Gift-giving cycles: kidney exchange stories from Britain and Israel

The Guardian has a podcast about a British kidney exchange involving three patient-donor pairs. They call it a "chain" but they mean a cycle--it's a cycle of gift giving. You can listen at the link.

Would you give your kidney to a stranger?
The UK’s living donor scheme allows six people to enter a chain, and three of them will get a new kidney from a stranger. Rachel Williams speaks to six participants. 

"The UK’s living donor scheme allows six people to enter a chain, and three of them will get a new kidney from a stranger. Such chains are anonymous but, for the first time, the Guardian’s Rachel Williams has brought together six participants.

In today’s episode, we hear from those giving and receiving a kidney, and Williams explains how the matches are made possible. "

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And from YNet, a story of a non-directed donor who became a directed donor and part of a cycle with four patient-donor pairs:

The kidney club: Doctors at Beilinson Hospital performed an extraordinary 8-way kidney surgery involving 4 donors and 4 recipients brought together by Matnat Chaim, dedicated to encouraging altruistic kidney donations.

the 4 recipients

"The transplant chain was facilitated by Matnat Chaim, an Israeli non-profit dedicated to encouraging healthy volunteers to donate kidneys to patients requiring a transplant. The organization, which has already facilitated 626 transplants to date, was founded in 2007 by Rabbi Yeshayahu Heber after he found himself needing a kidney, finding a donor and then setting out to help others who were in the same predicament.

"This kidney donor chain began with altruistic donor Benjamin, who donated to a man named Lee. Yardena, Lee’s partner, in turn donated a kidney to a woman named Leah, whose son, Yonatan, donated a kidney to a man named Suheib. Suheib’s mother, Maison, then donated her kidney to a woman named Gil—who was meant to be the original recipient of the kidney donated by Benjamin.

""I approached Matnat Chaim Chairman Rabbi Heber and asked him to help me find a kidney donor," said Gil, 36, adding, "to my delight, Benjamin, a person I don’t even know, agreed to donate his kidney … unfortunately though he wasn’t a match.”

"After tests conducted by doctors at Beilinson ahead of the planned cross-transplant, a possibility arose for Gil to be at the receiving end of a new kidney.

"We have all become like family," Gil continued, “All of us are from a different background—religious, secular, right and left-wing, Jews and Arabs—there is now a special connection between us."
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See my previous posts on Matnat Chaim
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Gift giving rings have for some reason reminded me today of the anthropological literature on gift giving in cycles through Kula rings in New Guinea, studied by the early anthropologist/ethnographer Bronisław Malinowski.

Merry Xmas to all of you for whom today (or yesterday) is a day of gift giving.

An English court awards a woman the costs of surrogacy in California (although commercial surrogacy is illegal in the UK)

Here's an unusual story about surrogacy, from the UK, with a legal opinion confirming that paying a surrogate is illegal in Britain, but that British citizens can legally pay a surrogate in California:

Woman left infertile after NHS failed to detect cancer for four years awarded £580k to cover surrogacy costs  by  Telegraph Reporters, 19 DECEMBER 2018

"A young woman left infertile because her cervical cancer was not spotted for more than four years has been awarded the costs of having surrogate children in America by the Court of Appeal.
...
"The High Court awarded XX a total of £580,000 in damages last year, including the costs of fertility treatment, cryopreserving her eggs and having children by surrogacy in the UK.

"However, XX's claim for the costs of four surrogacies in California, where commercial surrogacy is legal and binding, was dismissed as the court found that commercial surrogacy was still illegal in the UK and therefore contrary to public policy.

"But, giving judgment in London on Wednesday, senior judges allowed her appeal, meaning XX will now receive as much as an additional £560,000 to cover the cost of having children with commercial surrogates in the US.

"Her solicitors Irwin Mitchell say the ruling is the first time the costs of surrogacy in the USA have been awarded in a claim for clinical negligence.
...
"Finding that the ban on commercial surrogacy was "expressly limited to acts done in the UK", the judge said that "there seems to me to be an incoherence in depriving her of her claim at the outset when she personally proposes no wrongdoing, either under Californian law or under our own law".
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Update: here's an article from The Conversation that attempts to shed some light on the finer points of British surrogacy law.

"Under the Surrogacy Arrangements Act (1985), it is not illegal for a couple to pay a surrogate to carry a baby for them and it is not illegal for the mother to accept payment. However, it is illegal for any other person to take or offer money in relation to surrogate motherhood.

Commercial surrogacy agencies are therefore illegal, as are the activities of individual commercial surrogacy agents. And such commercial deals will not be upheld by the courts. By the terms of the Surrogacy Arrangements Act and section 36(1) of the Human Fertilisation and Embryology Act (1990), no surrogacy arrangement of any sort is enforceable in law."

Self regulation of black markets on the dark web?

Here's an interesting story from the Guardian, about some dark-web black markets in the U.K. banning fentanyl, as too deadly and (hence) too likely to attract vigorous police attention:

Dark web dealers voluntarily ban deadly fentanyl
Suppliers, fearing police crackdown, decide opioid is too high-risk to trade

"Major dark web drug suppliers have started to voluntarily ban the synthetic opioid fentanyl because it is too dangerous, the National Crime Agency has said.

"They are “delisting” the high-strength painkiller, effectively classifying it alongside mass-casualty firearms and explosives as commodities that are considered too high-risk to trade.
...
"Vince O’Brien, one of the NCA’s leads on drugs, told the Observer that dark web marketplace operators appeared to have made a commercial decision, because selling a drug that could lead to fatalities was more likely to prompt attention from police.

"It is the first known instance of these types of operators moving to effectively ban a drug.
...
"O’Brien said that the NCA is working with US law enforcement agencies to prevent the UK from having a similar fentanyl epidemic, though the number of people dependent on opioids in the UK compared to America means it has a much smaller market."

The Guardian celebrates British kidney exchange

One day. Six operations. Three kidneys. The story of an organ donor chain


"The process relies on logistical masterminding by staff at the UK’s 23 transplant centres, as much as it does on the mind-boggling computer science it’s built around. Ideally, all the operations in a chain are scheduled to take place on the same day, within eight weeks of a matching run, and only after everyone has been painstakingly assessed to ensure the matches will work and they are well enough for surgery.

"It’s a curiously under-recognised scheme, among the general public at least, but its impact is growing every year. The first UK kidney exchange took place in 2007, with a two-way swap between four people. In 2017/18, 127 of the 1,010 living kidney transplants carried out – one in eight – came about as a result of the sharing scheme. It’s also a British success story: the UK far outstrips any other country in Europe in this field, carrying out about half of all the transplants made possible by sharing schemes."

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And here's the NHS Blood and Transplant's ANNUAL REPORT ON LIVING DONOR KIDNEY TRANSPLANTATION REPORT FOR 2017/2018 (1 APRIL 2003 – 31 MARCH 2018)

"Key findings
• There were 940 adult living donor kidney transplants performed in the UK in
2017/18 an increase of 12 transplants compared to 2016/17. Of these, 449 (421 in
2016/17) were related, 237 (236 in 2016/17) were unrelated, 5 (18 in 2016/17) were HLAi, 41 (64 in 2016/17) were ABOi, 123 (109 in 2016/17) were paired/pooled and 85 (80 in 2016/17) were altruistic donor transplants. The equivalent number of paediatric transplants was 70, an 3% decrease from the previous year.
• The proportion of living donors across the UK being prescribed anti-hypertensive drugs is 5% at one year, 7% at five years and 11% at ten years post donation.
• Serum creatinine for living donors in the UK is 104 (IQ-range 90-121) at one year, 96 (84-111) at five years and 93 (81-106) at ten years post donation.
• The UK rate of graft survival five years after adult living donor kidney transplant by type is; unrelated 94%, related 92%, HLAi 81%, ABOi 87%, Paired exchange 95% and Altruistic 91%.
• 38% of registered patients have been transplanted and 63% of identified transplants proceed."

Discussion of marijuana in the U.K.--a police chief looks ahead

Now that medical marijuana is legal, can legal recreational use be far behind?  The Guardian has the story.
Former Met police chief urges rethink on cannabis
Bernard Hogan-Howe says there is clear evidence to warrant review of prohibition

"He said: “We already know from the evidence around the world that where people use it for medicinal purposes, it slides into recreational. Surely it’s better that we get ready for that potential change.”

"His intervention follows the legalisation of recreational cannabis in Canada last week, its decriminalisation in Uruguay, Portugal and in several US states, and the relaxation of cannabis laws in the UK to allow the prescription of cannabis-based medicines from next month.
...
"Hogan-Howe joins a growing list of prominent figures who have cast doubt on the coherence of the UK’s approach to enforcing laws that are often ignored with impunity, given that a number of police forces have publicly said they would not prosecute perpetrators of low-level cannabis offences."

Presumed consent: too early to declare failure, but cautions are plentiful

Frank McCormick points out a recent report in the journal Health Policy indicating that the Welsh move from opt-in to opt-out or ('deemed consent') for deceased organ donation has not so far been successful at raising transplant rates:

Welsh 2013 deemed consent legislation falls short of expectations
by Jordan Alexander Parsons

"Abstract: Wales, in 2013, was the first country in the United Kingdom to pass legislation introducing presumed (or deemed) consent for organ donation, and remains the only one. It was introduced in an attempt to increase the number of life-saving transplants taking place in the UK, in a move that policy makers hoped would mirror Spain’s success. More recently, pressure has been mounting for England to follow suit, with a public consultation currently in progress. However, the Welsh system has been far from a success, raising the question of why campaigners are so adamant that it should be replicated. Before the Welsh Government introduced the Human Transplantation (Wales) Act there had been no strong evidence to suggest it would make a difference, with countries boasting both high organ donation rates and presumed consent legislation demonstrating no clear causal relationship between the two facts. In addition, a recent report evaluating the Act has highlighted its failure to improve donation rates, and has even presented some potentially concerning statistics that may suggest a negative impact. This paper first considers presumed consent in other countries – Spain and Brazil – before illustrating the underwhelming progression of Wales’ new system and the need to look to other options."

Here's a paragraph that strikes me as important, because family consent is important in Wales, and automatic inclusion on the deceased donor registry reduces the signal value that the deceased wished to be a donor:

"Under the Welsh system, the deceased is deemed to have consented to donation unless (1) a decision as to donation by the deceased is in force, (2) the deceased had appointed a person or persons to make the decision on their behalf, or (3) a relative of friend of long standing objects on the basis of views held by the deceased and it is reasonable to assume the objection is accurate [2]. It is down to the medical team to determine whether a relative’s objection is their own, or one based on the views of the deceased. Unsurprisingly, doctors have not shown willing to challenge these objections, despite their legal right to; they consider it inappropriate to go against the wishes of the family."
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Here is a related article, which raises other potential problems:
Presumed consent will not automatically lead to increased organ donation
Sharif, Adnan
Kidney International , Volume 94 , Issue 2 , 249 - 251

"a review of the latest available data (2016) from the Global Observatory on Donation and Transplantation suggests no significant difference in overall transplantation activity between presumed versus explicit consent countries, with increased deceased organ donor rates balanced by decreased living donor rates among presumed consent countries (Table 1). Whether the consent process is presumed or explicit has no bearing on many inter-related factors that influence organ donation rates. For example, Coppen et al.4 observed a strong correlation between mortality rates and organ donation numbers (Spearman’s r = 0.81, P < 0.01) and that, after controlling for differences in relevant mortality rates, there was no significant influence of presumed versus explicit consent on organ donation rates."

Table 1 Organ donation and transplantation activity

Parameter	Presumed consent (mean ± SD per million population)	Explicit consent (mean ± SD per million population)	P value
Kidney (deceased)	30.9 ± 15.1	22.6 ± 11.1	0.078
Kidney (living)	4.8 ± 2.6	16.9 ± 8.4	<0 .001="" td="">
Liver (deceased)	12.9 ± 8.5	10.1 ± 5.3	0.265
Liver (living)	0.4 ± 0.9	2.7 ± 5.3	0.107
Heart	4.8 ± 3.5	3.1 ± 2.6	0.108
Lung	3.5 ± 4.0	4.2 ± 2.8	0.543
Pancreas	1.6 ± 1.6	1.4 ± 1.0	0.579
Overall transplant activity	59.1 ± 30.7	58.9 ± 23.4	0.982

From the Global Observatory of Donation and Transplantation registry ( www.transplant-observatory.org).
...
"The other concern with presumed consent is the reduced rate of living donation observed in presumed consent countries, a phenomenon repeatedly observed in systematic reviews and apparent in current registry data (Table 1). Many will argue that an increased supply of deceased organ donors with presumed consent overrides the need for living donors. However, it is unlikely switching to presumed consent can ever completely eradicate organ waiting lists, and living donation facilitates transplantation for many high-risk (predominantly kidney) recipients who would otherwise be deemed unsuitable for the transplantation procedure. Altruistic living kidney donors are a valuable resource to facilitate kidney transplantation for some of the most immunologically difficult and long-waiting end-stage kidney failure patients,7 and the risk of these numbers declining, although purely speculative in the setting of a switch to presumed consent, would jeopardize successful national living kidney sharing schemes. Declining living donation rates could therefore be further hampered by switching to presumed consent, with adverse consequences for established kidney transplantation programs."

Organ donation in the UK: the particular case of children

Children in need of transplants, particularly very young children, need appropriately sized organs, which can come from deceased donors of similar age. But there are obstacles, including family consent:

Despite removal of many obstacles, UK child organ donation rates remain low

"Despite the removal of many logistical/professional obstacles, and clear guidance from national bodies, UK child organ donation rates remain lower than in other comparable countries, say experts in a leading article published online in the Archives of Disease in Childhood.

"Many families of dying children are simply not even given the chance to consider the option, and potentially save another child's life, they argue.
...
"Family refusal remains a major obstacle to organ donation from children, emphasise the authors, but that is where trained staff are key, as they can ensure that "families are given the chance to consider donation, and that it is broached at the most appropriate time by the most appropriate person, and in the most appropriate way," say the authors.

"Immediate focus should be given to consent rates and supporting family decision-making, they urge."

Wales' organ donation opt-out law has not increased donors--BBC

Here's the story from the BBC:
Wales' organ donation opt-out law has not increased donors

"Wales' opt-out system for organ donation has not increased the number of donors in the two years since it was introduced, a study has confirmed.

"Adults in Wales are presumed to have consented to organ donation unless they have opted out.

"The data was published in a Welsh Government report about the impact of the Human Transplantation (Wales) Act.

"In the 21 months before the law changed in December 2015 there were 101 deceased donors in Welsh hospitals. The data showed there were 104 in the same time period since the law change.

Every quarter NHS Blood and Transplant releases figures for organ donation for each county in the UK.

Mr Gething acknowledged the figures and added: "The report suggests this may be because there have been fewer eligible donors over the short period since the change in law.

"It's important to remember that it's too early to know what the true impact of the change will be, but I'm confident we have started to create a culture where organ donation is openly discussed."

HT: Frank McCormick

Temporary brothels in Britain

The Guardian has the story:

How ‘pop-up’ brothels transformed Britain’s suburban sex industry
MPs are investigating a surge in flats being used short-term for prostitution – but the women who work in them say they often have no safer option

"Last month, MPs launched an inquiry into the apparent rise of so-called “pop-up” or temporary brothels. The phenomenon, where sex workers use Airbnb, hotels, or short-term holiday lets as a work base, has caused concern among politicians and the police. But what is the reality for women working in brothels in Britain today, and what is driving them to work in temporary set-ups?

“People think we’re either in five-star hotels or we’re on flea-bitten mattresses with a line of men outside the door,” says Amy, a single mother who works in the north London brothel. “Both of those things are real, both of those things happen, but the vast majority of us are just somewhere in the middle. Demystifying it is really important.”

...

"After a year, she found her current place with two others. With CCTV and a panic alarm, she says the more permanent setup means she has better security measures: “I honestly can’t imagine working any other way now and it astounds me that what we’re doing is technically illegal.”

Still, she does not want to paint a rose-tinted picture of her new situation. “When [sex workers] are talking to the press, there’s a lot of pressure for us to be like, ‘Oh I love my job, everything’s great’ when it’s not great. It’s like any other job – you have good days and bad days. It’s just like being in any kind of office job, or a call centre, just with more nudity, and dildos everywhere,” she jokes.

"Like many sex workers, trust and communication with the police is a huge issue for her and her workmates. “At the moment, I have absolutely no trust in the police whatsoever,” she says. “You can literally go from being the victim, to being the criminal in a matter of minutes.”

...

"How the law stands

• There are an estimated 72,800 sex workers operating in the UK.
• In a study of 6,000 men, 11% reported paying for sex. More than a half of these said they paid for sex outside the UK.
• The mortality rate for sex workwers is 12 times higher than average.
• Keeping or managing a brothel is illegal under the 1956 Sexual Offences Act.
• The sale and purchase of sexual services is legal in England and Wales, but certain related activities are not.
• In 2015 Northern Ireland made it illegal to pay for sex. The first prosecution was in October 2017."

Enticing new graduates to become prison guards, British edition

In the U.S., new college graduates are tempted into teaching in under-served schools through Teach for America, and in Britain through Teach First.  Here's a program for prison guards: Unlocked Graduates

Here's a story from The Guardian:

The graduates training as prison officers: 'People think we just turn keys and shout orders'
These are volatile times for prisons in England and Wales, with overcrowding and record levels of violence. Can a new scheme that aims to do what Teach First did in schools change things from the inside?

"Jack is one of the first cohort of Unlocked Graduates, a new, two-year prison-officer training programme modelled on the phenomenally successful Teach Firstscheme, which takes ambitious graduates and, after minimal training, parachutes them into inner-city schools where they are tasked with raising the aspirations of some of the most deprived children in the country.

"Teach First has been the biggest graduate recruiter for the past three years, training more than 1,400 graduates each year. Almost 60% remain in teaching with the rest going out into the world, tasked with building a movement of people leading efforts to tackle educational inequality in schools and beyond. About a fifth of teachers in low-income schools are now Teach First graduates, around 70%of them from elite Russell Group universities. Unlocked Graduates works in the same way and hopes to mirror Teach First’s success inside prisons – and outside, too.

The prison system is, without question, in urgent need of help. Two-thirds of prisons in England and Wales are overcrowded, with the population rising by more than 1,200 places in the 13 weeks since May. It is now higher than at any other point in the past four years. Ministry of Justice (MoJ) figures show 68% of prisons are housing more inmates than their “certified normal accommodation” – the limit for ensuring a “good, decent standard”, with some more than 50% over capacity.

"According to a report last month by the HM Inspectorate of Prisons, prisoners are living in cells that are too small, with inadequate ventilation, damaged furniture and unscreened, unhygienic toilets, for up to 23 hours a day. And with almost half of all prisoners returning to prison within a year of release, it is clear that more needs to be done to break the cycle of reoffending."

London crossing signs and diversity in marriages

Walking from HM Treasury to LSE, a quarter turn around Trafalger Square shows that British traffic wardens have a relaxed view of modern marriage--here are two walk signs (or maybe go-ahead signs) that seem to celebrate both traditional and same-sex marriage.  (I was in a bit of a hurry so I didn't have time to circumnavigate the square and look for other variations on this theme...)

Assisted dying appeal to be heard in Britain

The Guardian has the story
Assisted dying

Terminally ill former lecturer wins right to fight assisted dying ban
Appeal court reverses high court ruling in case of Noel Conway, who has motor neurone disease and seeks judicial review

"In their judgment, Lord Justice McFarlane and Lord Justice Beatson said: “It is arguable that the evidence demonstrates that a mechanism of assisted dying can be devised for those in Mr Conway’s narrowly defined group that is practical so as to address one of the unanswered questions in the [earlier Nicklinson right to die case].”

Supported by the organisation Dignity in Dying, Conway has instructed lawyers to seek permission for a judicial review of the ban on assisted dying, which he says prevents him ending his own life without protracted pain. Assisted dying is prohibited by section 2(1) of the Suicide Act 1961 and voluntary euthanasia is considered murder under English and Welsh law."

Kidney exchange, in Spanish, from the BBC

Alvin Roth, el premio Nobel de economía que sin buscarlo acabó salvando miles de vidas, Redacción BBC Mundo 14 marzo 2017

G translate (from the text): "According to data the BBC Department of Blood and Transplants gave to BBC Mundo, in 2015, 123 chain transplants were made out of a total of 1025 live kidney donations.
In Spain , a world leader in organ transplantation, the first cross-transplant was also performed for the first time in 2009. In 2015 , 125 patients received a kidney with this system ."

Two California surrogacy stories from Europe, and a (pretty sad) one from Italy via Russia

Here's a late breaking story about an Italian couple that enlisted a surrogate in Russia, had the child taken from them by Italian authorities, and has just lost their appeal to the European Court of Human Rights.

ECHR rules in surrogate case--Court overrules its previous verdict
 "(ANSA) - Strasbourg, January 24 - The European Court of Human Rights said in a ruling Tuesday that Italy had not breached the rights of a couple after taking away a child born to a surrogate mother in Russia with whom they had no biological ties. The child was taken away from the couple after they returned from Russia following DNA testing showed that neither the man or the woman were its biological parent, even though a Russian birth certificate put them as parents.
    Tuesday's ruling overrides a previous decision made by the Strasbourg court in January 2015. "The Court considered that the contested measures had pursued the legitimate aims of preventing disorder and protecting the rights and freedoms of others," the ECHR said. "On this last point, it regarded as legitimate the Italian authorities' wish to reaffirm the State's exclusive competence to recognise a legal parent-child relationship - and this solely in the case of a biological tie or lawful adoption - with a view to protecting children".
    The child has been adopted by another family."

"PARADISO-CAMPANELLI VERSUS ITALY"
Surrogate motherhood: stopped by the European Court for Human Rights. The Chambre supports the Italian Court
"(Strasbourg) “The Court rules that the relationship between the applicants and the child is not part of family life”: this has been ruled by the Grande Chambre of the European Court of Human Rights, issued today about “Paradiso-Campanelli versus Italy”. The case is about an Italian couple living in the province of Campobasso, who went to Russia in 2011: through a private organisation, the married couple had had a child from a “surrogate mother” who has no biological relationship with the couple. Under Russian law, the couple could record the child as their own child, but, once back in Italy, the Court refused to record the child as the couple’s child and, after finding there was no biological relationship, it ruled that the child should be taken away from the applicants (the child was about eight months old back then) and then adopted by a different family. Today’s ruling overturns a ruling issued by the Court in January 2015: it claimed that taking the child away from the first couple breached article no. 8 of the Convention on Human Rights (right to private and family life), regardless of the child’s interest. The new ruling states, instead, that the Italian Court had actually ruled in the child’s interest and also stopped surrogate motherhood."

HT: Dorothea Kuebler
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Here are two earlier stories, set in England and Italy, from the blog Above the Law. about surrogacy as a repugnant transaction (at home) and the resulting fertility tourism (to California):

1."British aristocrats, the Viscountess and Viscount Weymouth... welcomed their second son on December 30, 2016. In what is likely a first for the British aristocracy, the child was born via surrogate.

The baby boy is the second grandson of the 7^th Marquess of Bath. I’ll just assume this is kind of a big deal in England. Lady Weymouth suffers from medical complications that made a second pregnancy too dangerous. So the couple turned to a California surrogate. To their credit, they are reportedly* sharing their story to help remove some of the stigma associated with surrogacy. Welcome and all hail the Right Honourable Henry Thynn. No typo. Honorable is spelled that way on purpose."

*They explain the differences between surrogacy in California and Britain as follows:

"Ceawlin explains that the US state has the most advanced legal system for the procedure. 
For example, it allows money to be exchanged, while Britain insists no more than expenses can be paid to the woman who will carry the child.
‘Obviously, we would have preferred to do it closer to home, but the legal system in Britain has not evolved with medical technology, so any contract with a surrogate is not binding,’ he says. 
‘Even if the baby is 100 per cent yours (ie the sperm and egg) the surrogate still has the right to keep the baby. California has the most evolved legal system in the world [for surrogacy].’ 

2. "Italy Is Not A Great Place To Be Gay. The parents of the twins are a gay Italian couple. While the U.S. made the move to permit gay marriage in 2015, Italy still denies same-sex couples the right to marry. Italy also denies gay couples the right to adopt children. Italian same-sex couples can’t even adopt their own family members through kinship adoptions. And, unsurprisingly, there is no same-sex step-parent adoption since gays can’t marry in the first place.

Having limited family-building options, the couple turned to an egg donor and California surrogate to conceive their children, and complete the family they dreamed of. Two embryos were transferred to the same surrogate. One was a donor egg fertilized with sperm from dad 1; the second was a donor egg, but this time fertilized with sperm from dad 2. The twins are biologically half-siblings with the same birthday. The conditions for an Arnold Schwarzenegger/Danny DeVito situation probably couldn’t have been set any higher.

This Is What Partial A Victory Looks Like. The fathers returned from the United States to Italy with their twins in tow. But the Italian government initially refused to recognize the children as (1) sons of the fathers, and 2) eligible for Italian citizenship. The fathers’ appealed, and were able to obtain what many consider a victory.

The court determined that despite the children being born to a gay couple (strike 1), using donor eggs (strike 2 – donating eggs and/or sperm is illegal in Italy) and to a surrogate (strike 3 – surrogacy is also illegal in Italy), it would be in the children’s best interest for Italy to recognize the parent-child relationship. The court awarded parental rights of each individual twin to the genetically related father."  

(NB: the two twins aren't legally related in Italy...)

"It Could Have Been Much Worse. While this was not a complete victory, it was a step forward for Italy. In prior cases, an Italian court has denied parentage to both parents — or even taken away a surrogate-born child from the parents and made the child a ward of the state! In an infamous case from 2014, an infertile couple in their 50s — who had been turned down for adoption three times — turned to surrogacy. They paid a Ukrainian surrogate €25,000 to carry a child conceived with donated genetic material. When they brought the child back to Italy, the government refused to register the child as theirs and charged them with fraud. Sadly, the court went further, ruling that the child, whose genetic and surrogate parents were unknown, was a “child of no one.” Despite even an Italian prosecutor advising that the child be allowed to stay with the intended parents, the court ruled that the child must become a ward of the state and put up for adoption. Heartbreaking.

Europe’s Anti-Surrogate Tendencies. Italy is not an anomaly. Most of Western Europe (including France, Spain, and Germany, among others) bans surrogacy. This has led to a number of troubling cases when Europeans go elsewhere for surrogacy and then try to bring their children home. In France, for instance, several surrogacy cases have involved French courts denying parental rights. But couples have had success appealing to the European Court of Human Rights. There, a child’s right to his or her parents has prevailed over French domestic law."

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France introduces opt-out policy on organ donation

The Guardian has the story:
France introduces opt-out policy on organ donation
Change in law means consent for organs to be removed is presumed unless person joins official ‘refusal register’

"France has reversed its policy on organ donations so that all people could become donors on their death unless they join an official register to opt out.
The new law presumes consent for organs to be removed, even if it goes against the wishes of the family.

Until 1 January, when the legislation took effect, unless the person who had died had previously expressed a clear wish for or against donation, doctors were required to consult relatives who, in almost a third of cases, refused.

Those who do not want all or any of their organs to be used must now put their name on a “refusal register” – so far 150,000 people have signed up. The authorities have promised to make it easier for those who wish to refuse by allowing them to join the register online instead of by registered post.

Alternatively, those vehemently opposed to their organs being used can leave a signed document with their next-of-kin or transmit their wish orally to relatives who must make a written declaration of non-consent to doctors at the time of death. The process is explained on the agency’s Facebook page.

In November, the French Agence de la Biomédecine released a film, Déjà-vu2, aimed at encouraging 15- to 25-year-olds to agree to organ donation.

The European Union has highlighted the lack of organs for transplant and the increasing number of patients on waitings lists worldwide. Its figures claim that in 2014, 86,000 people were waiting for organ donations in EU states, Norway and Turkey, and 16 people were dying every day while waiting for a transplant.

In the UK, doctors lament one of the lowest consent rates in Europe, as well as a shortage of donors from black or Asian communities. A record number of organs were donated and transplanted in the UK in 2015-16, but the rate remains short of the target of 80% by 2020. The biggest obstacle remains relatives’ opposition, who have vetoed transplants even from registered donors.

NHSBT, which is responsible for the NHS organ donor register and for matching and allocating donor organs, said it was considering further steps it could take when approaching families to ensure more potential donors’ decisions were not vetoed.

One option would be to no longer ask the next-of-kin to confirm consent or authorisation. Their permission is not required by law if someone has registered a decision to donate on the NHS organ donor register.

Families in Scotland are already required to complete a retraction form to record why they overturned a relative’s decision to donate. NHSBT said a similar form be introduced across the UK."

HT: Frank McCormick

Nondirected donor kidney exchange chains come to the UK

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

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

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

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

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

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

"In turn, the first recipient’s friend or relative, who wants to donate to their loved one but cannot because they are not a match, donates to another patient in the scheme, the second recipient.
...
"Any adult can ­volunteer to be ­considered an altruistic donor. You must be over 18 in England, Northern Ireland and Wales, and over 16 in Scotland.

The 16 Brits who gave their kidneys to patients they did not know first had several months of physical and psychological tests at their local transplant centre to ensure they were able to safely donate, and to confirm which recipients would be a suitable match."

Family consent to deceased donation remains a concern in Britain

The Guardian has the story
Organ donation rates for transplants still too low in UK, says NHS
Consent rate one of lowest in Europe, with black, Asian and ethnic minority communities of particular concern

"A record number of organs were donated and transplanted in the UK in 2015-16 but the consent rate is still one of the lowest in Europe, with a worrying shortfall of donors from black or Asian communities.

In the 12 months to the end of March, 1,364 people became organ donors when they died and their donations resulted in 3,519 transplants taking place, figures published on Thursday show.

The consent rate stood at 62%, slightly up on 2012-13 when it was 57%, but well short of the target of 80% by 2020 with the biggest obstacle being family refusal, mostly when they were unaware of their deceased relative’s intentions.

The consent rate was much lower (34%) among potential black, Asian and minority ethnic (BAME) donors, which is of particular concern as 26% of the current waiting list are BAME."

House swapping in the UK

Neil Thakral writes:

Regarding ... public-housing residents switching units, I mentioned that this happens in the UK (https://www.gov.uk/apply-swap-homes-council). 

["You can swap your council or housing association home with another tenant if you follow certain rules and get permission from your landlord. This is often called ‘mutual exchange’."]

I thought there was something like this on Al's blog, and I found posts on buying/selling private homes (http://marketdesigner.blogspot.com/2009/01/house-swaps.html) and trading homes for vacations (http://marketdesigner.blogspot.com/2012/04/home-exchanges.html).

Here is a recent article: http://www.yorkshireeveningpost.co.uk/news/leeds-is-revealed-as-the-house-swapping-capital-of-the-uk-1-8028444

["The House Exchange website automatically matches house-seekers with properties that meet their needs. Once a social housing provider signs up with House Exchange, all its tenants can use the service for free. In Leeds, 100 per cent of social landlords have signed up, meaning all 102,000 social households across the city are able to use the service."]

and an example of a six-way swap from a while back:  http://www.mirror.co.uk/money/personal-finance/we-swapped-homes---get-moving-if-you-358806

Here are two platforms that seem to arrange this:

- http://www.houseexchange.org.uk

- https://www.homeswapper.co.uk

Reverse college admissions scramble in British clearing

In Britain, students get admitted to university (sometimes contingently) before their grades are known. So some students don't get the grades they need to fulfill their admissions requirement, and have to scramble for a position at a less selective school. But some students do much better on their exams than they anticipated, and find themselves in a position to go to more selective schools than they applied to (or were admitted to). But they need to scramble to find a place.

The Telegraph has the story: What are my options if I do better than expected at A-level?

British immigration: more time combating clandestine immigrants means less time investigating scams

What do immigration inspectors do?

The Telegraph has the story: Overwhelmed border guards diverted from other immigration scams to deal with threefold increase in migrants arriving by lorry and Channel Tunnel

“It's worrying that problems at the border meant that that organised crime and sham marriages were not properly investigated. In addition overstayers were not returned and illegal working was not tackled."