Friday, January 31, 2020

Residency explorer (for new doctors)

Amidst all the concerns about the ballooning number of applications and interviews involved in preparing for the NRMP resident match, here's a site (still in test mode) from the AAMC, intended to help applicants explore residency programs before applying:

Residency Explorer

"Residency Explorer helps medical students and applicants to U.S. residency programs research programs in their specialty of interest and compare themselves to previous matched applicants at those programs.

"Residency Explorer delivers insights and information based on:
Residency applicant data from AAMC (ERAS)
Matched applicant data from NRMP
USMLE data from the USMLE Program
COMLEX-USA data from the NBOME
Residency program directory information from ACGME
Program characteristics from the National GME Census Survey, jointly administered by the AAMC and AMA, to which 95% of residency programs self-report information about their programs.
The purpose of the Residency Explorer is to help residency applicants understand how they compare the applicants who previously matched at programs as well as explore program characteristics across many areas of interest."

Thursday, January 30, 2020

More on social studies of markets--from José Ossandón

José Ossandón writes, in response to my earlier post about social studies of markets:

" I was very glad to find the post in your blog that mentions an special issue we edited in the journal Economy & Society (January 6th ). I was less happy though when I read that you found the whole thing too abstract and hard to follow.

Of course, the type of research-problem that motivate us are very different. While your object is the design of markets, we are trying to find out how to study market designers. But, I would hope you and your colleagues can also understand what we do. With this in mind, I wrote a summary, that ended in the five points below, trying to be as clear as possible. Hope these – certainly very sketchy - notes will make what concern us more understandable.

  1. Policy makers around the world increasingly rely on markets as solutions for the most various collective issues. We denominate markets that are also policy instruments ‘markets for collective concerns’. The increasing reliance on markets for collective concerns opens relevant questions for researchers in different social scientific disciplines.

  1. Historians of economic ideas, for instance, have pointed out that there has been a crucial transformation in the concept of market in economics. Few decades ago, markets were understood in opposition to organization and design. There was, on the one hand, the market as a form of spontaneous coordination, and, on the other, planned designed formal organization. Today, instead, markets are seen as object of design. This is not only a conceptual change. To use Ian Hacking’s categories, there has been a transition from description to intervention. Today, economists see the market as an object of engineering.

  1. To sociologists of work, it could be argued that what we see is the consolidation of a new profession. The historical intersection that generated the niche for the market designer is, perhaps paradoxically, not the success but the failure of markets. When markets originally created as policy instruments did not work as well as those who developed them expected to work (for example, school choice and competition didn’t simply increase quality of learning), decision makers didn’t go back to non-market instruments. Instead, they turned to experts in market repair. Market designers’ claim of professional jurisdiction, to use Andrew Abbott’s term, is that, to work properly markets require them.

  1. For economic sociologists, these developments trigger new problems. Traditionally, economic sociologists assume that one of their roles is to produce sociological definitions of the concept of market (i.e. if markets are a type of social formation: what are the basic elements that delimit markets as a particular social form?). Studying the market of market designers, however, requires a different stance. When studying market designers, the concept of markets is not something sociologists can define in advance, it becomes an empirical variable. Market designers are practitioners that mobilize different and varying conception of markets, and those who study them have to follow these modifications case to case.

  1. Finally, for scholars in science and technology studies, it becomes relevant to know more about the practice of market designers. Today, crucial matters of collective concern (for instance, a fairer and better school system, a solution for electronic waste, or how to build a more sustainable energy grid), depends, at least partially, on the work of experts on market design. As market designers are tasked with crucial collective responsibilities, it becomes very important to understand better issues like how these technical scientists conceive their vocation, the type of ethic of their work, and how they understand responsibility and collaboration.

Hope this helps and thanks a lot for keeping an interest in our work,

Best regards


He also pointed me towards his paper

 Ossandón, José (2019) : Notes on market design and economic sociology,economic sociology_the european electronic newsletter, ISSN 1871-3351, Max Planck Institutefor the Study of Societies (MPIfG), Cologne, Vol. 20, Iss. 2, pp. 31-39,

which considers parallels between the social studies of markets and the growth of market design in economics.

Wednesday, January 29, 2020

Early admissions for medical residencies? An anguished response to the increasing numbers of applications and interviews.

Here's a proposal to introduce something like the early admissions programs that have become common in college admissions (where they cause new problems while partially addressing the issue of too many applications...)

Improving the Residency Application and Selection Process
An Optional Early Result Acceptance Program
Maya M. Hammoud, MD, MBA1; John Andrews, MD2; Susan E. Skochelak, MD, MPH2
JAMA. Published online January 23, 2020. doi:10.1001/jama.2019.21212

"from 2011 to 2019, applications per applicant increased from 15.2 to 34.8 for family medicine, from 30.5 to 61.3 for obstetrics and gynecology, and from 21.6 to 51.9 for psychiatry.1 Similarly, the number of applications received by each program also has increased across all specialties, some by more than 200%. For example, from 2011 to 2019, the mean number of applications received by family medicine programs increased from 76 to 251 and received by psychiatry programs increased from 115 to 446.1

"A cycle involving increased numbers of applications and increased reliance on standardized testing has resulted in behavioral changes in both applicants and residency programs. Currently, senior medical students spend large amounts of time and money during the last year of medical school applying to an increasing number of programs and meeting the demands of the residency application process.
"Meanwhile, to process the high volume of applications received, programs are likely relying more on quantitative metrics, such as United States Medical Licensing Examination (USMLE) Step 1 scores, for screening.
"A new approach to help decrease the number of applications by giving students the option of an early application and expeditious result match program may be helpful. One possible approach might be an early result acceptance program (ERAP), in which students would be permitted to apply to a maximum of 5 programs, and programs would be limited to filling half of all their available spots."

Tuesday, January 28, 2020

Patricia Kravey on non-directed organ donation

From my recent email, a nuanced yet inspiring story from non-directed donor Patricia Kravey.

"I’ve been meaning to write you for five years so it’s time I finally got around to it, but I’ll try to keep it short.
I’d been thinking about being an altruistic for many years without people being able to understand why. When my husband heard your interview on Freakonomics he finally got it and shared the podcast with me.
Your chapter on Kidney Chains has changed my life and the five people who received kidneys in the chain I was a part of. Without the power of knowledge from your book I would not have understood why my hospital was resistant to creating a national chain that went outside their hospital system. From your chapter I called the National Kidney Registry and UNOS to ask how they formed chains, how many people could receive kidneys in their chains and the barriers hospitals encounter in joining their programs. On the phone I was thrilled to speak to Ruthanne Leishman, she was in your book, she was famous!
After learning the cost for hospital to join NKR even though they have lengthy donor chains; I told my hospital, where I was also an employee, that I would only be donating through them if they participated in a chain through UNOS. Despite my request to wait the hospital ran their program and matched me internally. So I had this heavy weight of decision to give to the highly sensitized person my hospital matched me with or to pursue a donor chain. After sleepless nights I came up with what I thought was the perfect solution. I would agree to give to the recipient within the hospital and their mismatched donor would be the person officially enrolled in the UNOS program.
The surgery to my anonymous recipient went smoothly. I cried when the doctors told me he was doing well.
Months later I bumped into my transplant coordinator in the hallway at the hospital and she excitedly told me a news story was being released tonight. The mismatched donor of the person I had given to had completed her surgery and the kidney chain and continued on in the mad rush of 24 hours across the country. The news story was going to be about the hospital’s first national donor chain and the person who started it.
Since my donation wasn’t within the exciting 24 hours my hospital had decided I wasn’t part of the chain. I wasn’t included in the news story or even formally told about it. The story showed my recipient who I hadn’t decided if I was going to meet yet. My colleagues saw the story that night and could tell it was my story that didn’t include me.
Your book helped me understand why the hospital and the media would do that as well.
I did meet my recipient in person later. He was a lovely man. Charming, appreciative and so full of energy. He visited me at my office at the hospital several times and he sent a gift for my baby shower. I felt very lucky and grateful to have met him.
Four years after the transplant he died. Skin cancer got him. His wife told me the doctors had led him to believe that the kidney he’d received from me could be passed on. Of course it couldn’t be since it could contain cancer cells.
I have mixed feelings about being an altruist donor. It wasn’t perfect. It wasn’t the story or the fulfilling experience I had hoped it would be. But it was better and it benefited more people because of you. I hope people tell you everyday that your work has changed lives.
Thank you.
Best regards,
Patricia Kravey (Harvey)

(in rereading my interview in Swedish Medical Center's blog, I’m embarrassed that I didn’t cite you!)"

Monday, January 27, 2020

100 years since Prohibition

An op-ed in the NY Times points out that Prohibition didn't start suddenly when the 18th Amendment went into effect in January 1920--it was a popular movement that had started with ordinary legislation.

Why Americans Supported Prohibition 100 Years Ago
Temperance crusaders weren’t crackpots. They were fighting the business of making money off addiction.  By Mark Lawrence Schrad

"The United States had already been “dry” for the previous half-year thanks to the Wartime Prohibition Act. And even before that, 32 of the 48 states had already enacted their own statewide prohibitions.
“With little that differed from normal wartime prohibition drinking habits, New York City entered at 12:01 o’clock this morning into the long dry spell,” this newspaper solemnly noted.
"Temperance was the longest-running, most widely supported social movement in both American and global history. Its foe wasn’t the drink in the bottle or the drunk who drank it, but the drink traffic: powerful business interests — protected by a government reliant on liquor taxes — getting men addicted to booze, and then profiting handsomely by bleeding them and their families dry.
"For a better understanding of temperance and prohibition, forget Bible-thumping “thou shalt nots.” Think instead about a major industry making outlandish profits by getting people hooked on an addictive substance that could kill them. Maybe that industry uses some of those profits to buy corrupt political cover by currying favor with government and oversight bodies. Let’s call this substance “opioids,” and the industry, “Big Pharma.”
"This is the same type of predatory capitalism that the temperance-cum-prohibition movement fought 100 years ago. Should big businesses be able to use addiction to reap tremendous profits from the poor? If your answer is no, and you were around 100 years ago, you likely would have joined the vast majority of Americans calling for the prohibition of liquor traffic."

Sunday, January 26, 2020

The black market for haggis

If you celebrated Burns night last night, in honor of the Scottish poet who was born on January 25 1759, you may have eaten haggis.  And if it was the real thing, and you live in the U.S., then you were on the receiving end of smuggled goods.

The NY Times has the story:

Building the Perfect Meal With Sheep Lungs and a Suitcase
A federal agency bans the sale of sheep lungs, a key ingredient for Haggis. Lovers of the distinctive Scottish dish have found ways around that.

"On Saturday, Scots across the world will dine on haggis to celebrate the birthday of Robert Burns, the 18th-century Scottish poet. But for haggis purists in the United States, celebrating Burns Night can be a challenge. Since the 1970s, the Department of Agriculture’s food-safety division has banned the sale of sheep lungs, which give traditional haggis its distinctive crumbly texture.

"Many of the millions of Americans with Scottish ancestry have happily settled for an increasingly wide array of lung-less haggis (or, repulsed by the thought of eating sheep innards, avoided the dish entirely). For decades, however, a small but impassioned contingent has resorted to illicit methods to bring authentic haggis onto American soil, motivated by a commitment to tradition and a fondness for the taste and texture of boiled lung.

“If people want something, they’re going to get it,” said Patrick Angus Carr, the chairman of the New York branch of the Saint Andrew’s Society, a Scottish heritage group. “How much cocaine and fentanyl is smuggled into the country every day?”

Friday, January 24, 2020

Sam Trejo on non-directed kidney donation (in the LA Times)

It's always good to hear from former students.

Sam Trejo writes:

"Hi Dr. Roth,
I'm PhD student in the GSE who took your Behavioral class a couple years back; you probably don't remember me, I didn't talk very much. Anyways, I donated my kidney last month to start a chain and wrote about it here. Just wanted to let you know of a concrete way that your market design work is making an impact!


The op-ed he linked to in the LA Times is called:
By SAM TREJO, JAN. 19, 2020 

Thursday, January 23, 2020

Conference on Mechanism design for vulnerable populations in April at Pitt--call for papers: Update--Postponed!

Here's the call for papers:

Call for papers: 2020 NSF/CEME Decentralization Conference
Mechanism Design for Vulnerable Populations
April 17-19, 2020

Center for Analytical Approaches to Social Innovation (CAASI)
Graduate School of Public and International A airs
University of Pittsburgh

Submission Deadline: Friday, January 31th, 2020

The goal of this conference is to apply and extend mechanism design to the practical needs of institutions that serve vulnerable populations. These populations pose conceptual and technical challenges for the designer due to the high stakes decision making environments, complex constraints on agents' action space, and the cumulative effects of disadvantaged participation in previous mechanisms. We welcome both theoretical and empirical approaches.

The field of mechanism design has played a significant role in designing public sector allocative mechanisms, making important contributions to the FCC spectrum auctions, the creation of electricity markets, school matching algorithms, and more. Recently, scholars have begun to apply the tools of mechanism design towards institutions that serve vulnerable populations such as the construction of social safety nets. This endeavour will be challenging. Whether it is families facing housing insecurity, returning veterans, or the previously incarcerated, the daily struggles of these individuals are often unobserved by the designer, making it difficult to form accurate assumptions about agent types, action spaces, or perceptions of the mechanism. For vulnerable populations, small behavioral deviations or changes in allocations can result in dramatic differences, e.g. a missed car payment resulting in a job loss. In addition, marginalization is often the cumulative outcome of a sequence of mechanisms: the housing market affecting a child's school choice, which constrains his options in the job market, which in turn affects his outcome in the criminal justice system.

For the conference, we seek theoretical and empirical papers that try to bridge the gap between mechanism design theory and the needs of vulnerable population. Topics could include (but are not limited to):
* General theoretical papers on behavioral mechanism design and robust mechanism design
* Social work: service referral, adoption / foster care, transition to workforce, substance abuse treatments, mentoring programs
* Basic needs: low-income housing, housing integration by income and identity, food banks
* Education (school matching), transportation (route selection, transport markets) and criminal justice
* Public goods, participatory democracy and budgeting mechanisms

Submissions will be accepted until Friday, January 31th, 2020. Full papers are preferred, but extended abstracts will also be considered. Please email all submissions to with the subject line Decentralization Submission. We will announce the conference program by Friday, February 14, 2020. All participants should confirm their attendance by Friday February 21, 2020.

Sera Linardi (University of Pittsburgh)
Jinyong Jeong (University of Pittsburgh)
Scott E. Page (University of Michigan)

Program Committee:
Rediet Abebe (Harvard University)
Yan Chen (University of Michigan)
Selman Erol (Carnegie Mellon University)
Osea Giuntella (University of Pittsburgh)
Daniel Jones (University of Pittsburgh)
John Ledyard (California Institute of Technology)
Irene Lo (Stanford University)
Adam Kapor (Princeton University)
Luca Rigotti (University of Pittsburgh)
Utku Unver (Boston College)
Richard Van Weelden (University of Pittsburgh)
M. Bumin Yenmez (Boston College)

Wednesday, January 22, 2020

Alex Chan on deceased organ donation policy, in JAMA

Alex Chan comments on an earlier article in JAMA:
US Organ Donation Policy
Alex Chan, January 21, 2020

"To the Editor Ms Glazier and Mr Mone touted the success of the current opt-in organ donation system and argued for focusing on increasing registered donors to 75% of the adult population.1 A challenge is the intrinsic difficulty of such a task: more coordinated promotional efforts and new incentives like giving registered donors priority on organ waiting lists would likely be required.

"Even if such an increase in donor registration is possible, another challenge is the extent to which transplant centers recover organs from registered donors. Although the number of registered donors is more than half of the US population, only 36.3% of possible donors become actual donors.2 This loss of approximately one-third of registered donors suggests that obstacles to recovery of organs, such as family objection, transplant center rejections of imperfect organs, and OPO performance, are pivotal. Anecdotal evidence suggests that rejections of imperfect organs account for approximately 10% to 20%,2 leaving 10% to 20% of the loss still unaccounted for. Family consent or its lack may be a big part of the gap.
"Furthermore, 2 of the 3 states with the highest donor registration rates (Montana, 93%; Washington, 89%) have lower-than-average actual donation rates,1,2 but states like Nevada and Pennsylvania with registration rates lower than 50% have actual donation rates much higher than the national average.2 This suggests that registration is only part of the solution, and the ability of OPOs to obtain family consent and convert registrations into donations can bound the effectiveness of the current system."

Here's the earlier post, about the article on which Alex is commenting

Wednesday, August 14, 2019

Tuesday, January 21, 2020

Sixth Marketplace Innovation Workshop (MIW) Columbia University, June 2-3, 2020: Update--Postponed!

Sixth Marketplace Innovation Workshop (MIW)

Columbia University, New York, NY

June 2-3, 2020


Itai Ashlagi, Management Science and Engineering, Stanford University
Omar Besbes, Columbia Business School, Columbia University
Ilan Lobel, Stern School of Business, New York University
Gabriel Weintraub, Graduate School of Business, Stanford University


Markets are an ancient institution for matching the supply for a good or service with its demand. Physical markets were typically slow to evolve, with simple institutions governing trade, and trading partners generally facing a daunting challenge in finding the “right” partner. The information technology revolution, however, has generated a sea of change in how markets function: now, markets are typically complex platforms, with a range of mechanisms involved in facilitating matches among participants. Recent trends point to an unprecedented level of control over the design, implementation, and operation of markets: more than ever before, we are able to engineer the platforms governing transactions among market participants. As a consequence, market operators or platforms can control a host of variables such as pricing, liquidity, visibility, information revelation, terms of trade, and transaction fees. On its part, given these variables, market participants often face complex problems when optimizing their own decisions. In the supply side such decisions may include the assortment of products to offer and their price structure, while in the demand side they may include how much to bid for different goods and what feedback to offer about past purchasing experiences. The decisions made by the platform and the market participants interact, sometimes in intricate and subtle ways, to determine market outcomes.
In this workshop we seek work that improves our understanding of these markets, both from the perspective of the market operator and the market participants. With respect to the former we are particularly interested in work that derives useful insights on how to design these markets, taking into account their operational details and engineering and technological constraints. With respect to the market participants, we seek for work that introduces novel approaches to optimize their decisions and improves our understanding of their interactions within the market. We look for a mix of approaches including modeling, theoretical, and empirical, using a wide range of tools drawn from operations management, game theory, auctions and mechanism design, optimization, stochastic modeling, revenue management, econometrics, or statistics.
The list of markets to be studied includes but it is not restricted to:
  • Online marketplaces, such as eBay, Etsy, etc.
  • Internet advertising, including sponsored search and display ad exchanges
  • Sharing economy markets, such as Uber/Lyft, AirBnb, etc.
  • Online labor markets, such as Amazon mTurk, Upwork, etc.
  • Procurement markets, such as technology-enabled government procurement
  • Health care exchanges
  • Financial exchanges
The workshop will begin on the morning of June 2nd and continue through the afternoon of June 3rd.

Plenary speakers

The workshop will have several invited distinguished plenary speakers from academia and industry, including:
  • Jun Li (University of Michigan)
  • Vahideh Manshadi (Yale University)
  • Tim Roughgarden (Columbia University)
  • Daniela Saban (Stanford University)
  • Amin Saberi (Stanford University)
  • Glenn Weyl (Microsoft Research)

Conference on Mechanism and Institution Design, June 2020, at Alpen-Adria-University of Klagenfurt/Celovec, Austria.

Conference on Mechanism and Institution Design 2020 (CMID20)

Starts 11 Jun 2020, 08:00
Ends 13 Jun 2020, 20:00
AAU Klagenfurt
HS C, Z.1.08, Z.1.09, N.1.43, B02.2.05, B02.2.13
Universitaetsstr. 65-67
9020 Klagenfurt
Paul Schweinzer

Paper submission is through email to

Our 2020 conference will take place on Thursday-Saturday, 11th-13th June 2020, at the Department of Economics, Alpen-Adria-University of Klagenfurt/Celovec, Austria.

The University is situated a few hundred meters from Lake Wörthersee, well-connected to both Slovenia and Italy across the Karawanken mountain range and can be easily reached from Vienna, Ljubljana, and Graz.

The confirmed keynote speakers are:

Pierpaolo Battigalli, Bocconi University
Johannes Hörner, Yale University
Benny Moldovanu, University of Bonn 

Monday, January 20, 2020

Recommender systems behaving badly: YouTube and Instagram

Why are readers drawn to sensationalist stories?  Why do content providers produce them?  It likely has something to do with the recommender systems that direct readers' attention to certain stories more than to others.

Time magazine has the YouTube story:

YouTube Has Been 'Actively Promoting' Videos Spreading Climate Denialism, According to New Report

"YouTube has been “actively promoting” videos containing misinformation about climate change, a report released Thursday by campaign group Avaaz claims, despite recent policy changes by the platform intended to drive users away from harmful content and conspiracy theories.
"The “up next” feature dictates what users watch for 70% of the time they spend on YouTube. The exact make-up of the YouTube algorithm that drives recommendations, designed to keep users on the platform for as long as possible, is a closely guarded secret. Experts say the algorithm appears to have learned that radical or outrageous content is more likely to engage viewers.Avaaz examined 5,537 videos retrieved by the search terms “climate change,” global warming” and “climate manipulation,” and then the videos most likely to be suggested next by YouTube’s “up next” sidebar. For each of those search terms respectively, 8%, 16% and 21% of the top 100 related videos included by YouTube in the “up-next” feature contained information that goes against the scientific consensus on climate change – such as denying climate change is taking place, or claiming that human activity is not a cause of climate change. Avaaz claims this promotion process means YouTube is helping to spread climate denialism."
"The “up next” feature dictates what users watch for 70% of the time they spend on YouTube. The exact make-up of the YouTube algorithm that drives recommendations, designed to keep users on the platform for as long as possible, is a closely guarded secret. Experts say the algorithm appears to have learned that radical or outrageous content is more likely to engage viewers.

The NY Times has the Instagram story
This Is the Guy Who’s Taking Away the Likes
"Likes are the social media currency undergirding an entire influencer economy, inspiring a million Kardashian wannabes and giving many of us regular people daily endorphin hits. But lately, Mr. Mosseri has been concerned about the unanticipated consequences of Instagram as approval arbiter.
"Mr. Mosseri knows something about dealing with dystopian tech fallout. He came to Instagram in October 2018 after years overseeing the Facebook News Feed, an unwitting engine of fake news, inflammatory rhetoric and disinformation. He wants to avoid similar pitfalls at Instagram, which is owned by Facebook.

Sunday, January 19, 2020

Anat Admati on Economics and Politics

The title of Anat Admati's essay makes an abstract unnecessary. She's thinking of financial economics, but much of what she says will be of interest to market designers as well.

There is No Economics without Politics
Every economic model is built on political assumptions
By Anat Admati

"...historian Adam Tooze laments the narrowness of economics. He quotes economist Abba Lerner, who famously said in 1972: “Economics has gained the title Queen of the Social Sciences by choosing solved political problems as its domain.”

Saturday, January 18, 2020

Egg trading by hermaphrodite fish--evolutionary game theory by Peña, Nöldeke, and Puebla

Game theory is about how payoffs among multiple parties change the way they interact with each other. One of the most interesting areas of application is in the study of evolution of populations.  Here's a paper about reciprocity in reproductive strategies that depend on the thickness of various aspects of the market...

The Evolution of Egg Trading in Simultaneous Hermaphrodites
Jorge Peña, Georg Nöldeke, and Oscar Puebla

Abstract: Egg trading—whereby simultaneous hermaphrodites exchange each other’s eggs for fertilization—constitutes one of the few rigorously documented and most widely cited examples of direct reciprocity among unrelated individuals. Yet how egg trading may initially invade a population of nontrading simultaneous hermaphrodites is still unresolved. Here, we address this question with an analytical model that considers mate encounter rates and costs of egg production in a population that may include traders (who provide eggs for fertilization only if their partners also have eggs to reciprocate), providers (who provide eggs regardless of whether their partners have eggs to reciprocate), and withholders (cheaters who mate only in the male role and just use their eggs to elicit egg release from traders). Our results indicate that a combination of intermediate mate encounter rates, sufficiently high costs of egg production, and a sufficiently high probability that traders detect withholders (in which case eggs are not provided) is conducive to the evolution of egg trading. Under these conditions, traders can invade—and resist invasion from—providers and withholders alike. The prediction that egg trading evolves only under these specific conditions is consistent with the rare occurrence of this mating system among simultaneous hermaphrodites.

Here's the full text.

Friday, January 17, 2020

Germany sticks with opt-in donation for deceased donor organs for transplants

Axel Ockenfels points me to this story, in English, in Deutsche Welle:

German parliament: Explicit consent still necessary from organ donors
Germany's parliament has rejected a health ministry proposal for a new organ donation system. With low donor numbers, the health minister wanted a presumed-consent system, with the onus on people to refuse to donate.
Date 16.01.2020  Author Mark Hallam, Astrid Prange

"Germany's organ donation rules will remain largely unchanged after an emotional debate in the Bundestag on Thursday morning. The country will stick with a system of informed consent, whereby only people who voluntarily register as organ donors are eligible. Most, but not all, EU members have moved to an opt-out system that presumes a willingness to donate.
Presumed vs. informed consent
"Health Minister Jens Spahn, a Christian Democrat, had led the push to reform the system along with a Social Democrat, Karl Lauterbach. They had proposed a system of presumed consent, albeit also adding the chance for relatives to object to organ donations after the person's death. The motion failed by 292 votes to 397.
"A rival proposal, put forward by a group led by Green party lawmaker Annalene Baerbock, passed by 432 votes to 200, with 37 abstentions, in the decisive final vote. It advocated keeping the existing system of informed consent. However, in a bid to shorten Germany's transplant waiting lists, people will be asked when renewing their national identity cards if they'd like to donate organs. "

Recent, somewhat related post:

Monday, November 11, 2019

Thursday, January 16, 2020

Vacancy chains and hermit crab housing, revisited

Here's the story from the NY Times (with a nice video):
Even Hermit Crabs Have Wealth Inequality  by Elizabeth Preston, Dec. 13, 2019

"Hermit crabs face a uniquely competitive real estate market. They need bigger and bigger shells throughout their lives, but can’t grow these homes themselves. So they rely on castoff snail shells, and are constantly on the lookout for better properties entering the market.
A study that will be published next month in the journal Physica A found that the distribution of these shells in one hermit crab population was surprisingly similar to the distribution of wealth in human societies."

And here's the paper in Physica A.

A comparison of wealth inequality in humans and non-humans
 Ivan D.Chase, Raphael Douady, Dianna K.Padilla

"Abstract: Inequality in the distribution of material resources (wealth) occurs widely across human groups. The extent of inequality, as measured by the Gini coefficient, is less in small-scale societies, such as hunter-gatherers and pastoralists, and greater in large-scale ones like current nation states. In many societies, the statistical distribution of wealth takes a characteristic form: unimodal, skewed to the right, and fat-tailed. However, we have relatively little systematic information about the distribution of material resources in nonhuman animals even though such resources are vital to their survival and fitness. Here we present the first description of inequality in material resources in an animal population: the distribution of gastropod (snail) shells inhabited by the hermit crab Pagurus longicarpus. We find that the shell distribution for the crabs strongly resembles the characteristic form of wealth distribution in human groups. The amount of inequality in the crabs is more than that in some small-scale human groups but less than that in nations. We argue that the shell distribution in the crabs is not simply generated by biological factors such as survival and growth of either crabs or gastropods. Instead, the strong resemblance in the human and hermit crab distributions suggests that comparable factors, not dependent upon culture or social institutions, could shape the patterns of inequality in both groups. In addition to the similarity in their inequality distributions, human and hermit crabs share other features of resource distribution, including the use of vacancy chains, not seen in other species. Based upon these parallels, we propose that P. longicarpus could be used as an animal model to test two factors – individual differences and intergenerational property transfers – that some economists theorize as major factors influencing the form of wealth distributions in humans. We also propose that inequality in hermit crabs could provide a baseline for examining human inequality.
(297 crabs were re-homed to produce this paper about economics, published by biologists in a physics journal.)

See earlier post:

Saturday, July 21, 2012 Hermit Crab Vacancy Chains

Wednesday, January 15, 2020

Kidney Exchange in Israel (supported by Itai Ashlagi)

Dr. Tamar Ashkenazi, the head of the Israel National Transplant Center, writes in Maariv:

בשורה חשובה לחולים בארץ: הקמת המאגר הארצי להשתלות מוצלבות
רופאים משתילי כליות ונפרולוגים הגדירו את הכללים למציאת התאמות כמו נוגדנים, זמן המתנה להשתלה ועוד. כללים אלו הוגדרו בתוכנת ההצלבות של המרכז להשתלות
ד"ר תמר אשכנזי
Google translate: Important news for patients in Israel: The establishment of the national crossover transplant reservoir
Kidney transplant doctors and nephrologists have defined the rules for finding matches like antibodies, waiting time for transplant and more. These rules were defined in the Transplant Center's cross-over software.  by Dr. Tamar Ashkena

"The National Kidney-Exchange Transplant Database was established this year as part of the National Transplant Center's activities. One of the developers of the exchange program, Prof. Itai Ashlagi an Israeli who teaches at Stanford University in the USA, regularly assists the program. Kidney transplant and nephrologists have defined the rules for finding matches such as antibodies, waiting time for transplantation and more. Since April 2019, a number of exchanges have been found, and the record of course was a chain of six transplants jointly with the Czech Republic last month. Collaboration with other countries increases the possibility of finding accommodations, and this is important news for patients in the country. We call on all patients whose family members have not been found suitable to donate a kidney, which will join the national and international pool." 


Itai mentions that Sukolsak Sakshuwong, a PhD student at Stanford from Thailand, has been instrumental in developing the software.

Tuesday, January 14, 2020

Matching for platonic co-parenting: "like a divorce, without the wedding or the arguments."

The WSJ has the story, about two web sites that are trying to pioneer matching for people who want to conceive a child who will have two involved parents, who won't be married to each other:

Co-Parenting Sites Skip Love and Marriage, Go Right to the Baby Carriage
A new kind of online service matches people who want to have children, but not necessarily romance 
By Julie Jargon

"When Jenica Andersen felt the tug for a second child at age 37, the single mom weighed her options: wait until she meets Mr. Right or choose a sperm donor and go it alone.

"The first option didn’t look promising. The idea of a sperm donor wasn’t appealing, either, because she wanted her child to have an active father, just like her 4-year-old son has. After doing some research, Ms. Andersen discovered another option: subscription-based websites such as and Modamily that match would-be parents who want to share custody of a child without any romantic expectations. It’s a lot like a divorce, without the wedding or the arguments."
"Given the prominence in today’s society of both single parenthood and online dating, this digital approach could be seen as a natural progression. It could also be considered shocking or even, as some have called it, an affront to marriage.

Here's, which also offers to match prospective moms with sperm donors.

And here's Modafamily:, which speaks of romantic, co-parenting, or known-donor relationships.

Monday, January 13, 2020

The organization of organ donation: Jennifer Erikson and Abe Sutton call for an Office of Organ Policy

White House staffers from two very different administrations call for a reorganization of organ donation:

It's time to provide needed reform to the organ donation system

"Every day, Americans are dying because of an inefficient organ donation system. That reality is as tragic as it is fixable, and cemented a seemingly unlikely friendship between us as two former White House staffers who served two very different presidents.

"It might seem like there are not many points of policy agreement between the Trump and Obama White House, but organ donation reform is one.
"Organ donation policy has been split between different agencies within the federal government and even an external federal contractor called the Organ Procurement Transplantation Network. This splintering of responsibilities has led to an unaccountable system with patients left behind. As for one federal contractor responsible for oversight of other contractors, Grassley and Young called out the problem, writing: “we can no longer stand by idly while the fox guards the hen house.”

"The answer is to create a centralized Office of Organ Policy within HHS able to identify opportunities for reform, manage the system, and ensure that lives are saved and taxpayer dollars meant to support the system are not wasted."

HT: Frank McCormick 

Sunday, January 12, 2020

Regulation of transplant centers and OPO's

I'll be speaking this morning on regulation of transplantation at the 2020 Winter meetings of the American Society of Transplant Surgeons in Miami.

I'll be in a  Special Invited Presidential Session: Transplantation Metrics Roundtable     Moderators:Lloyd Ratner, MD, MPH Timothy Pruett, MD

Transplantation Metrics Roundtable
End Time
10:05 AM
10:20 AM
Welcome and Introduction
Lloyd Ratner, MD, MPH
Lloyd Ratner, MD, MPH
Tim Pruett, MD
10:20 AM
10:35 AM
Introductory Presentation from Dr. Pruett
Tim Pruett, MD
10:35 AM
10:50 AM
Introductory Presentation from Dr. Roth
Al Roth, PhD
10:50 AM
12:00 PM
Transplantation Metrics Roundtable Discussion
All panelists (listed below)

Panel Participants
Paul Conway – Chair of Policy and Global Affairs and Immediate Past President of AAKP
Alexandra Glazier – CEO of New England Donor Services
Rick Hasz, BS, MFS, CPTC – Vice President of Clinical Services for the Gift of Life Donor Program
Maryl Johnson, MD – President of UNOS and Professor of Medicine, Heart Failure & Heart Transplantation at University of Wisconsin
Richard Knight, MBA – President of AAKP
Kevin Longino – CEO of the National Kidney Foundation (NKF)
Jean Moody-Williams, RN, MPP – Deputy Director of the Center for Clinical Standards and Quality at Centers for Medicare and Medicaid Services (CMS)
Ken Moritsugu, MD, MPH, FACPM – Rear Admiral, U.S. Public Health Service (Retired) and Acting Surgeon General of the United States in 2002 and from 2006–2007
Alvin Roth – Professor of Economics at Stanford University and awarded the 2012 Nobel Memorial Prize in Economics

The title of my talk (which Alex Chan and I prepared) is:
Performance Metrics and Regulation of Transplantation