Who Gets What and Why at the European School of Management and Technology (ESMT), in Berlin.

I'm in Berlin to speak about Who Gets What and Why...

Wednesday, March 09, 2016, 07:00 pm

Who Gets What and Why: The New Economics of Matchmaking and Market Design

AMERICAN ACADEMY BOOK PRESENTATION

In his lecture, Alvin E. Roth shines a light on the everyday world of matching markets in diverse areas such as organ donation, public school choice programs, college admissions, employment, and online dating. Unlike commodity markets such as stocks and bonds, where price alone determines who gets what, in a matching market you are not free to choose but must also be chosen. Roth is in the forefront of the “market design” school, which aims to solve problems plaguing matching markets that are not “thick” enough (lacking sufficient participants) or suffer from “congestion” (an overwhelming range of options). As an example, he points out that over 100,000 people in the U.S. are waiting for kidney transplants, yet only about 11,000 non-directed kidneys become available each year. Using market design principles, Roth helped design the New England Program for Kidney Exchange. As another example, he examines the college application process, a vicious cycle in which, as students apply to more colleges, acceptance rates go down. After reading Roth’s book, readers may or may not make better matches, but they will better understand how matching markets work.

Moderated by Christoph von Marschall, Managing Editor, Der Tagesspiegel

In cooperation with Siedler Verlag and the European School of Management and Technology (ESMT).

Who Gets What and Why: The New Economics of Matchmaking and Market Design will be released
in March 2016 by Siedler Verlag as Wer kriegt was und warum? Bildung, Jobs und Partnerwahl: Wie Märkte funktionieren.

The lecture will take place at the European School of Management and Technology (ESMT), Schloßplatz 1, 10178 Berlin.

See also  ESMT Open Lecture und Buchpräsentation mit Wirtschaftsexperte und Nobelpreisträger Alvin E. Roth

James Hathaway: Plan for, rather than simply react to, refugee movements

Mitu Gulati points me to this piece by James Hathaway:
A global solution to a global refugee crisis
JAMES C. HATHAWAY 29 February 2016

His summary:

 How should we proceed?

A team of lawyers, social scientists, non-governmental activists, and governmental and intergovernmental officials, drawn from all parts of the world, worked for five years to conceive the model for a new approach to implementing the Refugee Convention. We reached consensus on a number of core principles.

1. Reform must address the circumstances of all states, not just the powerful few.

Most refugee “reform” efforts in recent years have been designed and controlled by powerful states—for example, Australia and the EU. There has been no effort to share out fairly in a binding way the much greater burdens and responsibilities of the less developed world, even at the level of financial contributions or guaranteed resettlement opportunities. This condemns poorer states and the 80% of refugees who live in them to mercurial and normally inadequate support—leading often to failure to respect refugee rights. It is also decidedly short-sighted in that the absence of meaningful protection options nearer to home is a significant driver of efforts to find extra-regional asylum, often playing into the strategies of smugglers and traffickers.

2. Plan for, rather than simply react to, refugee movements.

The international refugee system should commit itself to pre-determined burden (financial) sharing and responsibility (human) sharing quotas. Such factors as prior contributions to refugee protection, per capita GDP, and arable land provide sensible starting points for the allocation of shares of the financial and human dimensions of protection. But, as the recent abortive effort to come up with such shares ex post by the European Union makes clear, the insurance-based logic of standing allocations can only be accomplished in advance of any particular refugee movement.

3. Embrace common but differentiated state responsibility.  

There need be no necessary connection between the place where a refugee arrives and the state in which protection for duration of risk will occur, thus undercutting the logic of disguised economic migration via the refugee procedure. And rather than asking all states to take on the same protection roles, we should harness the ability and willingness of different states to assist in different ways. The core of the renewed protection regime should be common but differentiated responsibility, meaning that beyond the common duty to provide first asylum, states could assume a range of protection roles within their responsibility-sharing quota (protection for duration of risk; exceptional immediate permanent integration; residual resettlement)—though all states would be required to make contributions to both (financial) burden-sharing and (human) responsibility-sharing, with no trade-offs between the two.

4. Shift away from national, and towards international, administration of refugee protection.

We advocate a revitalized UNHCR to administer quotas, with authority to allocate funds and refugees based on respect for legal norms; and encouragement of a shift to common international refugee status determination system and group prima facie assessment to reduce processing costs, thereby freeing up funds for real and dependable support to front-line receiving countries—including start-up funds for economic development that links refugees to their host communities, and which facilitate their eventual return home. Our economists suggest that reallocation of the funds now spent on domestic asylum systems would more than suffice to fund this system. And since as described below positive refugee status recognition would have no domestic immigration consequence for the state in which status assessment occurs, this savings could be realized without engaging sovereignty concerns.

5. Protection for duration of risk, not necessarily permanent immigration.

We should be clear that this is a system for which migration is the means to protection, not an end in and of itself. Managed entry regimes should be promoted where feasible, though the right of refugees to arrive wherever they can reach without penalization for unlawful presence must be respected (thus undercutting the market for smugglers and traffickers). Some refugees—such as unaccompanied minors and victims of severe trauma—will require immediate permanent integration, though others should instead be granted rights-regarding protection for duration of risk. Creative development assistance linking refugees to host communities would increase the prospects for local integration, and many refugees will eventually feel able to return home. But for those still without access to either of these solutions at 5-7 years after arrival, residual resettlement would be guaranteed to those still at risk, enabling them to remake their lives with a guarantee of durable rights—in stark contrast to the present norm of often indefinite uncertainty.

If we are serious about avoiding continuing humanitarian tragedy—not just in Europe but throughout the world—then the present atomized and haphazard approach to refugee protection must end. The moment has come not to renegotiate the Refugee Convention, but rather at long last to operationalize that treaty in a way that works dependably, and fairly.

First paired kidney exchange transplant done in Singapore

Here's the story from the Straits Times, about a short non-directed donor chain:  First paired kidney exchange transplant done in Singapore

"Ms Siti was put on dialysis while waiting for a donor, but time was running out. It was then that doctors put forth a novel proposal, known as a paired kidney exchange transplant.  Under this arrangement, a good Samaritan would donate his or her kidney to Ms Siti. In exchange, Madam Rafidah would give one of her own kidneys to someone on the national waiting list.

"While this procedure has been approved since 2009, it has never been carried out due to the lack of a donor who is both willing and medically fit.
...
"Every year, said Professor A Vathsala, who is co-director of the National University Centre for Organ Transplantation at the National University Hospital, only two or three healthy people come forward to donate their kidneys. And of these, only one would be assessed as medically fit.

"On the other hand, the average person on the national waiting list for a new kidney would have to wait nearly a decade for a new organ."
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Other coverage:
First living paired kidney exchange in Singapore performed at NUH (news broadcast with a video.)
Posted 29 Feb 2016 15:50

Kidney exchange: a European research initiative

Here's an announcement of a European research initiative: European Network for Collaboration on Kidney Exchange Programmes

Penn celebrates differential privacy (and an application to anti-terrorism surveillance)

Briefly on Penn's front web page, here's the story.
Balancing Privacy and Security in Network Analysis

Something about the pictures caught my eye:

(L to R) Steven Wu, Michael Kearns, Aaron Roth, and Grigory Yaroslavtsev

Unified enrolment in Oakland

The NY Times has an article about controversies in Oakland public schools, including about the prospect of instituting a unified enrollment system that would give parents one application form for both district and charter schools:
Oakland District at Heart of Drive to Transform Urban Schools

"Mr. Wilson says that a single application form, where parents rank their choices among all schools and students are assigned through a computer algorithm, will reduce the ability of well-connected parents to place their children in the most desirable schools and force charters to be more open about how they admit students. Similar systems have been put in place in Washington and New Orleans and are being considered in Boston."

NYC High School Match Day

If you are a NYC 8th grader, or have one in your family, this is a big day. Good luck!

Chalkbeat has the story (with links to their earlier coverage of high school admissions):
On high school match day, a Chalkbeat guide to high school admissions debates
By Stephanie Snyder

"Most of New York City’s eighth-graders will find out what high school they were matched with on Friday — which means it’s going to be a day of stress, celebration, and a few tears.

"Students have been waiting for the last three months to hear where they would be placed after navigating the city’s complicated choice-based high school system. In December, nearly 75,000 teenagers finished that process, often sifting through a 649-page directory to find and rank their top picks."

Sri Lanka Destroys Illegal Elephant Tusks

 The NY Times has the story: Sri Lanka Destroys Illegal Elephant Tusks

"A group of saffron-robed monks chanted as officials crushed more than 300 elephant tusks in a seaside ceremony on Tuesday, as the new government of President Maithripala Sirisena sought to differentiate itself from its predecessor by sending a powerful message of intolerance for elephant poaching.

Sri Lanka is the first South Asian nation to publicly destroy ivory obtained through elephant poaching and the 16th country in the world to destroy confiscated elephant tusks so that they cannot be traded in the black market.

The previous Sri Lankan government, led by Mahinda Rajapaksa, had planned to distribute the tusks to Buddhist temples around the island, including the Sacred Temple of the Tooth, the country’s most revered. That spurred an outcry from Sri Lankan environmentalists and international wildlife agencies, who argued that the ivory would later be traded."

Signaling English language proficiency with video interviews

Colleges are increasingly availing themselves of video and internet technology to assess language skills of foreign applicants: see e.g. this story in the WaPo:
Amid fraud fears, colleges vet China applicants with video

I'm an advisor to one of the companies they mention, Initial View.

"One service provider, InitialView, was launched in Beijing in 2009 by an American couple. While many colleges have interviewed students themselves on the Internet, the company offers verification of student identities. InitialView conducts interviews in 14 cities across China and has begun operating in other countries. "
************

Here's an earlier, related NYT story: Chinese Students and U.S. Universities Connect Through a Third Party

First Uterus Transplant in the U.S., at the Cleveland Clinic

Uterus transplants were pioneered in Sweden, where surrogacy is illegal. But there is also demand in the U.S.

The NY Times has the story: First Uterus Transplant in U.S. Bolsters Pregnancy Hopes of Many

"The procedure’s purpose is to enable women born without a uterus, or who had theirs removed, to become pregnant and give birth. The patient will have to wait a year before trying to become pregnant, letting her heal and giving doctors time to adjust the doses of medication she needs to prevent organ rejection.

Then she will need in vitro fertilization to become pregnant. Before the transplant, the patient had eggs removed surgically, fertilized with her husband’s sperm and frozen. The embryos will be transferred into her uterus.

The transplant will be temporary: The uterus will be removed after the recipient has had one or two babies, so she can stop taking anti-rejection drugs.

The Cleveland hospital’s ethics panel has given it permission to perform the procedure 10 times, as an experiment. Officials will then decide whether to continue, and whether to offer the operation as a standard procedure. The clinic is still screening women who may be candidates for the operation.

The leader of the surgical team is Dr. Andreas G. Tzakis, who has performed 4,000 to 5,000 transplants of kidneys, livers and other abdominal organs. To prepare for uterus transplants, he traveled to Sweden and worked with doctors at the University of Gothenburg, the only ones in the world to have performed the procedure successfully so far. Nine women have had the operation in Sweden, with the transplants taken from living donors. At least four recipients have had babies, who were born healthy though premature.

About 50,000 women in the United States are thought to be candidates for transplanted uteruses."

Update on the Gastroenterology match

Dr Debbie Proctor at Yale, who was instrumental in re-starting the match for gastroenterology fellows, sends this update:

"The GI match is alive and well. The main concerns are still about "research" positions being offered outside the match, but when actually investigated, the evidence is slim to none that this happens and always with a good reason. That being said, I am sure there are some offers outside the match, but I estimate less than 10%.

We now match in Nov/Dec for people to start in July - 6-7 months later. The residents now interview in the middle of their 3rd year, which makes a huge difference. Remember, we used to interview them and make offers at the beginning of their 2nd year - right after completing internship? What a different 18 months makes in the careers of these young folks!"
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For those of you who haven't been following along for decades, here are links to some of the papers around the re-design and restart of the gastro match:

• Niederle, Muriel and Alvin E. Roth, "Unraveling reduces mobility in a labor market: Gastroenterology with and without a centralized match," Journal of Political Economy, 1. 111, no. 6, December 2003, 1342-1352. .
• Niederle, Muriel and Alvin E. Roth, "The Gastroenterology Fellowship Match: How it failed, and why it could succeed once again," Gastroenterology, 127, 2, August 2004, 658-666.
• McKinney, C. Nicholas, Niederle, Muriel and Alvin E. Roth, "The collapse of a medical labor clearinghouse (and why such failures are rare)," American Economic Review, 95, 3, June, 2005, 878-889.
• Niederle, Muriel and Alvin E. Roth, "The Gastroenterology Fellowship Market: Should there be a Match?," American Economic Review, Papers and Proceedings, 95,2, May, 2005, 372-375.
• Niederle, Muriel, Deborah D. Proctor and Alvin E. Roth, â€œWhat will be needed for the new GI fellowship match to succeed?,Gastroenterology, 130, January 2006, 218-224.
• Niederle, Muriel, Deborah D. Proctor and Alvin E. Roth, ''The Gastroenterology Fellowship Match: The First Two Years,''Gastroenterology , 135, 2 (August), 344-346, 2008.
• Niederle, Muriel, and Alvin E. Roth,''The Effects of a Central Clearinghouse on Job placement, Wages, and Hiring Practice'', inLabor Market Intermediation, David Autor, Editor, The University of Chicago Press, 2009, 273-306. 

The market for jobs in international schools (elementary through high school)

Two search firms seem to facilitate the market for teachers who want to work internationally:

International Schools Services, and Search Associates

Unraveling of the philosophy job market

The American Philosophical Society has posted the following Statement on the Job Market Calendar

The following statement was adopted by the board of officers at its November 2016 meeting. It is effective beginning with the 2016-2017 academic job market season. 

For tenure-track/continuing positions advertised in the second half of the calendar year, we recommend an application deadline of November 1 or later. It is further recommended that positions be advertised at least 30 days prior to the application deadline to ensure that candidates have ample time to apply.

In normal circumstances a prospective employee should have at least two weeks for consideration of a written offer from the hiring institution, and responses to offers of a position whose duties begin in the succeeding fall should not be required before February 1.

When advertising in PhilJobs: Jobs for Philosophers, advertisers will be asked to confirm that the hiring institution will follow the above guidelines. If an advertiser does not do so, the advertisement will include a notice to that effect.

The Chronicle of Higher Ed has picked up the story this month:
A Disciplinary Association Aims to Rein In a ‘Chaotic’ Hiring Calendar

"Q. What problem is this statement reacting to?

A. Over the last few years, as more philosophy departments have moved away from in-person interviews at the APA’s Eastern Division meeting and toward other approaches, such as web-based interviews or elimination of first-round interviews altogether, we’ve begun hearing from members that application deadlines have crept earlier and earlier, as have deadlines for accepting offers of employment.

These changes have disadvantaged job candidates by, for example, forcing them to make a decision on an offer from one institution before having even been interviewed by another. Many members, as well as an internal APA task force, have suggested that an APA policy statement would help to address these concerns about the job-market calendar.

Q. What are the goals of this statement? What would the APA like the calendar to look like?

A. Our goals with this statement are to set clear expectations for hiring departments, and also, by including a notice on ads for jobs that don’t follow the calendar, to provide job candidates with better information at the outset of their job searches so that they can make more-informed decisions.

The statement specifies the earliest date by which applications for academic positions should be required, and the earliest date by which final acceptance of offers of employment should be required — the two portions of the job-market calendar that are of most concern to our members. We respect that different departments have different approaches to the hiring process, so the statement is limited to just those two dates."

HT: Ricky Vohra

A Freakonomics listener was inspired to become a non-directed kidney donor by the podcast on kidney exchange

In June, 2015, right around the time my book Who Gets What and Why was published, Steven Dubner and his team at Freakonomics published a podcast called Make Me a Match, in which he interviewed me and others about kidney exchange, among other things. Now, in a new podcast, Dubner interviews a listener named Ned Brooks who was inspired by that interview to become a non-directed kidney donor and start a kidney exchange chain. In fact, not only does Dubner interview the donor, he interviews the woman who received his kidney, and in fact introduces the two of them for the first time. Pretty dramatic stuff.

Here's the link to the podcast, where you can (both) listen to it and read the whole transcript.

Ask Not What Your Podcast Can Do for You, February 25, 2016 by Stephen J. Dubner

Below is the part of the transcript that has to do with kidney donation and transplantation. If you read it through, I predict you'll be moved (at one point Dubner says he's crying, so at least he was moved), and if you get to the end you'll find out about a new organization that Brooks has established to help find new donors for people who need them.

"Let me introduce you now to Ned Brooks.

DUBNER: Ok. Hello, Ned?

NED BROOKS: Stephen, how are you?

DUBNER: Hey! Great, how’re you? Nice to meet you.

BROOKS: Nice to hear you.

DUBNER: Thanks for doing this, the interview, but doing the actual deed.

BROOKS: It was a very easy thing to do.

Ned Brooks is 65 years old.

BROOKS: I live in Norwalk, Connecticut. I’m semi-retired after a couple of careers, on Wall Street and in real estate.

He’s been married for 34 years. Three grown children. One day last year, Brooks was in his car.

BROOKS: And we were listening to your podcast about Alvin Roth, the Nobel Prize winner in economics who created a model to trade indivisible items without the use of money. And I think he was talking about houses at the time, but it seems to work very well for the kidney chain as well.

The episode was called “Make Me a Match.” Al Roth was describing how he and others had created a series of algorithms that helped match people in need of a kidney transplant with potential donors

BROOKS: And I listen to the podcast with growing interest because what came through to me about the power of the kidney chain, as somebody with a business background, is the concept of leverage. That one altruistic donor — and an altruistic donor is someone who gives a kidney without having anybody particular in mind to receive it. And it provides a lot of options for the people who put these things together, to start a kidney chain. And that results in a sequence of transplants that can affect a lot of people.

DUBNER: Now, have you ever considered giving a kidney before then?

BROOKS: No, no I did not.

DUBNER: And what was it about, about the message from Al Roth in that podcast that either, kind of, alerted you? What did you learn, or what changed your mind that made you start to think about that, then?

BROOKS: Well, the concept that we have two kidneys and we only need one.

DUBNER: Now did you know that ahead of time, or not really?

BROOKS: Yes, I did know that much. What I did not know is all the benefits that accrues to one who donates a kidney. The process is lengthy in terms of the amount of testing that you go through to do so. But …

DUBNER: Now, you’re saying that the medical tests were the benefits?

BROOKS: Oh, absolutely.

DUBNER: I just want to clarify here.

BROOKS: Absolutely. Look, you get many thousands dollars of testing for free.

DUBNER: Can I just say something, Ned? I think you and I are fundamentally different people, because if I were going to get several thousands of dollars worth of something free I would want it to be, you know, golf, or something, fishing boat. Not medical testing, but tell me more about your great desire …

BROOKS: Well, you’re not 65, and knowing that all your organs are free of any contaminants is a very reassuring thing, actually.

Let me be clear. It wasn’t really all the free medical testing that made Brooks want to become a kidney donor.

BROOKS: I think this is something I have to do. It required some thought, discussion with my wife that day in the car. I spent one restless night, probably about three hours trying to understand what my own motivations were and if they were the right ones to be doing this. And once I put that to rest, then it was a very easy thing to do.

DUBNER: Did you decide immediately to become a non-directed donor? Meaning that your kidney would be available for anyone who needed it? Or, did you think about trying to help someone in particular?

BROOKS: As great as it would be to help someone in particular, I didn’t know anyone who needed a kidney. And in fact, the leverage comes from being an altruistic donor. You can’t start a kidney chain unless you’re altruistic about it.

DUBNER: Let’s say I need a kidney and my wife is willing to donate or someone else in my family is willing to donate, but they’re not a match. They’re not a physiological match for me. But they would donate a kidney of theirs to someone else who is a match. They then enter the chain, correct?

BROOKS: So, call them “Couple A.” And Couple B is in the same situation as is Couple C, D, down the line.

DUBNER: But then there is this wildcard, X, that’s you. This guy who comes in that doesn’t have anyone that needs one, that just wants to give. Does that make you much more valuable?

BROOKS: That makes me valuable because it allows the algorithm to maximize the length of the chain and kick it off. If you didn’t have the altruistic donor to start, you’d have to have a perfect match. 

DUBNER: Talk about the procedure, working with the hospital, and talk about how the relationship works so that you are not made to feel that you’re being pressured.

BROOKS: Sure. In my case, I had the operation done at New York-Presbyterian. And I chose New York-Presbyterian because they do a lot of these operations. And I think that with any surgery like this you want to go to a place that does a lot of them. And so I was very comfortable with their record. They’ve never lost a donor yet. They provide you with two advocates. And those advocates are there to protect your interest throughout the process. And you go in for testing, you do it through your advocate, you go in for psychological testing, physical testing. They want to make sure you are financially able to this, because, of course, you cannot be compensated for a kidney donation.

DUBNER: To what degree did they push back? In other words, to what degree did they try actively to discourage you or at least make you take a step back and think it through a little bit more?

BROOKS: They didn’t actively discourage me.  The psychiatrist probed quite a bit. But after I seemed to have satisfied her on the answers, that was the end of it.  What they will not do is they will not come after you to keep you coming to hospital for every procedure that needs to be done. In other words, they set the time and the date for your next appointment, and they won’t call you. It’s up to you to make sure that you’re there.

DUBNER: Oh that’s interesting, yeah. And at no point did they catch on to the fact that you were just in it for the free medical testing?

BROOKS: Actually, actually yes. The doctor I spoke with there said, “This is a little-known secret, but the testing is so good that everyone should at least start out to be a kidney donor and find out how their tests go.”

DUBNER:  That is a secret that I’m guessing they really don’t want broadcast. Because I can see an army of senior citizens flooding in for their tests saying, “You know, I think I’m going to hang on to this — to the other kidney.”  And then talk to me about your family’s response.  Was everyone on board?

BROOKS: My wife was supportive. As I said, I have three children. One was very supportive, one was skeptical, and one was opposed. And I guess that’s what you get when you get three children. But the skeptical one, and the one who was opposed, turned around once they felt like they got a lot more facts about it.  It’s a very safe procedure relative to surgery, in general. And once they understood that, then I think their reservations went away.

DUBNER:  I understand you wrote a letter to your family when you had gotten pretty far along in the process. By then you’d undergone some of the testing?

BROOKS: Yes, yes.

DUBNER: Do you happen to have that letter handy?

BROOKS: Actually, I do have it here.

DUBNER:  If you don’t mind giving that a read, that would be great.

BROOKS: Sure. This is a letter that I wrote to my family when I realized that it was what I wanted to do, and I wanted to inform them all at the same time. So, I sent them an email and it goes like this:

All, as you have commented upon, I have had a number of medical tests over the summer. I did not fully answer your questions about those because I wanted to wait until I had cleared all the tests. I’m happy to report that I’m about as healthy as is possible for a 65-year-old male to be.  

Back in the spring, I was listening to a Freakonomics podcast about a man who won the Nobel Prize in economics for constructing a model of a market to trade indivisible objects without the use of money. He was thinking about houses, but it turns out that the model works very well for other things. His work had been used to create an extensive network for the matching of kidney donors and recipients. The more I listened to the podcast, the more fascinated I became as I learned that just one altruistic donor — a person who donates without a targeted recipient — can launch a chain of kidney transplants that can number as high as 43.

I spoke with the National Kidney Foundation and learned more about the process. I registered as a potential donor and began extensive series of tests at New York-Presbyterian, which have now concluded with me be being accepted as a kidney donor.

So why am I doing this? Many of our friends and acquaintances have had their share of health challenges in recent years. It is mightily frustrating to watch the pain and suffering and be unable to give any help. I, on the other hand, am in perfect health. I have no need for my second kidney, and I appreciate that my actions may greatly benefit the lives of not just the recipients of those kidneys but their entire families. Without it being too much of a stretch, my one wholly redundant organ can potentially change and improve the lives of hundreds of people.

There were 5,355 kidney transplants from living donors last year, and there are over 100,000 people on the wait list right now for a kidney.  The operation is several hours. They start about 3 a.m. in order to catch the morning flights around the country, particularly Los Angeles. L.A. does more transplants than any place in the country, and New York-Presbyterian does the most east of the Mississippi. They’ll have me walking that same day, and I should stay two days in the hospital. I’ll be uncomfortable for two weeks, and fully recovered after four weeks. The operation is laparoscopic, with a single incision in the abdomen. I’ve been working hard with my trainer on my abs.

My advocate tells me that because I am blood type O, a universal donor and an altruistic donor, I will light up computer screens across the country when they list me tomorrow. I am happy to report that Mom is fully on board with this. I could go on for a while, but I think you have the picture. If you have interest in hearing the podcast that inspired me, you can find it here and the short Freakonomics blog on the subject here. Let me know if you have any questions.

Love you all, Dad.

The left kidney that Brooks donated wound up launching a three-recipient chain.

BROOKS: I knew nothing about my recipient until the day of the surgery when I was told that it was a 37-year-old female in Denver area and that she was very, very sick and unlikely to find a donor anytime soon. And that this was a real one-in-a-million match.

DUBNER: Did you know anything about the cause of her illness? And would that have mattered to you if you did know?

BROOKS: No, I had no idea.

DUBNER: Look, you’re not getting paid; you might get thanked, you might not get thanked. You’re doing this for your own set of reasons. Was it important to you that that person appreciate those reasons, or appreciate you? Or did it not really work that way for you?

BROOKS: This is where the leverage comes in. They ask that same question in the initial stages in a little bit different way. What they ask is, “If something happens to your recipient, how upset are you going to be?” Quite frankly, my answer was, “This is multiple people who are getting a transplant because of what I’m doing. And if one of them doesn’t work out, I’m terribly sorry, but it’s going to change the lives for all the others.”

DUBNER: So Ned, you learned a little bit about your recipient, and from what I understand, you’ve been in contact — you’ve received a letter from her — is that right? Expressing her thanks?

BROOKS: The way this works is I go through my advocate at the hospital writing a letter to the recipient that goes through the advocate at her hospital to her. Then if she chooses to do so, she comes back to me with whatever she wants to say. And then through the advocates I go back and disclose my identification, then she does that back to me if she wants to. And that’s the way it worked. And we’ve exchanged emails. And I’ve gotten Christmas cards and such from her family, and so forth.

DUBNER: So you haven’t met with her or spoken with her by phone?

BROOKS: I have not met or spoken to her.

DUBNER: OK so, here’s the story. I believe that if technology has served us well that she’s on the other line right now. Danielle from Centennial, Colorado.

BROOKS: Oh my god!  I’ve not spoken to her yet! This would be great.

DUBNER: Danielle, can you hear us? This is Stephen Dubner.

DANIELLE SHAFFER:  Hi, I can hear you guys.

BROOKS: It’s Ned.

SHAFFER:  Hi Ned.

BROOKS: Hi.  

SHAFFER: How are you doing?

BROOKS: I’m doing great.

SHAFFER:  Good, good. This is exciting.

BROOKS: This is very exciting. It’s great to hear your voice. How are you feeling?

SHAFFER:  I’m doing good! I’m feeling real good. Lately it’s been a struggle since the surgery but I’m doing good. A lot better than I was.

BROOKS: Are you on lots of meds?

SHAFFER:  Yeah, unfortunately, I’ll have to be on a ton of meds for probably the rest of my life.  

DUBNER: Hey Danielle, this is Stephen. Can you tell us a bit about what led to your need for the kidney?

SHAFFER: Sure, sure. It all started October 8, 2014. I had received a call from my doctor saying that my blood work had come back — I’d gone to my regular doctor just because I was having a severe headache that wouldn’t go away. And so they did some blood work, they called me the next day and said, “You need to get to the hospital immediately.” They were telling me creatinine was at a 12 and I had no idea what that was. And so, I went to the hospital and was immediately hospitalized for the next 15 days, getting biopsies and MRIs and plasma freezes and dialysis and getting all these tubes put in my neck and chest. It just all happened so fast. To this day, they still don’t have any reason. It happened three weeks after I had my son but they don’t want to associate it to that. So they really have no answers of why this all happened to me.

DUBNER: And what was your, a) I guess, prognosis? Did they think that you would survive? And what was your prognosis for getting a donated kidney?

SHAFFER: Well, when I was hospitalized and they had no answers, and they were functioning a small part, but they said that they were failing. But they had hope — since they really had no idea what was going on with me — that they would kind of kick back in and restart themselves. So we kind of just waited and I started dialysis and everything. And while we were waiting for those next couple months, I actually tried acupuncture for, you know, organ treatment, specifically for that. You know, I was trying everything. And I said, you know what, I’m not going to wait any longer for them to restart. I better get on this transplant list now. So, come January of 2015, I started the process of getting on the transplant list. And starting there.

DUBNER: And what were you told about how long that would likely take you to get you a donated kidney?

SHAFFER: Well, it came back that I had antibodies in my blood from blood transfusions that I had during the hospitalization, and from having children they said I had created all these antibodies. So it made me a very rare match for  — I wasn’t a match to any of my family and so they said because of my rare antibodies I could possibly be on the list five or six years. So that’s the kind of range they gave me back in January of 2015. That, I was looking at five-to-six years being on dialysis.

DUBNER: Wow. How long was it before you heard that there was a donor?

SHAFFER: Well, it was probably come May of 2015 that I started getting word. Me and my father, we decided since I was having such a hard time and nobody in my family matched with me, my father really wanted to donate on my behalf. So we heard about the paired-donor program through the hospital and he wanted to donate his kidney on my behalf. So, it was probably around May of 2015 that we started the chain process. I had several chains lined up throughout the summer of 2015 but it kept falling through due to scheduling with some part of the chain — it kept falling through. So I had many chains lined up throughout the summer, and it was finally in August that we found — I guess Ned was matched to me, and we got the surgery date of September 22, and it kind of just happened really quickly from there.

DUBNER: Way to go, Ned.

BROOKS: Thanks.

DUBNER: What’s it feel like for you, Ned, hearing Danielle talk now? She’s obviously in a much better situation today with your kidney in her than she would be without. So what’s that feel like to hear her on the other end of the line?

BROOKS: It’s emotionally very powerful. It means a lot. A great deal.

SHAFFER: Yeah, it was a real struggle going through dialysis in the last year. I had to do four hours of treatment three days a week. So basically it took 15 hours out of my time every week. And I would go into a dialysis center. And, the first thing you do is you get checked in and they do your blood pressure, your weight, your temperature. They go through all your symptoms that you’re feeling. There’s really no privacy when they’re doing that — I mean, the next patient is five feet from you in their chair, and you’re talking about all of your bodily functions that are not going well for you with all the medications you’re taking and everything and it takes away a little bit of your integrity having to do that so publicly. And then, just to sit there for four hours doing nothing. I can’t get up, I can’t move. My blood is just sitting there, you’re watching your blood go through this machine and it’s really, really depressing. And, it was hard for me. I mean, I cried the first couple times just because I would sit there and I’d look around and I was the youngest, you know obviously, in the whole building. I was 37 years old. And I was the only one driving myself there. It’s just a really hard and depressing time to spend in your day. It was really hard for me to do because I have two small children as well.  

DUBNER: It’s remarkable. You say you were crying then. Now you sound so strong. Ned’s on the other line blubbering there. I’m on the border, holding it together. So…

SHAFFER:  It’s emotional every time I talk about my story too, so.

DUBNER: I’m curious, you said that your dad had entered the donor chain. Did he end up giving a kidney, and if so does he know who the recipient was?

SHAFFER: He ended up giving his kidney. And all we really know is that it went to Connecticut over there where Ned is, and we have not heard from the recipients on that end.

DUBNER: I have a copy of the letter that you wrote to your donor. It’s unclear to me whether you knew exactly who Ned was at this time. It begins, “To my wonderful kidney donor, I don’t even know where to begin.” And I’ve already started to cry. Sorry. I have nothing to do with either of you and I’m crying. OK. So, but then, toward the end, you write, “Just to let you know, your kidney is doing awesome, and I’m already getting my energy back.” Danielle, what’s it like to have this guy Ned’s kidney inside of you? Do you feel whole again? Do you feel different?  

SHAFFER: You know, it was amazing because the very next day after surgery, I felt incredible. I felt 100 percent different. I didn’t feel any of the symptoms that I was having before with the illness and the nausea and the anxiety and everything I was going through. I immediately felt better. My body felt better, and yeah. I was eating and drinking the foods and liquids I was restricted to for so long, and it’s just — I do have the energy again. It’s amazing how much better I feel. And I don’t know if he had any food habits that I’ve picked up, but.

BROOKS: How do you feel about single-malt scotch?

SHAFFER:  You know, I haven’t had the craving for any scotch. It is funny because we joke about that with my dad because he’s a single-malt scotch drinker too, and we say, “Oh, that person’s probably craving it now.”

DUBNER: Well, Danielle, I’m glad you’re doing better and I hope you continue to do even better.

SHAFFER: Yes, thank you so much. And Ned, thank you so much for everything you’ve done for me and my family.

BROOKS: No need to thank me anymore. Thank you for being such a great recipient, and we’ll be in touch.

SHAFFER:  Yes, we will. Thank you.

DUBNER: Danielle, thanks for jumping on the phone with us. Bye bye.

SHAFFER: Alright bye guys.

DUBNER: Bye. Well, Ned, how do you feel now? See what you’ve done now?

BROOKS: Boy, I was shaking in here. This is really something. She’s a great person.

DUBNER: Well, I know you didn’t do it for the thanks, but thanks!

BROOKS: My pleasure.

Ned Brooks, inspired by his own experience — and the huge need for more kidney donations — is starting an organization to help build more altruistic kidney-donor chains. It’s called Donor to Donor."

*     *     *

Resolving the Organ Shortage, American Society of Transplantation Cutting Edge of Transplantation Conference

I'm heading to Phoenix today, for the American Society of Transplantation Conference: CEOT 2016: RESOLVING THE ORGAN SHORTAGE: Practice, Policy, and Politics. February 25-27, 2016

Here's the program.

I'll be participating in this Friday pair of sessions:

Session 4, Part 1:  Removing Disincentives and Exploring Controversies of Incentives Co-Moderators: Robert S. Gaston, MD, FAST, University of Alabama at Birmingham, and Larry B. Melton, MD, PhD, FAST, Dallas Nephrology Associates
11:00 am	World and Historical Perspectives John Gill, MD, MS, FAST, The University of British Columbia
11:30 am	Undue Incentives and Repugnant Transactions: One Economist’s Perspective Alvin Roth, PhD, Stanford University Nobel Laureate
12:00 pm	Bioethical Perspectives on Incentivizing Organ Donation and the Impact of NOTA on Pilot Projects I. Glenn Cohen, JD, Harvard Law School
12:30 pm	What is an Incentive and a Critical Appraisal of Possible Pilot Trials of Incentives in Organ Donation? Robert S. Gaston, MD, FAST, University of Alabama at Birmingham and Daniel R. Salomon, MD, Scripps Research Institute
1:00 - 1:15 pm	Pick Up Lunch and Proceed to Workshop
1:15 - 3:15 pm	Session 4, Part 2:  Luncheon Workshop Discussing the Spectrum of Disincentives and Incentives: Where Do You Stand? Afternoon Session with Audience Engagement: A structured discussion of the all issues related to disincentives and the implementation of incentives, with the goal of guiding AST's direction in the future and drafting a position document on the subject. Moderators: Robert S. Gaston, MD, FAST,  University of Alabama at Birmingham and Larry Melton, MD, PhD, FAST, Hackensack University Medical Center and Daniel R. Salomon, MD, Scripps Research Institute

Caps on payment to egg donors abolished in antitrust settlement

Kim Krawiec has the news at the Faculty Lounge:  below is her post

Egg Donors Get Pay Limits Axed With Antitrust Settlement

From Law360:

Egg Donors Get Pay Limits Axed With Antitrust Settlement

By Kelly Knaub

Law360, New York (February 1, 2016, 7:01 PM ET) -- A class of human-egg donors who allege the American Society for Reproductive Medicine violated antitrust laws by capping compensation to donors asked a California federal court Friday to approve a settlement requiring the organization to remove the compensation guideline, calling the agreement an “excellent resolution” of the case.

Under the proposed settlement, ASRM will remove language stipulating that “[t]otal payments to donors in excess of $5,000 require justification and sums above $10,000 are not appropriate,” effectively benefiting all women who donate eggs in the future.

. . .

In addition, ASRM will pay a total of $1.5 million under the agreement to compensate the plaintiffs’ counsel for fees and costs incurred in in the litigation, as well as up to $150,000 to cover the costs of notice to the class.

They could have saved that $1.5 million dollars in legal fees if they had listened to me about this back in 2009.  :-)

Related posts:

The NY Times Weighs In On Egg Donor Price Fixing

If You Want A Market, Have A Market . . . Otherwise

“Feeble Even By Normal Litigation Standards”

Egg Donor Antitrust Suit In Today’s WSJ

Sunny Samaritans’ Suit Survives

ASRM Seeks Dismissal of Egg Donor Suit

Kamakahi v. ASRM et al. — Updates

Politics And Profits in The Egg Business (When Sunny Samaritans Sue, IV)

When Sunny Samaritans Sue, Part III

When Sunny Samaritans Sue, Continued

When Sunny Samaritans Sue

The Value of Smart Eggs

Posted by Kim Krawiec at 03:24 PM in Reproductive Markets, Taboo Trades | Permalink

The Startup Grind

I'll be at a very Silicon Valley conference today, the Startup Grind, in an onstage conversation with Simon Rothman of Greylock Partners and Andre Hagiu of HBS.  Here's the program.

Update: there's a podcast of our discussion here: Using Economics to Win with Simon Rothman

Autos as platforms: the market for radio, and the connected car

The NY Times has a story on the fight that Sirius radio won, and the challenges that it faces
SiriusXM Fights to Dominate the Dashboard of the Connected Car

"SiriusXM has hit on the formula for getting people — nearly 30 million of them — to pay for radio, a form of media that has always been free. But while the company likes to emphasize the awesomeness of its audio “mosaics,” there is another, more mundane, explanation for its success: cars.

SiriusXM pays about $1 billion a year in subsidies and revenue splits to automakers, and according to the company, 75 percent of all new vehicles sold in the United States come with satellite radio installed. (It works with every major carmaker.) Of the 29.6 million subscribers to SiriusXM at the end of last year, 24.2 million paid the $11 to $20 monthly fee themselves, with the rest covered through promotions by car companies."

A non-directed donor kidney exchange chain in Australia

Here's a heartwarming longish story about a longish kidney exchange chain in Australia:
7 kidney donors, 7 recipients, 6 hospitals, 3 cities. What could possibly go wrong?  Medical ingenuity and the kindness of a stranger brought together 14 people in a life-changing event.

February 20, 2016

What should a well educated student read?

I've already read most of these myself, and was flattered to be included: What should the well-educated student read?