Performance Feedback and Organ Donor Registrations, by House, Lacetera, Macis, and Mazar.

 When you register for a driver's license in the U.S., you fill out a form that has an opportunity to register as an organ donor. Did the clerk who accepts your form ask you if you had checked the box?  Would it help if he/she got feedback on how many organ donor registrations she had facilitated?

Here's an experiment about the equivalent interaction in Canada, where "most of the organ donor registrations in Ontario (pre-Covid-19 pandemic: 85 %) occurred during in-person visits to ServiceOntario centers (Trillium Gift of Life, 2017), which through their customer service representatives (CSRs) provide a wide range of services to residents ranging from issuing driver and vehicle licensing to public health insurance registration and business licensing."

House, Julian, Nicola Lacetera, Mario Macis, and Nina Mazar. "Nudging the Nudger: Performance Feedback and Organ Donor Registrations." Journal of Health Economics (2024): 102914.

"Abstract: In a randomized controlled trial conducted in three waves over 2.5 years and involving nearly 700 customer-service representatives (CSRs) from a Canadian government service agency, we studied how providing CSRs with repeated performance feedback, with or without peer comparison, affected their subsequent organ donor registration rates. The feedback resulted in a 25 % increase in daily signups compared to otherwise equivalent encouragements and reminders. Adding benchmark information about peer performance did not amplify or diminish this effect. We observed increased registration rates for both high and low performers. A post-intervention survey indicates that CSRs in all conditions found the information included in the treatments helpful and motivating, and that signing up organ donors makes their job more meaningful. We also found suggestive evidence that performance feedback with benchmark information was the most motivating and created the least pressure to perform."

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Related post:

Monday, July 22, 2024

Don't take "No" for an answer in deceased organ donor registration (a paper forthcoming after ten+ years)

Knights and Knaves reimagined by Jacob Glazer and Ariel Rubinstein

 Knights and Knaves are a venerable class of logical puzzles in which knights always tell the truth and knaves always lie, and the task is to think of a way to interrogate a knight or knave to learn the truth about something.  Here's a paper by Glazer and Rubinstein that looks like it opens a new vista of such problems (but don't trust me, I could be a knave...)

Magical Implementation by Jacob Glazer and Ariel Rubinstein, July 21, 2024

"Abstract: A principal would like to decide which of two parties deserves a prize. Each party privately observes the state of nature that determines which of them deserves the prize. The principal presents each party with a text that truthfully describes the conditions for deserving the prize and asks each of them what the state of nature is. The parties can cheat but the principal knows their cheating procedure. The principal “magically implements” his goal if he can come up with a pair of texts satisfying that in any dispute, he will recognize the cheater by applying the “honest-cheater asymmetry principle”. According to this principle, the truth is with the party satisfying that if his statement is true, then the other party (using the given cheating procedure) could have cheated and made the statement he is making, but not the other way around. Examples are presented to illustrate the concept."

Before getting technical, the paper begins with this delightful example.

"Two invigilators, A and B, have witnessed a student receiving a whispered message from another student during an exam. The invigilators have not seen the questions on the exam but would be able to solve them. It is known that A does not like the student who received the message while B does. The exam includes multiple questions but only one refers to the variable α and reads as follows: “Solve the equation α + 1 = 4.” The student answers the question correctly. Invigilator A claims that the whispered message was: “α = 3.” This is a serious allegation and if correct, the student’s exam will be disqualified. Invigilator B claims that the whispered message was: “Solve the equation α+1 = 4 first.” If he is right, then the student’s answer genuinely reflects his knowledge of the material and there will not be any serious consequences. Who should be believed: A or B?

"Although there is no definitive proof one way or the other, we would choose to believe B. The reasoning would be that if the message was “Solve the equation α + 1 = 4 first”, then A (who dislikes the student) could solve the equation himself and claim that the message was “α = 3”. On the other hand, if the message was “α = 3” it is very unlikely that B (who likes the student and who, as mentioned, has not seen the exam questions) could guess that the equation to be solved is α+1 = 4 rather than any other equation with the same solution. Hence, there is an asymmetry between the two conflicting claims which makes it possible to reasonably conclude that B’s claim is the truthful one."

The End Kidneys Death Act has growing support

I've earlier blogged about the Coalition to Modify NOTA (the National Organ Transplant Act of 1984).

Here is a summary of their proposed legislation

The End Kidney Deaths Act Summary

It begins this way:

"The End Kidney Deaths Act is a ten year pilot program to provide a refundable tax credit of $10,000 each year for five years ($50,000 total) to living kidney donors who donate a kidney to a stranger, which will go to those who have been waiting longest on the kidney waitlist. By the 10th year after the passage of the End Kidney Deaths Act, up to 100,000 Americans who were dying on the waitlist will instead have healthy kidneys, and taxpayers will have saved $10-$37 billion. Deceased donor kidneys last half as long as living donor kidneys, the gold standard of kidney care.

"One author of the National Organ Transplant Act, Representative Al Gore, said 40 years ago in 1984 that if transplant centers conclude efforts to improve voluntary donation are unsuccessful, incentives including tax credits, should be provided to donors."  

Their list of supporters is growing, and includes many transplant professionals as well as many people who have already donated or received kidneys.

Redesigning academia

 Here's an article that presents for discussion possible market design changes in academic earth sciences.  Some of them don't apply immediately to Economics (e.g. we already admit grad students to departments without assigning them to specific advisors and grants), but others refer to much broader practices.

Kemeny, P.C., Phillips, A.A. and Johnson, D.L., 2024. Replaying the tape of academia: Fourteen alternative practices for the physical sciences. Perspectives of Earth and Space Scientists, 5(1), p.e2024CN000240. 

Don't take "No" for an answer in deceased organ donor registration (a paper forthcoming after ten+ years)

 Here's a paper reporting a "field in the lab" experiment with actual organ donor registrations, that took over ten years to get published (after considerable revision and additional data collection).  But it has an important message for how to ask people to agree to donate their organs after they die, should they happen to be among those rare cases in which deceased organs can be donated.  The paper has two messages: one is that it doesn't increase donor registration to ask people to answer 'yes' or 'no', compared to just asking if they want to register at this time.  The second message is that people who have declined to register as a donor in the past may agree if asked again (so, don't take "no" for a final answer).

Here's the pre-publication version that will appear in AEJ:Policy.

Increasing Organ Donor Registration as a Means to Increase Transplantation: An Experiment With Actual Organ Donor Registrations  by Judd B. Kessler and Alvin E. Roth, AMERICAN ECONOMIC JOURNAL: ECONOMIC POLICY (FORTHCOMING)

Abstract: The U.S. has a severe shortage of organs for transplant. Recently — inspired by research based on hypothetical choices — jurisdictions have tried to increase organ donor registrations by changing how the registration question is asked. We evaluate these changes with a novel “field-in-the-lab” experiment, in which subjects change their real organ donor status, and with new donor registration data collected from U.S. states. A “yes/no” frame is not more effective than an “opt-in” frame, contradicting conclusions based on hypothetical choices, but other question wording can matter and asking individuals to reconsider their donor status increases registrations.

And here's the blog post about and link to the 2014 NBER working paper (which was itself a revision of an earlier version), and some of the press coverage it received at the time:

Tuesday, September 2, 2014

Don't take "No" for an answer: a reconsideration of how to do deceased donor registration

Signaling for medical residencies: the first few years

Two papers report on signaling in Otolaryngology and Orthopaedic surgery.

 The Otolaryngology societies have a summary of the current state of affairs that's worth hearing. A number of specialties (including Oto) allow many signals, and these seem to be acting as a soft cap on applications, rather than as a signal of special interest as in specialties that (like Economics) allow only a small number of signals.

Preference Signaling in Otolaryngology—Past, Present, and Future: A Comment From the Society of University Otolaryngologists (SUO), Association of Academic Departments in Otolaryngology (AADO), and the Otolaryngology Program Directors Organization (OPDO)  by Steven D. Pletcher MD, Bradley F. Marple MD, David J. Brown MD, The Laryngoscope Early View,  First published: 04 July 2024  https://doi.org/10.1002/lary.31613

"The year 2020 was a year of change. The residency application process, already suffering from spiraling application numbers,1 now faced the COVID-19 pandemic with a loss of away rotations and apprehension about virtual interviews. In the face of change, the Otolaryngology Program Directors Organization Council (OPDO) approached the leadership of the Association of Academic Departments in Otolaryngology (AADO) and the Society of University Otolaryngologists (SUO) with a recommendation to implement preference signaling. This system, originally described in the economics PhD marketplace,2 allows students a set number of signals (Otolaryngology used 5 in its inaugural year) to send to programs of particular interest. 

...

"Following the lead of Otolaryngology, Urology, General Surgery, Internal Medicine, and Dermatology implemented preference signaling the following year. Since that time, signaling has grown exponentially and is now utilized in the residency application process of nearly every specialty. 

...

"In the 2024-2025 residency application cycle, the evolution of preference signaling continues. Building on Otolaryngology's experience, in the 2023 application cycle Orthopaedic Surgery implemented a high-signal approach, providing applicants with 30 signals. This transition shows promise for reversing the vexing problem of spiraling application numbers—“Big Signaling” has now been adopted by Otolaryngology and four additional specialties the majority of whom have shown a 25%–30% decrease in applications submitted per student saving students a combined $2.5 million in application fees alone. Obstetrics and Gynecology has piloted a tiered signaling system, providing three gold and 15 silver signals to their students. 

...

"Because the number of signals received by programs is not publicized, students are unable to reliably target programs where their signals are less likely to be diluted by competing signals. Specialties should consider providing voluntary “signal cohort” (i.e., my program received between 75 and 100 signals in the 2024 application cycle) data to help applicants make more informed signal decisions and programs with low signal numbers will likely attract additional candidates. 

...

"One of the key statistics to guide applicants in high signal specialties is the interview offer rate for non-signal applications: this helps define the value of applications beyond the set number of signals."

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Preference Signaling in the Orthopaedic Surgery Match: Applicant and Residency Program Attitudes, Behaviors, and Outcomes, by Guthrie, Stuart Trent MD, FAOA1,a; Dagher, Tanios BSE2; Essey-Stapleton, Jodi MS, MEd3; Balach, Tessa MD, FAOA2,  JBJS Open Access 9(2):e23.00146, April-June 2024. | DOI: 10.2106/JBJS.OA.23.00146

"In the first year of preference signaling, applicants reported applying to 16% fewer programs than if preference signaling had not been available. These results align with AAMC data, which report applications per program dropping 17.4% (from an average of 639.6 to 774.6), and applications per applicant dropping to 76.9 from 86.07,8. Further changes could occur in future cycles as students become more accustomed to the influence of signaling on their application."

Black markets in everything bagels (in S. Korea)

 South Korea is not a hub of everything bagels, it turns out. In fact they are banned.

The NYT has the story:

Why Everything Bagel Seasoning Was Banned in South Korea. The seasoning is sold by Trader Joe’s, a brand whose popularity has skyrocketed in the region in recent years.By Eve Sampson

"Food containing poppy seeds, “including popular bagel seasoning blends,” is considered contraband in South Korea, according to the U.S. Embassy, making the coveted topping a forbidden treat.

...

"As more travelers have tried to bring the popular seasoning mix into South Korea, local news and social media sites have reported in recent weeks on an increase in confiscations at airports.

"Poppy seeds are not opiates but may be contaminated by the plant’s fluid, which contains opiates, when they are harvested. 

...

"In South Korea, poppy seeds are banned because they are considered a narcotic.

...

"South Korea is among the few countries with laws regulating poppy seeds. The United Arab Emirates bans the seed, and Singapore requires anyone wishing to import poppy seeds to submit a sample for opiate testing.

"In the United States, there has also been mixed messaging about poppy seeds. In 2023, the Department of Defense warned members of the military that eating poppy seeds could result in a positive drug test, despite the military previously feeding service members poppy seed breads in ready-to-eat meals."

Congratulations to ESA Fellows

 The Economic Science Association (ESA) has decided that the stock of old experimenters is sufficient to start naming fellows.  (I heard of this when I saw an announcement from UC Santa Cruz celebrating Dan Friedman as an inaugural fellow:)

I was president of the ESA from 2011-2013, and the list includes many past presidents.

Here's the announcement:

The ESA Fellows program

The ESA was first established in 1986 as a society organized to promote experimental methods in economics. We can safely say that our endeavor has been a resounding success. Experiments are well established as a mainstream economic methodology. Numerous individuals have devoted their careers to accomplishing this remarkable feat.

We have instituted a designation of Fellow of the Economic Science Association to recognize the lifetime contributions of ESA members who have advanced the frontier of knowledge in economics through the use of laboratory and field experiments. The designation of an individual as an ESA fellow is intended as a permanent recognition of their contribution to experimental science and to economics. The contributions may be scientific in nature or consist of activities that have furthered the establishment and growth of the ESA. The ideal candidate should have made contributions in both areas. The appointment to fellow does not include a monetary award.

The Inaugural 2024 ESA Fellows are (in alphabetical order):

James Andreoni

Colin Camerer

Timothy Cason

Yan Chen

James Cox

Catherine Eckel

Ernst Fehr

Robert Forsythe

Daniel Friedman

Jacob Goeree

Elizabeth Hoffman

Charles Holt

John Kagel

Thomas Palfrey

Charles Plott

Alvin Roth

Andrew Schotter

Vernon Smith   

Kidney exchange in Germany: draft of a proposed law

 Yesterday the German Federal Cabinet published the draft of a law that would allow kidney exchange in Germany. Below is the text of the press release from the Ministry of Health,  via Google Translate. (Prof. Dr. Karl Lauterbach is the Federal Minister of Health.)

Lauterbach: Überkreuzspende gibt Nierenkranken Hoffnung  Cross-donation gives hope to kidney patients

July 17, 2024

"In the future, kidney donations should also be possible between two different couples. This is the aim of the draft of a third law amending the Transplantation Act - amendment of the regulations on living organ donation, which was approved by the Federal Cabinet today.

This makes it possible for a donor's kidney to go not only to their partner, but also to a recipient from a second couple who in turn donates a kidney (living cross-donation). At the same time, the law ensures increased protection for donors, who should receive better information and medical and psychosocial support.

Dying on the waiting list must come to an end. In the long term, we therefore need the opt-out solution. In the short term, we can make more organ donations possible through cross-donation: those who donate themselves can be helped more quickly in their personal environment. Up to now, living donations have only been possible between partners. In the future, it should also be possible between couples who are not so close. This initially gives hope to many kidney patients.

Federal Minister of Health Prof. Karl Lauterbach

The main changes

Cross-living kidney donations are made possible

Donation and receipt of a kidney “crosswise” by another organ donation partner in medically incompatible organ donation couples.

In the case of a cross-donation, the two couples no longer have to know each other - but the close relationship between the incompatible partners remains mandatory.

Regulation of non-directed anonymous kidney donations.

The tasks of the transplant centers in the context of a cross-living kidney donation and a non-directed anonymous kidney donation are regulated. The transplant centers decide on the acceptance of incompatible organ donation pairs and non-directed anonymous kidney donations from donors and transmit the data required for the placement to a central office for the placement of kidneys in the context of the cross-living kidney donation. After the placement decision has been made, the transplant centers concerned organize the removal and transfer jointly.

Establishment of a national program for the arrangement and implementation of cross-living kidney donations. A body for the arrangement of kidneys within the framework of cross-living kidney donations will be established or commissioned. The arrangement procedure will be laid down by law.

Distribution of kidneys in the context of cross-living kidney donations exclusively according to medical criteria and while maintaining anonymity. The authorization of the German Medical Association to determine the state of medical science in guidelines is expanded to include the rules for accepting and distributing kidneys from incompatible organ donation pairs and from non-directed anonymous kidney donations in the context of cross-living kidney donations.

The previously applicable principle of subsidiarity in Section 8 Paragraph 1 Sentence 1 Number 3 TPG is repealed in order to also enable preemptive kidney transplants.

Previously: removal of organs from a living person only if no post-mortem organ was available.

Donor protection is further strengthened

Expansion of the regulations to clarify and specify donor suitability.

Introduction of compulsory psychosocial counseling and evaluation. The necessary knowledge and skills for the

Psychodiagnostic evaluation and psychotherapeutic treatment can only be carried out by medical or psychological specialists with specific training or further education in psychological, psychosomatic or psychiatric issues (so-called mental health professionals). The independence of the expert ensures that the consultation and evaluation is not influenced by the transplant medical managers in the transplant center, that there are no professional dependencies with these managers and that the expert is solely committed to the interests of the donor. The requirements for the qualifications of the independent expert will in future be set out in the guidelines of the German Medical Association.

Individual support for donors through the introduction of a living donation companion who accompanies and advises the donor throughout the entire donation process in the transplant center. The living donation companion must be a doctor, nurse or person experienced in psychological or psychotherapeutic issues and must be professionally experienced and independent of the specific transplant process. He or she may not be involved in the removal or transfer of the organs, nor be subject to instructions from a doctor who is involved in these measures.

Introduction of federal legal requirements for the activities of living donation commissions.

Granting of additional points

Living kidney donors who themselves require a kidney transplant later in life due to an illness should receive additional points when kidneys are arranged, the amount of which should be determined in the guidelines of the German Medical Association."

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Axel Ockenfels writes:

" I took a quick look at the draft bill that was passed by the federal cabinet in Germany today and that would allow kidney exchange. There are many good aspects in the bill, such as the mandatory participation of hospitals in a national exchange program and the possibility of non-directed donations (which was more controversial), as we suggested to the Ministry in a paper by Ashlagi, Cseh, Manlove, Ockenfels and Pettersson.   

"I am happy to see that the draft seems to agree that the details of matching should be delegated to experts and not overly specified in the law, as suggested by Tayfun Sönmez, Utku Ünver and me in a comment on the previous draft, as well as by others.  

"One consequence of the previous draft would have been that non-directed donations would almost always have gone to patients on the waiting list and would not have been included in the kidney exchange. We advised against this and are happy to see that the draft bill document now states that "a non-directed anonymous kidney donation is in principle initially made in favour of a recipient of an incompatible organ donor pair" (p. 67, DeepL translation), and that it also allows chains of kidney donations initiated by non-directed donors (although I find the wording of the draft somewhat unclear in this respect).  

"We also strongly recommended that compatible pairs be allowed to participate in kidney exchanges, yet the bill would still make this impossible: "Participation as a pair of compatible organ donors and organ recipients in a crossover living kidney donation, on the other hand, is not envisaged, as a living organ donation would be immunologically possible in these pairs. There is therefore no need to enable cross-living kidney donation for these couples as well" (p. 66, DeepL translation). 

"This is unfortunate because the inclusion of compatible pairs has many benefits and can sometimes make everyone better off, including the patient in the compatible pair, additional donor-patient pairs, and patients on the waiting list. However, this may not be the last word, as there is still room for change in the upcoming legislative process. 

"The document also comments on the possibility of cross-border exchanges: "Commissioning the institution that already handles the procurement of post-mortem donated organs [namely Eurotransplant] also opens up the option of establishing an international programme - comparable to the exchange of post-mortem donated organs - within the Eurotransplant Network" (p. 31, DeepL translation)."

############

Here are all my posts on Germany and kidney exchange.

Becoming a matchmaker

 The company built around the marriage pact is now offering matchmaking tools to the public: Matchbox.

"Matchbox is the matching algorithm behind your next great event.

"We know how to make great matches, but the event is yours⁠—⁠decide who to invite, where to host, and when.

"We’ll give you everything you need to run the matching algorithm."

Surrogacy in Israel

In Israel, where commercial surrogacy is legal, surrogates are more and more coming from educated and religious communities. 

Haaretz has the story:

Married, Educated, Not in It for the Money: The New Profile of Israeli Surrogate Mothers. Who are the Israeli women who wish to be pregnant and give birth for others? The answer to that question has changed dramatically over the past decade  by Ronny Linder

""I'm a little tired of women telling me how disadvantaged all surrogates are, so I thought of starting a thread just for surrogates, with: name + our occupation + town. I'll go first." This is what one moderator of an open Facebook surrogacy group wrote, about a year ago – and the responses came pouring in: a computer programmer from Tekoa, a sociolinguistics Ph.D. from Kfar Sava, a school principal from Jerusalem, a postgraduate student of gender studies from Hatzeva, a lawyer from Gush Etzion, an oncology nurse from Mevasseret Zion and so on and on.

"The post and the responses to it, written in reaction to the prevalent perception that views surrogacy as bearing the potential for exploitation of disadvantaged women who must "hire out" their uteruses for money, largely reflects the great transformation, over a few short years, in the profile of surrogate mothers and of the entire field in Israel. 

...

"Since the surrogacy law was legislated in 1996, almost 1,300 children have been born in Israel through surrogacy procedures. In recent years, the number has averaged around 80 children per year. Data collected by the Health Ministry about surrogate mothers between 2022 and 2023, reveals the changes in the profiles of women who choose to take on the task, as compared with the last study, in 2010. That study, which reviewed surrogate mothers during the years 1996-2010, was conducted by Etti Samama as part of the work for her doctoral thesis in health-system management at Ben-Gurion University. To compile recent data, Adam Ringel and Eti Dekel, for many years the national supervisor of the surrogacy law, collected information from 246 cases – 90 percent of the cases filed with committee in the last couple of years. 

...

"The data indicate a fundamental change in the socio-economic status of women who choose to become surrogates. In terms of education, while in 2010 the majority of surrogate mothers had a high school education (70 percent), nearly one fifth (18 percent) had less than 12 years of schooling, and only 7 percent had academic degrees. Less than a decade and a half later, however, the picture has been transformed: 65 percent of surrogate mothers have an academic degree, and only about one fifth have only a high school education (14 percent) or less than 12 years of schooling (8 percent). The proportion of those with academic degrees among surrogates is significantly higher than that group's share of the population, which is 38 percent.

"A similarly changed picture emerges in terms of employment: In 2023, only 2.5 percent of surrogates were unemployed, compared with 25 percent in 2010. No less interesting is the finding regarding geographical dispersal of surrogates, as compared with the general public: In recent years, almost half (45 percent) of them come from kibbutzim, moshavim and organized communities – compared with just 12 percent in 2010.

...

"An absolute majority of surrogates come from [the world of] religious Zionism, on the one hand, or are secular women from kibbutzim and other organized communities, on the other," Ringel elucidates. "These two groups are seemingly worlds apart, but in the world of surrogacy, you see the resemblance between them. These are independent, strong women, with a fully developed values-based worldview, who are looking to do something big for others, who see surrogacy as a calling, as female empowerment and as the ultimate giving."

"What happened between 2010 and 2024 that led to such dramatic change in the profile of surrogate mothers? Experts in the field ascribe the change mainly to the opening up of the option for married women to become surrogates, beginning in 2010 – a move that significantly increased the pool of potential surrogates and also changed their socio-economic backgrounds.

"This is indeed a transformation: in 2010, all surrogates were unmarried women, 75 percent of them divorced, the rest single (and a few widows). In contrast, in 2022-2023, 80 percent of surrogates were married or in relationships, and only 20 percent were divorced or single.

...

 "There was always an altruistic element with surrogates, but ever since married and more affluent women entered the picture – the economic part became more of a bonus, rather than the main motive," Dekel points out."

Dealing with the harms of harm reduction

 Some of the jurisdictions that pioneered harm reduction measures to reduce drug overdose deaths are dealing with problems of public drug use.

The NYT has this story:

Bold Experiment or Safety Risk? Canada Is Divided on How to Stop Drug Deaths.  British Columbia’s partial retreat from an experiment to decriminalize drug possession reveals a political shift in Canada over combating the opioid crisis. By Vjosa Isai

"decriminalization, a policy introduced as a way of alleviating the opioid crisis, has instead been blamed for deepening it. Scenes of people openly using drugs on city streets have led several elected leaders, other critics and even some supporters to say that decriminalization is contributing to a sense of public disorder.

...

"In May, the federal government, which regulates controlled substances, approved a provincial request to reverse the policy and again make public drug use and possession in British Columbia a crime.

"The shift came not long after a similar experiment in Oregon ended in April, following a vote by the state Legislature to re-criminalize drugs amid soaring overdose deaths.

...

"practices, collectively known as harm reduction, are driven by a strategy meant to keep drug users alive rather than getting them to quit.

"Services that fall under this category include needle exchanges, safe injection sites, the distribution of naloxone, a drug used to reverse overdoses, and the testing of street drugs to reveal the presence of any other harmful substances.

...

"Safe injection sites, along with decriminalization, are among the harm reduction measures that have come under attack from critics who claim they lead to crime and perpetuate a cycle of drug abuse.

"In British Columbia, critics say the province should not have pursued decriminalization without also bolstering other services that drug users need, like housing and addiction treatment.

...

"Many residents, he added, complained of increased drug use on public transit, near schools and in entrances to businesses.

...

"Some frontline workers say harm reduction practices are being targeted to score political points at a time when death tolls are reaching new highs and different approaches are necessary to keep users alive."

Kidney exchange collaboration: Alliance for Paired Kidney Donation (APKD) and MedSleuth

 Here's a press release from MedSleuth about their collaboration with the Alliance for Paired Kidney Donation.

The Alliance for Paired Kidney Donation, MedSleuth Partner to Increase Access to Kidney Transplants  NEWS PROVIDED BY MedSleuth  

"SAN FRANCISCO and TOLEDO, Ohio, July 9, 2024 /PRNewswire/ -- The Alliance for Paired Kidney Donation (APKD), a global leader in paired kidney donation, and transplant software company MedSleuth announced today a U.S. partnership launched to increase access to lifesaving kidney transplants. The organizations have consolidated their two paired kidney donation software platforms into one program called Kidney Matchgrid, significantly expanding the pool for matching living kidney donors with transplant candidates nationwide.

"Today in the U.S., family, friends and other loved ones may offer the gift of living kidney donation to a person in need of a kidney transplant. While these willing donors are not always compatible with their intended recipient, this incompatibility doesn't have to mean the end of their journey. A process called paired donation allows incompatible donor-recipient pairs to be matched to each other. Paired donation can result in a kidney exchange, in which two incompatible donor-recipient pairs are matched to each other, or a kidney chain, in which a willing donor gives a kidney to a stranger and starts a domino effect of kidney donations.

"Before launching the new collaboration, MedSleuth and APKD operated independently to provide paired donation services and software to match living kidney donors with recipients. APKD focused on kidney exchanges between transplant centers, while MedSleuth focused on kidney exchanges within a single transplant center that was supported by software to improve living donor intake. With this new partnership, transplant centers now have access to a larger pool of patient data from which they can choose between internal, regional or national kidney exchanges.

"As a result, Kidney Matchgrid, a HIPAA-compliant, SOC 2 Type II certified software powered by a Nobel Prize-winning algorithm, better enables transplant centers to deliver both process efficiency and access to more transplants for their hard-to-match transplant candidates and living kidney donors.

"This partnership is an example of what can be achieved when organizations combine their strengths to better serve patients and medical teams across the transplant community," said Dr. Michael A. Rees, transplant surgeon and CEO of APKD. "Bringing together the transparent APKD matching process and the straightforward business practices of MedSleuth puts transplant centers first, giving them tools to make the best choices for the patients they serve."

"Transplant centers working with APKD and MedSleuth will upload information about their donor-recipient pairs and non-directed living donors to Kidney Matchgrid, from which transplant centers and APKD will perform match runs as frequently as desired. MedSleuth will support the partnership by overseeing the sales and marketing of Kidney Matchgrid for all participating transplant centers, allowing APKD to focus on helping transplant centers deliver kidney exchange and first-rate care to the living donors who make kidney exchange possible.

"This partnership enables us to channel our energy into delivering exceptional customer service and outcomes for transplant centers from the first contact and continuing with every match run coordinated by our partners at APKD," said Ben Nightingale, COO of MedSleuth. "We look forward to working with transplant centers nationwide to further living donor transplant effectiveness and save more lives."

"In addition to Kidney Matchgrid, the expanded transplant center network will continue receiving access to services and software provided independently by MedSleuth and APKD.

"APKD's best-in-class support services include concierge-level support for transplant coordinators, donor and recipient protection programs offering lost wage and travel reimbursements, and the APKD KidneyPledge™, which gives priority for chain-ending kidneys to non-directed donors and their family members should they need a kidney transplant in the future. MedSleuth will continue offering transplant centers its BREEZE software to simplify living donor intake, as well as solutions that streamline the transplant process from recipient evaluation through the donor and recipient follow up.

"More information about Kidney Matchgrid and the associated transplant center, patient and donor support services provided by the new partnership is available through APKD at paireddonation.org and MedSleuth at medsleuth.com.

About the Alliance for Paired Kidney Donation

"The Alliance for Paired Kidney Donation (APKD) is a 501c3 with global reach that manages a kidney registry powered by a Nobel Prize-winning algorithm. APKD revolutionized kidney donation by performing the world's first non-simultaneous altruistic donor chain and the first international chain. APKD's commitment to innovation, research, education, technology and generosity allows it to fulfill its mission of saving lives by securing a living donor kidney transplant for every patient who needs one."

About MedSleuth 

MedSleuth seeks to expand access to transplantation by streamlining the transplant process. In addition to kidney paired donation, our BREEZE software platform simplifies candidate evaluation, optimizes waitlist management, and facilitates transplantation, with a focus on living donation. The patented, clinically validated platform collects relevant clinical and demographic data remotely, aiding participating transplant centers in their operations. For more information, visit medsleuth.com."

Covid vaccine boosters: promoting uptake is hard

 A recent study published in Nature shows that inexpensive nudges (to get Covid revaccinations) can have small but measurable effects (about 1 percentage point). The large scale study involving 18 coauthors planned to message 3,662,548 CVS Pharmacy patients  with reminders. The  experimental treatments included one message that also offered free rides to pharmacies. However that message did not further increase revaccinations.

Megastudy shows that reminders boost vaccination but adding free rides does not. by 

Katherine L. Milkman, Sean F. Ellis, Dena M. Gromet, Youngwoo Jung, Alex S. Luscher, Rayyan S. Mobarak, Madeline K. Paxson, Ramon A. Silvera Zumaran, Robert Kuan, Ron Berman, Neil A. Lewis Jr, John A. List, Mitesh S. Patel, Christophe Van den Bulte, Kevin G. Volpp, Maryann V. Beauvais, Jonathon K. Bellows, Cheryl A. Marandola & Angela L. Duckworth, Nature (2024)

Abstract: Encouraging routine COVID-19 vaccinations is likely to be a crucial policy challenge for decades to come. To avert hundreds of thousands of unnecessary hospitalizations and deaths, adoption will need to be higher than it was in the autumn of 2022 or 2023, when less than one-fifth of Americans received booster vaccines1,2. One approach to encouraging vaccination is to eliminate the friction of transportation hurdles. Previous research has shown that friction can hinder follow-through3 and that individuals who live farther from COVID-19 vaccination sites are less likely to get vaccinated4. However, the value of providing free round-trip transportation to vaccination sites is unknown. Here we show that offering people free round-trip Lyft rides to pharmacies has no benefit over and above sending them behaviourally informed text messages reminding them to get vaccinated. We determined this by running a megastudy with millions of CVS Pharmacy patients in the United States testing the effects of (1) free round-trip Lyft rides to CVS Pharmacies for vaccination appointments and (2) seven different sets of behaviourally informed vaccine reminder messages. Our results suggest that offering previously vaccinated individuals free rides to vaccination sites is not a good investment in the United States, contrary to the high expectations of both expert and lay forecasters. Instead, people in the United States should be sent behaviourally informed COVID-19 vaccination reminders, which increased the 30-day COVID-19 booster uptake by 21% (1.05 percentage points) and spilled over to increase 30-day influenza vaccinations by 8% (0.34 percentage points) in our megastudy. More rigorous testing of interventions to promote vaccination is needed to ensure that evidence-based solutions are deployed widely and that ineffective but intuitively appealing tools are discontinued.

Growth pains for legal marijuana, in Germany and New York

Transitioning from a thriving black market for marijuana to a regulated legal market isn't so easy.

The Guardian has the story from Germany, where so far clubs, but not shops, have been legalized:

Cannabis legalisation hampered by most German of substances: red tape. Activists say the rollout of laws permitting recreational use of the drug has been hampered by a ‘bureaucratic monster’  by Deborah Cole

"Joints now mingle openly with pints among fans watching the European football championship in host nation Germany, which in the spring became the first big EU country to legally allow personal recreational use of cannabis.

"That is, provided the fan is over 18, only carrying a small amount of the narcotic, not smoking in the stands of a stadium and not in possession of more than three plants at their officially registered home.

...

"The hotly disputed law passed by Olaf Scholz’s three-party coalition, which took effect in April, legalised cultivating up to three plants for private consumption, the possession of 50g (1.75oz) of cannabis at one time at home and 25g in public.

...

"A key phase began on 1 July with the establishment of registered cannabis clubs, which proponents say are vital to assuring the smooth path towards legal weed and supplanting the underworld street trade.

...

"In order to thwart drug tourism, members must have lived in Germany for six months, sign up to a club for a minimum of three months and have a clean criminal record for narcotics.

"Clubs are dependent on fee-paying members to start operating but are not allowed to advertise, said Marten Knopke of the Cannabis Social Club Leipzig, thus robbing them of a key source of capital needed to rent offices and land for growing purposes. Consumption on club premises is also verboten.

“We are subject to more restrictions than any alcohol company,” Knopke said, echoing a frequent complaint from the cannabis scene about drinking, which kills more than 60,000 people in Germany each year. “The government has also made it really difficult for us to stand up to the hidden [narcotics] market.”

...

“There are no shops where you can buy, meaning they [foreign tourists]" will end up buying something on the underground market, which is very dangerous in Berlin,” because of contaminated drugs and the role of the mafia in the trade, he said."

********

And here's the New York Times on New York:

The Real Problem With Legal Weed, By Charles Fain Lehman

"When New York legalized recreational marijuana in 2021, the future seemed bright. ...

"Three years later, things are not going to plan. Gov. Kathy Hochul has called New York’s legalization rollout “a disaster.” Mayor Eric Adams has spent months demanding that Albany fix the current system. “What happened?” The New Yorker recently asked in a feature on the collapse of the state’s marijuana “revolution.”

...

"There are around 140 recreational dispensaries operating statewide — about one for every 148,000 New Yorkers. Instead of shopping legally, New Yorkers tend to get their weed from the illegal shops that now blanket the state. Estimates suggest that there are anywhere from 2,000 to 8,000 in New York City alone, with uncounted more from Ithaca to Oneonta. Recent crackdowns have temporarily sealed more than 400 stores — only a small fraction of the total in the city.

"These shops undercut the legal stores, offering the same high at a fraction of the price. And they attract crime: There were 736 robbery complaints at unlicensed shops last year, according to the New York Police Department. Shootings are not uncommon, including the killing of a 36-year-old man captured on video last April.

"They also sell to teenagers, as The Times has reported. Teachers, prevention experts and pediatricians have raised the alarm about high schoolers smoking or vaping marijuana at school."

"Discreteness is the better part of value" (Vince Crawford)

 One of the themes of the conference celebrating Vince Crawford (in anticipation of his 75th birthday) is how two of his early famous papers (Crawford and Knoer, 1981 and Kelso and Crawford, 1982)  helped unify matching theory and the theory of markets and competitive equilibria, and thus began to bring matching theory into mainstream economics.

Vince remarked that the unification of matching with the rest of economics also brought discrete (as opposed to continuous) mathematics into the mainstream of economic theory.

He said he had come to realize that "Discreteness is the better part of value."*

*This is of course a play on the common English language expression "Discretion is the better part of valor," which has an indirect and complicated Shakespearean connection, but in common usage is meant to give advice like "Look before you leap."

Great Market Hall in Budapest

 It's good to remember that before markets were digital, essentially all marketplaces were places.

Here I am trying to take in Budapest's Great Market Hall.

Child labor in soccer

Many laws seek to protect children from being exploited in the labor market, and there is widespread repugnance when it appears that such exploitation is taking place. (Think of the issues associated with children sewing soccer balls in Pakistan...)

But minors can also be professional athletes, and that turns out to be an issue in the Euro 2024 competitions, because star Spanish player Lamine Yamal is only 16 years old. (He was scouted at 6...)

Here's the story

Why Spain are Risking 30,000 Euro Fine by Playing Lamine Yamal at Euro 2024, by Robin Mumford 

"Yamal has started in each of Spain's group games so far, against Croatia and Italy, but a German law put Spain at risk of a €30,000 fine for his involvement in the game against Italy. That's because the German Youth Protection Act prohibits under-18s from working beyond a certain time - usually 8pm.

"Spain's first group game kicked off at 6pm local time, but their game against Italy started at 9pm. While there is an exceptional rule within the German law that authorises athletes to work until 11pm, the match finished very close to that time anyway, and post-match showers and interviews are also considered within the realms of labour, which means Spain may very well have met the conditions to be hit with a fine."

HT: Peter Biro

##########

The Centre for Sport and Human Rights has a White Paper called

CHILD LABOUR IN SPORT. Protecting the Rights of Child Athletes

Top-trading-cycles for multiple-type housing markets by Di Feng , Bettina Klaus , and Flip Klijn

 On it's 50th anniversary, top trading cycles (TTC) is still well worth studying. Here's the latest:

Characterizing the typewise top-trading-cycles mechanism for multiple-type housing markets by Di Feng a, Bettina Klaus b, Flip Klijn , Games and Economic Behavior, Volume 146, July 2024, Pages 234-254

Abstract

"We consider the generalization of the classical Shapley and Scarf housing market model (Shapley and Scarf, 1974) to so-called multiple-type housing markets (Moulin, 1995). Throughout the paper, we focus on strict preferences. When preferences are separable, the prominent solution for these markets is the typewise top-trading-cycles (tTTC) mechanism.

"We first show that for lexicographic preferences, a mechanism is unanimous (or onto), individually rational, strategy-proof, and non-bossy if and only if it is the tTTC mechanism. Second, we obtain a corresponding characterization for separable preferences. We obtain additional characterizations when replacing [strategy-proofness and non-bossiness] with self-enforcing group (or pairwise) strategy-proofness. Finally, we show that for strict preferences, there is no mechanism satisfying unanimity, individual rationality, and strategy-proofness.

"Our characterizations of the tTTC mechanism constitute the first characterizations of an extension of the prominent top-trading-cycles (TTC) mechanism to multiple-type housing markets."

Mechanism and Institution Design in Budapest, in honor of Vince Crawford's 75th birthday: July 8-12 at Corvinus University

 Here's the high level program, and here's the detailed program.

I plan to speak on Wednesday about Ethical Issues in Market Design.

And here's the guest of honor: VINCENT P. CRAWFORD

Morals and the limits of markets, WZB Berlin, 11 - 12 July 2024

 Here's a conference that looks interesting:

Morals and the limits of markets, WZB Berlin, 11 - 12 July 2024

Organizers:  Hande Erkut and Dorothea Kübler

"The workshop will focus on the limits of markets, the morality of decisions in markets, and paternalism. It will bring together scholars from different disciplines (mainly economics, political science, and philosophy) who are working on these topics. The workshop aims to foster discussions across disciplines on the ethical considerations surrounding market activities, repugnant markets, and the government’s role in regulating such markets."

Preliminary Program:Preliminary Program:

Thursday, July 11, 2024

9:00 – 9.30 Registration/ Workshop Opening

9:30 – 10.50 Sandro Ambühl (University of Zurich)  Interventionist Preferences and the Welfare State: The Case of In-Kind Nutrition Assistance

Tammy Harel Ben Shahar (University of Haifa), Lean Out: On the Morality of Participating in Positional Competitions

10:50 – 11:10 Coffee Break

11:10 – 12:30 Benjamin Sachs-Cobbe (University of St Andrews) Taking Jobs and Doing Harm

Colin Sullivan (Purdue University) Paternalistic Discrimination

12.30 – 13:20 Lunch

13:20 – 15:20 Hande Erkut (WZB), Repugnant Transactions: The Role of Agency and Severe Consequences

Erik Malmqvist (Univeristy of Gothenburg)  How Exploitation Harms

Constanze Binder (Erasmus University Rotterdam) Universities and Markets: New Challenges to Academic Freedom

15:20 – 15:50 Coffee Break

15.50 – 17:10 Robert Stüber (NYU Abu Dhabi) Why High Incentives Cause Repugnance: A Framed Field Experiment + Do Prices Erode Values

Aksel Sterri (Oslo Metropolitan University)  Bodily Justice

17:30 Visit to Neue Nationalgalerie

19:00 Conference Dinner

Friday, July 12, 2024

9.30 – 10:50 Axel Ockenfels (University of Cologne)  The Demand and Supply of Paternalism

Søren Flinch Midtgaard (Aarhus University) Reaction Qualifications and Paternalism

10:50 – 11.10 Coffee Break

11:10 – 12:30 Roberto Weber (University of Zurich) What Money Shouldn’t Buy: Aversion to Monetary Incentives for Health Behaviors

Amy Thompson (Oxford University) Defending a Moral Limit to Markets: Beyond a Singular Asymmetry Thesis

12.30 – 13:30 Lunch

13:30 – 15:30 Sili Zhang (LMU Munich)  What Money Can Buy: How Market Exchange Promotes Values

Peter Dietsch (University of Victoria)  The Centrifugal Nature of the Labour Market, Justice, and Public  Policy

Rahel Jaeggi (Humboldt University Berlin)  TBA

15:30 – 16:40 Coffee Break / Poster Session

Miguel Abellán (University Lüneburg) Timo Heinrich (TU Hamburg)

Victor Chung (University of Toronto) Iliana Melero (University of Zaragoza)

Denise Feigl (University of Regensburg) Brandon Long (University at Buffalo)

Ben Grodeck (University of Exeter) Reha Tuncer (LISER)

16:40 – 18:00 Nicola Lacetera (University of Toronto) Save and Let Die? Economic Factors and the Support of Medically Assisted Death

Stefan Gosepath (Frei University Berlin) Containment of the Market

19:00 Farewell Dinner

The Morality of Markets, by Mathias Dewatripont and Jean Tirole, in the JPE

 Are markets moral, immoral, or amoral?  Here's a new entry to that argument.

The Morality of Markets, by Mathias Dewatripont and Jean Tirole, Journal of Political Economy, online ahead of print.

Abstract: "Scholars and civil society have argued that competition erodes supplier morality. This paper establishes a robust irrelevance result, whereby intense market competition does not crowd out consequentialist ethics; it thereby issues a strong warning against the wholesale moral condemnation of markets and procompetitive institutions. Intense competition, while not altering the behavior of profitable suppliers, may, however, reduce the standards of highly ethical suppliers or not-for-profits, raising the potential need to protect the latter in the marketplace."

"The irrelevance result.—We ask: does the combination of unethical (or, more generally, UPI [unethical/present biased/influenceable]) consumers and of suppliers with consequentialist social preferences imply that moral behavior deteriorates under more intense competition? Our answer to this question is no. Indeed, under weak assumptions, the degree of competitive pressure is irrelevant to ethical behavior (moral choices are independent of demand functions) if prices are flexible.

"The intuition behind the irrelevance result goes as follows: when a supplier faces more intense competition (a more elastic demand), raising ethical behavior has a bigger negative impact on the supplier’s market share and is therefore costlier for the supplier; ceteris paribus, this makes suppliers cut ethical corners in reaction to the increase in competition, as indicated in the conventional wisdom. However, next to this first market share effect, there is a second reduced-stakes effect: a more intense competition reduces prices and markups, making supplier ethical concerns loom larger relative to material ones. We show that a sufficient condition for these two effects to exactly offset each other is that suppliers have consequentialist preferences and returns to scale are constant.

"The irrelevance result, which applies as well to ethical or indifferent consumers, is important not only because it sheds light on the validity of the widespread concern about markets expressed by the public opinion, social scientists, politicians, and religious leaders but also because it affects our stance vis-à-vis key competition-enhancing public policies, such as the opening of borders to free trade, competition policy, and the deregulation of industries. The irrelevance result is also in stark contrast with earlier theoretical results on the irrelevance of social preferences in highly competitive environments, in particular, with Dufwenberg et al. (2011) and Sobel (2015): in our case, the social preferences of suppliers and of consumers matter regardless of the competitive pressure, and it is the intensity of competition that is irrelevant. The difference is driven in particular by the fact that in their settings, one can affect others’ utilities only through one’s impact on their quantities traded or the market price, an impact that vanishes under perfect competition. In our setting, an individual may want to change her action just because it is objectionable to herself or others, even if this does not affect their ability to trade, a feature that is widespread in the real world. See the literature review for a detailed comparison."

YingHua He 何 英华 has died.

 Yan Chen passes on the devastating news that YingHua He 何 英华 passed away on Tuesday night, after struggling with kidney cancer.

May his memory be a blessing.

He graduated from college in China in 2001, got an MA at Peking University, received his Ph.D. at Columbia in 2011, taught in Toulouse, and was an associate professor at Rice University when he died.

Here's his CV, and here is his Google Scholar page.  He did important work on market design, including on school choice and kidney exchange.

He was one of the pioneers of empirical market design, combining econometrics with matching theory. 

He had many friends, and I was lucky to be among them. Here's a photo I took of him giving a seminar at Stanford, when he was a visiting scholar in 2014-15

Yinghua He at Stanford, January 2015

Here are some of my blog posts on his work:

Tuesday, January 25, 2022

Multiple offer mechanisms in school choice, when information gathering is costly

Sunday, November 6, 2022

Limiting congestion by limiting applications, or making them costly

Sunday, September 13, 2020

A proposal for non-simultaneous kidney exchange in pairs and chains and with deceased donors...

Friday, May 24, 2019

Matching early when information is costly, by Grenet, He, and Kübler

Kidney Exchange in KSA

 Here's a press release from King Faisal Specialist Hospital and Research Centre in Saudi Arabia:

KFSHRC Performs Over 5,000 Successful Kidney Transplants

Published: Jul 01, 2024

RIYADH, Saudi Arabia, July 01, 2024 (GLOBE NEWSWIRE) -- King Faisal Specialist Hospital and Research Centre (KFSHRC) has successfully performed 5,000 kidney transplants since the inception of its Transplant Program in 1981...

...

"Over the past decade, the program has experienced significant growth, with more than 3,000 transplants performed since 2010 and approximately 1,250 transplants in the last three years alone.

"Moreover, the establishment of the Kidney Paired Donation (KPD) program has significantly revolutionised the transplantation landscape by addressing the challenge of compatibility between patients and their donors. This program has helped patients who would otherwise face considerable obstacles in finding suitable matches. :

A proposal to assess public opinion in Europe on compensation for organ donors

 Here's a paper that proposes doing an experiment. Concerning compensation for organ donors. In Europe.  With the hope of influencing policy and reducing the shortage of transplants.  (A very worthy cause, that brings to mind Titian's painting of Sisyphus...)

Ambagtsheer, Frederike, Eline Bunnik, Liset HM Pengel, Marlies EJ Reinders, Julio J. Elias, Nicola Lacetera, and Mario Macis. "Public Opinions on Removing Disincentives and Introducing Incentives for Organ Donation: Proposing a European Research Agenda." Transplant International 37 (2024): 12483.

Abstract: The shortage of organs for transplantations is increasing in Europe as well as globally. Many initiatives to the organ shortage, such as opt-out systems for deceased donation and expanding living donation, have been insufficient to meet the rising demand for organs. In recurrent discussions on how to reduce organ shortage, financial incentives and removal of disincentives, have been proposed to stimulate living organ donation and increase the pool of available donor organs. It is important to understand not only the ethical acceptability of (dis)incentives for organ donation, but also its societal acceptance. In this review, we propose a research agenda to help guide future empirical studies on public preferences in Europe towards the removal of disincentives and introduction of incentives for organ donation. We first present a systematic literature review on public opinions concerning (financial) (dis)incentives for organ donation in European countries. Next, we describe the results of a randomized survey experiment conducted in the United States. This experiment is crucial because it suggests that societal support for incentivizing organ donation depends on the specific features and institutional design of the proposed incentive scheme. We conclude by proposing this experiment’s framework as a blueprint for European research on this topic.