Nondirected liver donation in Canada--from the beginning

The Ottawa Citizen has the story:

The Gosling Effect: How one man (and his liver) forever changed Canadian health care. In 2005, Kevin Gosling became the first living Canadian to anonymously donate an organ to a stranger. It set a cascade of kindness into motion.  by Elizabeth Payne 

"It had been a long road for the then-46-year-old from Cornwall, Ont. For months, health officials wouldn’t take him seriously when he offered to donate the organ anonymously. We don’t do that here, he was told. Not only that, it had never been done before anywhere in Canada.

"Some top officials in Canada’s leading liver transplant program were adamantly opposed to Gosling’s proposal. They said it was unethical and immoral. They questioned his motives, even his sanity. But Gosling persisted, so far as to undergo months of physical and psychological testing and preparation.

"After more than a year and a half, everything was set to go.

...

"Gosling didn’t know much about the recipient. He only knew that it was a child.

...

"Gosling’s stubborn altruism and unwavering belief that he could make a life-changing difference to someone in desperate need almost single-handedly changed Canada’s health-care system.

"In the 19 years since that fateful day when transplant surgeons removed part of Gosling’s liver and transplanted it into the body of the very ill child, the Toronto General Hospital has completed more than 137 such operations involving people donating anonymously to strangers – more than any other hospital in the world.

...

"He was a pioneer in an area in which Canada is now a world leader – the act of anonymously donating part of a liver – a phenomenon that continues to be met with disbelief in some parts of the world.

...

"Gosling’s offer was turned down multiple times until he was eventually put in touch with the head of the multi-organ transplant program at University Health Network, one of only two hospitals in the country where living liver transplants are now routinely done. Along the way he met health officials who were adamantly opposed to the idea, even citing the Hippocratic oath. (Later, he was told by one staunch opponent that following Gosling’s case had made him change his mind.)"

HT: Colin Rowat

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See also:

Cattral, Mark S., Anand Ghanekar, and Nazia Selzner. "Anonymous living donor liver transplantation: The altruistic strangers." Gastroenterology 165, no. 6 (2023): 1315-1317.

and here are all my posts on nondirected donors: https://marketdesigner.blogspot.com/search/label/nondirected%20donor

Gail Cornwall responds to the recent NY Times story on SF schools

Gail Cornwall, who follows San Francisco schools, replies to a recent article in the NY Times:

A cautionary tale about linking school choice and segregation

"Late last month, New York Times’ national education reporter Dana Goldstein wrote about public school choice and segregated schools in San Francisco. Headlined San Francisco Had an Ambitious Plan to Tackle School Segregation. It Made It Worse, the story hits several nails squarely on the head.

...

"But there are several important weaknesses in Goldstein’s article that could mislead parents, readers, and policymakers.

"The piece lays blame for segregation at the feet of San Francisco’s citywide public school choice system. It oversimplifies the views and priorities of lower-income non-white families. And, though Goldstein told me it wasn’t meant to, the article seems to endorse a controversial return to a restriction of choice in favor of a form of neighborhood attendance zones."

**********
Here's my earlier post on the NY Times article:

Tuesday, May 7, 2019

School choice in San Francisco--update in the NYT

I've blogged about other articles by Ms. Cornwall.

Information, school quality and school choice

Here's a recent article by Gail Cornwall in The Atlantic, summarizing some of the work on school choice which points out that it is easier for parents to judge the test scores of graduates than the value-added by the school.

Why Parents Make Flawed Choices About Their Kids' Schooling
A new study shows that families act on insufficient information when it comes to figuring out where to enroll their children.

It covers (among other things) work by Atila Abdulkadiroglu and Parag Pathak and various colleagues, including the recent NBER working paper

Do Parents Value School Effectiveness?

Atila Abdulkadiroglu, Parag A. Pathak, Jonathan Schellenberg, Christopher R. Walters

NBER Working Paper No. 23912
Issued in October 2017
NBER Program(s):   ED   LS 

School choice may lead to improvements in school productivity if parents' choices reward effective schools and punish ineffective ones. This mechanism requires parents to choose schools based on causal effectiveness rather than peer characteristics. We study relationships among parent preferences, peer quality, and causal effects on outcomes for applicants to New York City's centralized high school assignment mechanism. We use applicants' rank-ordered choice lists to measure preferences and to construct selection-corrected estimates of treatment effects on test scores and high school graduation. We also estimate impacts on college attendance and college quality. Parents prefer schools that enroll high-achieving peers, and these schools generate larger improvements in short- and long-run student outcomes. We find no relationship between preferences and school effectiveness after controlling for peer quality.

School choice in San Francisco faces ongoing problems (and not just school choice)

The SF Chronicle has the story:

Why San Francisco needs a full-time school board
By Gail Cornwall, May 17, 2017  

"Ever wonder why the pace of change in public education falls somewhere between inching and crawling in arguably the most progressive, innovative city in the world? San Francisco Unified School District’s red tape and lack of resources are to blame, but there’s also a story of unpaid workers, organizational mutiny and missed opportunity.

Here’s an example: In 2009 the school board set out to redesign its method for assigning students to schools. Though the topic sounds dry, matching thousands of children to seats at more than a hundred programs — while taking into consideration parental preference, geography, diversity and more — involves the sexiest corner of economics: game theory.

Luckily, the board had the assistance of a group representing Harvard, Stanford, Duke and MIT. Nobel Prize winner Alvin Roth, Muriel Niederle, Clayton Featherstone and others proposed helping to create, monitor and adjust a cutting-edge algorithm for free. In March 2010, the board voted unanimously to take the offer.

But that September, district staff sent Roth’s team an email amounting to “Thank you, goodbye.” District officials had decided to instead “develop software to implement the new design on their own,” Roth reported.

Today, the state of the district’s homegrown assignment algorithm, known to parents as “the lottery,” is described by board member Mark Sanchez as “broken” and “untenable,” and by board member Rachel Norton as “probably the biggest policy issue that our community engages with us on.”

Neil Dorosin directs the Institute for Innovation in Public School Choice, a nonprofit Roth and his team formed. When I recently asked Dorosin what kind of personnel would be needed to create an effective school assignment algorithm, he said, “Either a mathematician or an economist who knows about algorithms, and … a software engineer who could operationalize it. I would be stunned if they have that.”

Those who shared these concerns back in 2010 called on district staff to explain themselves. Despite making a pledge to the board to disclose the algorithm developed in-house, by March 2012 staff still hadn’t issued “a complete enough description to [know] … if they in fact implemented the plan … the board adopted,” said Roth.

Lack of compliance with board directives sounds crazy, but Sanchez, who served on the board from 2001 to 2009 and won re-election in November, said it happens all the time. “There are so many examples,” he said.

How could that be possible? Because board members each receive “about $6K a year — and everyone has a full-time job doing something else — they’re just too busy to check in and cajole, Sanchez said. The only thing the board really can do, he said, is fire the superintendent when “a lot of that piles up.”

That’s why Sanchez and San Francisco Supervisor Jane Kim have discussed putting forward a ballot measure to increase school board member compensation. Sanchez said it would give board members “the average beginning pay for a teacher in the Bay Area ... probably ending up at around $45,000” (drawn from the city’s budget, rather than the school district’s). Following the model adopted by Los Angeles in 2006, the full amount would be available only to those who forsake other employment, he said.

Meanwhile, parents fret over the lottery. The long, complex application process — where paperwork is submitted in person in January and decisions are issued in March, then again in May, through three more rounds of supplication and the first two weeks of school — fails low-income families who lack the time or bureaucratic savvy to effectively engage. Those who do manage to navigate the process, one emotional parent told the school board committee Monday night, often find the experience “time-consuming, frustrating and stressful.” Raman Khanna, a member of the Ulloa Elementary School PTA, referred to another outcome: professional “flight.” Because of the lottery, he said, “a lot of the colleagues that I talk to … leave the city or they go to private school.”

Roth’s and Dorosin’s organization has worked with cities across the country to use data and technology to improve school assignment. Dorosin said the nonprofit’s modest fees are often covered by outside grants and other funding. This March they invited SFUSD board members and district officials to reach out again.

The response? The board committee announced Monday it would “not be taking action,” and district staff proposed two timelines for reform: one would give the board two years to articulate a new direction for the assignment system; the other, labeled “if policy development moves quickly,” would still give them a full year to do so and then another 18 months for district staff to implement it. Tommy Williams, a parent who works for the U.S. Army Corps of Engineers, said: “The fact that we’re talking about the 202[0] or 2021 school year is very frustrating.”

Board members could start meeting with national experts with just days’ notice to hash out a broad-strokes plan, but that won’t happen until the fall. “It’s clearly an urgent issue,” Sanchez said, “but it’s one of many, many things that we have to deal with. ... We had to hire a superintendent, and now we’re involved in negotiations for the contract so we wanted to focus on that.”

Rionda Batiste, co-chair of the district’s African American Parent Advisory Council, won many approving head nods at Monday’s meeting when she said: “I don’t understand why this is something that cannot happen simultaneously.”

“If we really wanted to speed things along,” Sanchez told me, “we’d have more meetings. Intuitively, we all know [paying board members] would make things move faster.”


Nationally, school board compensation is all over the board. Connecticut pays nothing, while Florida’s lowest paying county, as of 2014 reportedly offered $24,290 a year. According to the National School Boards Association, approximately 75 percent of small-district school board members serve as volunteers while around 40 percent of large-district ones receive a “modest salary.”

This divide makes sense, because there’s much more work to be done in a district with 50,000 students than one with only a few hundred. When being an effective board member requires a full-time commitment from someone who must already work full-time elsewhere, “it’s a structural problem,” Sanchez said.

A second one resurfaced at Monday’s meeting. Orla O’Keefe, the district’s chief of policy and operations, told the board: “We need a larger number of staff with the technical skills and knowledge needed to complete assignment runs,” including to “[e]xplore leveraging district ... online registration functionality with a potential online application pilot.” In other words, while the board takes its time deciding what major changes to make, district staff propose once again building in-house. Meanwhile, a Nobel Prize-winning economist — and the tools his team has honed — wait in the wings.

Maybe instituting board salaries can buy our elected representatives the time they need to pursue public-private partnerships that bring expertise and manpower to the task of matching students with schools. Hopefully, this time it will be with the support of district staff, such as newly anointed Superintendent Vincent Matthews who, calling the meeting “democracy in action,” said Monday he’s “looking forward to moving this forward.”

Until then, Sanchez said, “It’s in a holding pattern.”