Increasing the supply of transplantable organs, in the long term, and sooner.

 Here's an article on the website of The American Council on Science and Health, on technologies that might eventually replace the need for human organ transplants, and on policies to increase their supply while still needed.

We Urgently Need More Organs For Transplantation. Science And Policy Can Come To The Rescue. By Henry I. Miller, MS, MD and Sally Satel, MD

"Both scientific and policy advancements could provide desperately needed organs for transplantation. For example, there have been some promising early studies using kidneys from pigs genetically engineered to prevent rejection, but a policy change – paying human donors for donating organs – could be implemented immediately and would be a game changer.

...

"[A] sector of medicine that desperately needs breakthroughs is the transplantation of solid organs, which are in severely short supply. Currently, more than 100,000 Americans are waiting for transplants, and due to a shortage of hearts, lungs, livers, and kidneys, at least 17 die each day. Donor organs — from a living person or cadaver — must match the rejection recipient’s tissue type and size; they are often not perfect. By one estimate, approximately half of transplanted organs are rejected by recipients’ bodies within 10-12 years, despite a constantly expanding understanding of what causes rejection. Another obstacle is that the organ procurement system in the U.S. is inefficient, inconsistent, and unaccountable – in short, a mess that causes preventable deaths.

"We are making progress, but too slowly. Two new high-tech approaches to providing organs for transplantation might ultimately both eliminate the need for organ donors and reduce the risk of tissue rejection. And there is also a low-tech approach that would require only a tweak in healthcare policy.

"Organs produced by 3D bioprinting"

...

"Organs from genetically modified pigs"

...

"The low-tech policy approach

"Although friends and relatives and even the occasional “good Samaritan” donor can donate kidneys, they must be given without compensation. Under section 301(a) of the National Organ Transplant Act of 1984 (NOTA), it is a federal crime for “any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation if the transfer affects interstate commerce.”  Therefore, we propose a federal tax credit for living donors willing to save the life of a stranger. The value of the reward should be between $50,000 and $100,000, which physicians and others who endorse donor compensation believe would be sufficient to address the organ shortage. An economic analysis published in 2022 estimated that a reward of $77,000 could encourage sufficient donations to save 47,000 patients annually.

"The credit would be universally available—refundable in cash for people who do not owe income tax, not phased out at high-income levels, and available under the alternative minimum tax. NOTA’s restriction on payments by organ recipients and other private individuals and organizations would not change—it would still be illegal for recipients to buy organs.

"A qualified organ donation would be subject to stringent safeguards. As all donors are now, prospective compensated donors would be carefully screened for physical and emotional health. A minimum six-month waiting period before the donation would filter out impulsive donors and donations by financially desperate individuals seeking instant cash.

"In addition to saving lives, the credit would save the government money, perhaps as much as $14 billion per year, by reducing expenditures on dialysis. Thus, donors would receive financial compensation from the government for contributing to the public good and bearing the risk of a surgical operation to remove the organ.

"This would be a compassionate and pragmatic policy. Moreover, it could be implemented immediately, rapidly clearing much of the backlog of Americans waiting for organs in advance of the longer-term high-tech approaches.

"The organ shortage kills thousands of Americans every year. We must do all we can to alleviate it now."

HT: Frank McCormick

Innovations in addiction technology--illicitly manufactured fentanyl (IMF) combined with xylazine

 The fight against addictions is complicated by the fact that those who sell addictive goods can be innovative on many levels. (In the case of legal addictive substances such as nicotine, we are becoming accustomed to that competition, e.g. in connection with the growth of non-combustible vaping.)

Here's an article about innovation involving illegal opioids.

The emerging fentanyl–xylazine syndemic in the USA: challenges and future directions, by David T Zhu, Joseph Friedman, Philippe Bourgois, Fernando Montero, Suzanne Tamang, Lancet, August 24, 2023 DOI:https://doi.org/10.1016/S0140-6736(23)01686-0

"Xylazine, a non-opioid analgesic and sedative approved only for non-chronic veterinary use, is spreading across unregulated North American drug markets and becoming increasingly implicated in opioid overdoses. Between 2018 and 2021 in the USA, estimated fatal drug poisonings involving xylazine, often co-occurring with synthetic opioids such as fentanyl, increased from 260 to 3480 cases.1 This use of xylazine takes place in the context of the ongoing US opioid overdose crisis, which is expected to claim an estimated 1·2 million additional lives by 2029, barring urgent substantial policy reforms.2 The White House Office of National Drug Control Policy identified fentanyl adulterated or associated with xylazine (FAAX) as an emerging threat and in July, 2023, issued a response plan leveraging the Emerging Threats Committee and other vital stakeholders.3 Although this is a welcome strategy that sets out the federal government's plan to address xylazine, further non-punitive efforts and public health interventions are needed from health-care systems, policy makers, and community leaders to address the longer-term structural factors driving this crisis.

...

"Although more evidence is needed about why xylazine is combined with fentanyl, some reports suggest that by adding xylazine as an adulterant for synthetic opioids such as IMF, manufacturers can potentially maximise profits and distinguish their brand in the market, attracting a wider customer base.6,  7 This has most notably been observed in Philadelphia, PA, USA—regarded as an epicentre of the emerging xylazine crisis in mainland USA—where over 90% of the city's street opioid supply has shifted to FAAX.8 Further, xylazine has been described by people who use drugs as lengthening the sedative effects of IMF—solving the disadvantage of fentanyl's short duration of effect—thereby postponing craving and physical withdrawal symptoms"

Market Shaping at the University of Chicago: Promoting needed innovation

 One of many exciting talks yesterday at the first day of the New Directions in Market Design conference was by U. Chicago's Rachel Glennerster who announced the new market design initiative at U. Chicago:

Introducing the University of Chicago's Market Shaping Accelerator. Designing market shaping mechanisms to spur innovation to help solve some of the biggest global challenges.

"Accelerating Innovation

"Threats to the global community — such as climate change and pandemics — demand urgent innovation and action at scale. But when commercial incentives for innovation trail behind the social value, market shaping instruments are required to credibly signal demand and spur and scale up innovation.

"The Market Shaping Accelerator aims to harness the momentum and interest in these tools generated from global successes in vaccine development to accelerate their adoption by governments, multilateral institutions, and philanthropies to solve the world’s most pressing challenges.

"Nobel Laureates, Leading Scholars and Innovators Advance the Use of Market Shaping Instruments to Address Global Challenges​

"The Market Shaping Accelerator brings together the world’s leading market shaping experts. The team behind the Accelerator has contributed to both foundational research and prominent policy successes of market shaping mechanisms, including the Pneumococcal and Frontier Advanced Market Commitments (AMCs)."

Rachel Glennerster speaking about market shaping