing the Network Service Providers to profit from new revenue streams from their underutilized data networks. With this new form of micro-commerce, everyone in the mobile data ecosystem wins: from Mobile Operators and Network Service Providers to equipment and software vendors, aggregators and financial clearing companies and, of course, the end user of the device. Learn more about BandwidthX at

Friday, September 15, 2017

An optimistic view of transplants in China from the Washington Post

I've written a number of posts linking to optimistic stories about China's move away from using executed prisoners as sources of organs for transplants, and others expressing some skepticism. The Washington Post has some elements of reporting that indicates that they explored and discounted some of the reasons for skepticism, so I think this is the most credibly optimistic assessment I've seen to date.

Here's the Washington Post story:
China used to harvest organs from prisoners. Under pressure, that practice is finally ending.

"China had more than 600 organ transplant centers in a sprawling, unregulated system. That number was whittled down to about 160 registered and approved centers in 2007, when legislation was also introduced to outlaw organ trafficking and ban foreigners from coming to the country to receive Chinese organs.
"Chinese law does not explicitly rule out using organs of prisoners condemned to death by the criminal courts, and Huang himself was quoted in Chinese media in late 2014 and early 2015 as saying prisoners could “voluntarily” donate organs.
Huang now disavows those comments, insisting there is “zero tolerance” for using any prisoners’ organs in the hospital system. But in a country of 1.3 billion people, he said at a Vatican conference in February, “I am sure, definitely, there is some violation of the law.”
Lawyer Yu Wensheng said that one of his clients had shared a Beijing prison cell with a man facing the death penalty last November and that the condemned man was given a form to sign to “voluntarily” donate his organs.
Death-row prisoners, he said, were “given the choice not to sign the forms, but they would receive much more mistreatment and suffer much more. If they sign, their last days of life would pass more easily.”
Yet the supply of organs from executed prisoners seems to have been drying up because the number of death sentences appears to have fallen dramatically after a 2007 mandate requiring the Supreme Court to review all capital cases."
"Transplant patients must take immunosuppressant drugs for life to prevent their bodies from rejecting their transplanted organs. Data compiled by Quintiles IMS, an American health-care-information company, and supplied to The Post, shows China’s share of global demand for immunosuppressants is roughly in line with the proportion of the world’s transplants China says it carries out.
Xu Jiapeng, an account manager at Quintiles IMS in Beijing, said the data included Chinese generic drugs. It was “unthinkable,” he said, that China was operating a clandestine system that the data did not pick up.
Critics counter that China may also be secretly serving large numbers of foreign transplant tourists, whose use of immunosuppressant drugs would not appear in Chinese data. But this assertion does not stand up to scrutiny.
Jose Nuñez, head of the transplantation program at the World Health Organization, which collects information on transplants worldwide, says that in 2015 the number of foreigners going to China for transplants was “really very low,” compared with the traffic to India, Pakistan or the United States, or in comparison with transplant-visitor numbers in China’s past.
Chapman and Millis say it is “not plausible” that China could be doing many times more transplants than, for instance, the United States, where about 24,000 transplants take place every year, without that information leaking out as it did when China used condemned prisoners’ organs.
And lawyers who have defended Falun Gong practitioners also reject allegations that those prisoners’ organs are being harvested.
“I have never heard of organs being taken from live prisoners,” said Liang Xiaojun, who said he had defended 300 to 400 Falun Gong practitioners in civil cases and knew of only three or four deaths in prison.
In China, despite state repression, family members can be determined in speaking out and seeking justice when relatives vanish.
If tens of thousands of Falun Gong practitioners were being executed every year, that information would emerge, experts say.
A U.S. congressional commission on China, the State Department and the Falun Gong community website have separately tried to estimate the number of political prisoners in China, and the figures range from 1,397 to “tens of thousands” — and even that upper number is significantly lower than the 500,000 to 1 million claimed by Gutmann and others."

Thursday, September 14, 2017

An Invitation to Market Design by Kominers, Teytelboym and Crawford

Scott, Alex and Vince have written an introduction to what I gather is a special issue of the Oxford Review of Economic Policy devoted to market design.  It is also a concise and easy to read introduction to the field, with some guesses about where we're going.

An Invitation to Market Design
Scott Duke Kominers, Alexander Teytelboym, Vincent P. Crawford
 September 4, 2017

Abstract: Market design seeks to translate economic theory and analysis into practical solutions to real-world problems. By redesigning both the rules that guide market transactions and the infrastructure that enables those transactions to take place, market designers can address a broad range of market failures. In this paper, we illustrate the process and power of market design through three examples: the design of medical residency matching programs; a scrip system to allocate food donations to food banks; and the recent “Incentive Auction” that reallocated wireless spectrum from television broadcasters to telecoms. Our lead examples show how effective market design can encourage participation, reduce gaming, and aggregate information, in order to improve liquidity, efficiency, and equity in markets. We also discuss a number of fruitful applications of market design in other areas of economic and public policy

Wednesday, September 13, 2017

Kidney exchange proposed for Qatar

Here's a story from the Gulf Times.

Kidney donation: Qatar study reveals incompatibility

"Kidney Paired Donation (KPD) has emerged as an attractive option for donor-recipient pairs who are not immunologically compatible with each other.
The study 'Safe and ethical living kidney donation in Qatar: A national health system’s approach', recently appeared on Qatar Medical Journal which is part of the publications on, an online publishing platform from Hamad Bin Khalifa University Press.
The study was conducted by three Hamad Medical Corporation (HMC) officials, Mohamed Asim, Yousuf al-Maslamani, and Hassan al-Malki.
The study suggests that establishment of a national KPD registry and perhaps a unified registry in the Gulf region will have the potential to maximise living donor transplant rates. Collaboration with international societies such as Transplantation Society, International Society of Nephrology, and European Society for Organ Transplantation would facilitate the establishment of desensitisation and KPD programmes to optimise living kidney transplantation in Qatar.
Successful implementation of these programmes will invariably require resources and expertise and in return, it will ensure that maximum number of LKDs achieve their noble ambition.
The study highlights that LKDs are a unique group of people who should be carefully and respectfully evaluated to determine their suitability for donation.
As per the study, HMC offers a culturally and linguistically tailored living kidney transplant programme that focuses on protecting the rights and best interests of the LKDs. The programme’s legal and policy framework prohibits organ commercialism while providing a safe, supportive, and compassionate environment for those who come forward.
The study also points out that incidence of dialysis therapy for end-stage renal disease in Qatar has increased from 82 per million population in 2013 to 104 in 2016. The increasing incidence of end-stage kidney disease in Qatar has led to growing demand for donor kidneys.
The deceased donor kidney programme has yet to achieve its full potential. Although many of the barriers to deceased donor transplantation related to legislation and infrastructure have been overcome, unfavourable public attitudes toward deceased organ donation still prevail, leading to desperately low consent rates for organ donation.
Hence, living kidney donation has been widely adopted as an appropriate alternative. The reliance on living kidney donors however, raises a number of social, ethical, and legal concerns surrounding informed consent, voluntarism, psychosocial evaluation, perioperative care, and long-term follow-up of the donors. Many of these concerns become heightened in a multicultural, multilingual society such as Qatar, the study says."

Tuesday, September 12, 2017

Global kidney exchange and repugnance in the AJT: comments and replies

The forthcoming issue of the American Journal of Transplantation is going to have a number of conflicting views about Global Kidney Exchange (GKE).  Just as yesterday's post showed how Kidney Exchange faced some repugnance at the turn of this century, these interactions show that GKE will have to overcome some repugnance too. (I just returned from Geneva where I talked about GKE among other things, in an attempt to start bridging this divide.)

It all started with our article proposing GKE and reporting the case of a Philippine patient-donor pair, which came out in March, along with an accompanying editorial suggesting that maybe the whole idea is repugnant.

Here's the original article:

Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation
by M. A. Rees, T. B. Dunn, C. S. Kuhr, C. L. Marsh, J. Rogers, S. E. Rees, A. Cicero, L. J. Reece, A. E. Roth, O. Ekwenna, D. E. Fumo, K. D. Krawiec, J. E. Kopke, S. Jain, M. Tan, S. R. Paloyo
American Journal of Transplantation, Volume 17, Issue 3 March 2017, Pages 782–790

And here's the accompanying editorial:
Walking a Tightrope or Blazing a Trail?
by A. C. Wiseman, J. S. Gill

Here is our forthcoming reply to the editorial
Global kidney exchange: Financially incompatible pairs are not transplantable compatible pairs
M. A. Rees, S. R. Paloyo, A. E. Roth, K. D. Krawiec, O. Ekwenna, C. L. Marsh, A. J. Wenig and T. B. Dunn
Version of Record online: 1 SEP 2017 | DOI: 10.1111/

And here is a letter saying that GKE is essentially organ trafficking…

Francis L. Delmonico and Nancy L. Ascher
Accepted manuscript online: 21 AUG 2017 09:05AM EST | DOI: 10.1111/ajt.14473
·        Abstract  Article  PDF(63K)

And our replies:

You have free access to this content
People should not be banned from transplantation only because of their country of origin
Alvin E. Roth, Kimberly D. Krawiec, Siegfredo Paloyo, Obi Ekwenna, Christopher L. Marsh, Alexandra J. Wenig, Ty B. Dunn and Michael A. Rees
Accepted manuscript online: 1 SEP 2017 09:25AM EST | DOI: 10.1111/ajt.14485

  1. You have free access to this content
    Open dialogue between professionals with different opinions builds the best policy
    Ignazio R. Marino, Alvin E. Roth, Michael A. Rees and Cataldo Doria
    Version of Record online: 11 SEP 2017 | DOI: 10.1111/ajt.14484
  2. Here's the text of the Roth et al. letter:

"Previously [1,2], we described how a Filipino husband-and-wife patient–donor pair were included in an American kidney exchange.1,2 Delmonico and Ascher object in the strongest terms.3 They write that ethical Global Kidney Exchange (GKE) with patient–donor pairs from the developing world “is not feasible when the culture is so experienced with organ sales.”

Among the proposers of GKE are experienced surgeons and clinicians, a senior lawyer, and a veteran market designer. We take black markets with the utmost seriousness. That’s why the first GKE pair was started with a husband and wife. We think the right course of action is to proceed carefully, slowly at first, and with constant monitoring. The second GKE pair from Mexico were cousins cared for by Dr. Ricardo Correa-Rotter, a world-renowned nephrologist and signatory of the Declaration of Istanbul.4,5

We also take seriously long-term postoperative care for both patients and donors. That’s why we propose GKE in partnership with developing countries that already have some first-rate hospitals that perform living donor transplantation. Rees et al. describe how we coordinated care with the Philippine General Hospital and St. Luke’s Medical Center in Manila.2 We also provided an escrow fund for long-term continuing care. Ivan Carrillo describes our care of the donor and recipient in the second GKE and it is clearly celebrated by Mexican media as a beautiful way to help citizens of both Mexico and the United States.4,5

Kidney exchange (KE) itself is a relatively new “matching market,” of a kind that does not involve any payments to donors. It has been successfully launched in many countries, and proposals for international cooperation are underway.6 What makes KE special is that two or more patient–donor pairs help each other. What makes GKE special is that helping first-world patients get transplants saves money, because dialysis is so expensive, and these savings can benefit poor patients and donors in poor countries who would otherwise be unable to help themselves, but can participate in GKE for free.

Delmonico and Ascher propose that poor people with ESRD in poor countries, and the donors who love them, must all be regarded as potential criminals who would inevitably corrupt first-world medicine by being included in it. In the current political climate this is a bit like proposing a blanket ban on granting asylum to refugees from some countries. We do not adopt this point of view. On the contrary, GKE is a proposal that says there are many deserving patients who need our help, who we can help, and who can help us—if we invite them carefully and take care of them attentively.

Fear is not the path forward. Bold, careful innovation has led transplantation to where it is today, and remains our best collective future.

Disclosure The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

1. Rees MA, Paloyo S, Roth AE, et al. Global Kidney Exchange: Financially Incompatible Pairs Are Not Transplantable Compatible Pairs. Am J Transplant. 2017;17:782-90.
2. Rees MA, Dunn TB, Kuhr CS, et al. Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation. Am J Transplant 2017;17:782-90.
3. Delmonico FL, Ascher NL. Opposition to Irresponsible Global Kidney Exchange. Am J Transplant 2017;17:IN PRESS THIS ISSUE.
4. A bridge of life: Global kidney exchange between Mexico and the U.S. (Accessed 8/23/2017, at
5. Carrillo I. Un puente de vida (English Translation: A bridge of life). Newsweek en Español 2017 April 14, 2017:16-25.
6. Biró P, Burnapp L, Haase B, et al. Kidney Exchange Practices in Europe, First Handbook of the COST Action CA15210: European Network for Collaboration on Kidney Exchange Programmes (ENCKEP)2017.

Today I'm in D.C. at a meeting of NLDAC, the National Living Donor Assistance Center.

Monday, September 11, 2017

Kidney exchange in Switzerland in 1999, and some early repugnant reaction

Kidney exchange is well established and growing in Europe today, but the first exchange was greeted in some quarters as a repugnant transaction.

The first kidney exchange in Europe was actually an international exchange, involving a German couple and a Swiss couple. It was conducted in Basel on May 23rd 1999, and reported in

G. Thiel, P. Vogelbach, L. Guerke, T. Gasser, K. Lehmann, T. Voegele, A. Kiss, and G. Kirste  ”Crossover renal transplantation: hurdles to be cleared!”, Transplant Proc , 2001

They report that
"The Swiss Health Insurance paid the hospital bill without hesitation. The German insurance, however, refused to pay, despite the fact that the cost (including donor nephrectomy) was lower in Basel than cadaveric transplantation alone would have been in Germany and despite huge savings for the German insurance by being released from further payments for dialysis treatment. The insurance agency argued that crossover transplantation is not allowed in Germany, and that they would not pay for an illegal procedure. …Crossover transplantation is legal in Switzerland”

Following the publication of the paper, press coverage reflected a good deal of repugnance for kidney exchange and criticized the German surgeon Prof Dr. Gunter Kirste (with whom I have discussed these matters prior to my recent talk in Geneva). Muriel Niederle pointed me to this story from Der Spiegel 12.02.2001: “[Opening the] Door to Commerce”

Here's another, from the Suddeutsche Zeitung, also in 2001, kindly supplied by Dr. Kirste, which compares kidney exchange to organ trafficking: "Organs of a Travelling Salesman"

Sunday, September 10, 2017

Why don't museums sell art (except to buy more art)?

Brian Frye over at the Faculty Lounge published three nice posts about the professional repugnance that art museums have about selling art.

Here's the first:
Are Deaccessioning Norms Ethical?

It's about the rules that associations of art museums have to prevent museums from selling art. It's a professionally repugnant transaction.
 He argues that it's a way to make sure that capital gains on the secondary market accrue only to private collectors...

And here's the second:
Watching the Deaccessioning Police
"One of the biggest stories in the art world this week is the Berkshire Museum's plan to "deaccession" (read "sell") 40 artworks from its "permanent collection" worth about $50 million, in order to pay for renovations and shore up its endowment. The museum plans to auction at Sotheby's works by Norman Rockwell, Frederic Church, Albert Bierstadt, Alexander Calder, and Charles Wilson Peale, among other artists."
"Predictably, the deaccessioning police went ballistic. The American Alliance of Museums (AAM) and the Association of Art Museum Directors (AAMD) issued a joint statement saying they are “deeply opposed to the Berkshire Museum’s plans to sell works from its collection to provide funds for its endowment, to make capital investments, and to pay for daily operations.” The AAM and AAMD also noted that their "ethical" codes prohibit museums from selling artworks in order to cover operating costs. And their art world allies piled on, with perennial deaccessioning critics like Lee Rosenbaum lamenting the museum's decision."

And the third:
Deaccessioning Police Redux
"Predictably on cue, the "deaccessioning police" have raised their usual hue and cry. One of loudest voices in the claque is Christopher Knight of the LA Times, who has now gone "full nihilist" on deaccessioning. As Donn Zaretsky of the Art Law Blog observed, Knight's most recent column takes the anti-deaccessioning position to its inevitable reductio ad absurdumendpoint:
Here’s an idea: Don’t sell the art. Do close the museum. Start behaving like the charitable institution you are supposed to be. Spend the next several years responsibly overseeing the dispersal of the collection.
To paraphrase: "We had to destroy the museum in order to save it." 
See this earlier post of mine, concerning university museums:

Tuesday, August 9, 2016