Yesterday was Loving Day: 50 years of legal inter-racial marriage throughout the United States

Yesterday was Loving Day, the anniversary of the Supreme Court decision on June 12, 1967 in the case of Loving v. Virginia, that bans on interracial marriage were unconstitutional.

I don't think anyone can help being reminded of the Supreme Court decision on June 26, 2015, that decided that bans on same sex marriage were unconstitutional (in the less fortuitously named case of OBERGEFELL ET AL. v. HODGES, DIRECTOR, OHIO DEPARTMENT OF HEALTH, ET AL.).

Here's the NY Times, on a couple married in 1950 in California: ‘We Are Not Unusual Anymore’: 50 Years of Mixed-Race Marriage in U.S.

"When they married in Oakland in 1950, mixed-race marriage had just become legal in California, the result of a lawsuit that reached the State Supreme Court. They are among the oldest living interracial couples legally married in the United States. It would be nearly two decades before all couples like them across the country were allowed to marry.

On Monday, they will mark the 50th anniversary of Loving v. Virginia, the United States Supreme Court case that overturned antimiscegenation laws nationwide. Mildred and Richard Loving, a black woman and a white man, had been sentenced to a year in a Virginia prison for marrying each other. The case would serve as a basis for the Supreme Court decision allowing same-sex marriage."

Organ preservation could bring big changes to transplantation

Transplantation would be a lot less hectic if organs could be preserved. Here's a 42-author paper (the biggest coauthorship I've been involved in) that discusses some of the possibilities.

The promise of organ and tissue preservation to transform medicine 
 Sebastian Giwa, Jedediah K Lewis, Luis Alvarez, Robert Langer, Alvin E Roth, George M Church, James F Markmann, David H Sachs, Anil Chandraker, Jason A Wertheim, Martine Rothblatt, Edward S Boyden, Elling Eidbo, W P Andrew Lee, Bohdan Pomahac, Gerald Brandacher, David M Weinstock, Gloria Elliott, David Nelson, Jason P Acker, Korkut Uygun, Boris Schmalz, Brad P Weegman, Alessandro Tocchio, Greg M Fahy, Kenneth B Storey, Boris Rubinsky, John Bischof, Janet A W Elliott, Teresa K Woodruff, G John Morris, Utkan Demirci, Kelvin G M Brockbank, Erik J Woods, Robert N Ben, John G Baust, Dayong Gao, Barry Fuller, Yoed Rabin, David C Kravitz, Michael J Taylor & Mehmet Toner

Nature Biotechnology 35, 530–542 (2017) doi:10.1038/nbt.3889
Published online 07 June 2017

Abstract: The ability to replace organs and tissues on demand could save or improve millions of lives each year globally and create public health benefits on par with curing cancer. Unmet needs for organ and tissue preservation place enormous logistical limitations on transplantation, regenerative medicine, drug discovery, and a variety of rapidly advancing areas spanning biomedicine. A growing coalition of researchers, clinicians, advocacy organizations, academic institutions, and other stakeholders has assembled to address the unmet need for preservation advances, outlining remaining challenges and identifying areas of underinvestment and untapped opportunities. Meanwhile, recent discoveries provide proofs of principle for breakthroughs in a family of research areas surrounding biopreservation. These developments indicate that a new paradigm, integrating multiple existing preservation approaches and new technologies that have flourished in the past 10 years, could transform preservation research. Capitalizing on these opportunities will require engagement across many research areas and stakeholder groups. A coordinated effort is needed to expedite preservation advances that can transform several areas of medicine and medical science.

View full text

Portable hemodialysis?

When I was in Trento I was approached by a team from an Italian-Californian startup that is trying to develop a portable hemodialysis system that could fit in the overhead compartment on a plane, or could allow a van to become a mobile dialysis provider.  Here's their webpage: EasyDial, and good luck to them.

FutureEd

FutureEd is a new(ish) educational think tank at Georgetown, founded by veteran Ed writer Thomas Toch.


"FutureEd is an independent, solution-oriented think tank at Georgetown University's McCourt School of Public Policy. We are committed to bringing fresh energy to the causes of excellence, equity, and efficiency in K-12 and higher education on behalf of the nation's disadvantaged students. As a nonpartisan, public-facing organization, we work to produce clear, compelling analysis on key education issues for policymakers, practitioners, the media, and other key education change agents and influencers at the federal, state, and local levels—promoting smart policymaking in a complex and fast-changing educational landscape."

School choice is one of the topics they cover.

Snippets of Advice to Young Economists

During the AEA meetings in January, the Lindau festival recorded some short video snippets. Here's an edited collection of words of advice for young economists from eight old ones...

California's right to die law: early days

The Mercury News brings us up to date on California's right to die law
California’s right-to-die law: Patients struggling to find doctors who will help
"It’s been nearly a year since California began allowing terminally ill residents to end their lives with the help of a physician. And for Ray Perman, the right-to-die law worked exactly as lawmakers intended.

"On Feb. 4, as his family gathered around his bed, the 64-year-old Piedmont resident ingested a lethal dose of sedatives and passed away peacefully — in his own home, on his own terms — after years of battling cancer.
...
"But for many other Californians, the End of Life Option Act — which took effect June 9, 2016 — has led to a desperate race against time. Frustrated and unable to care for themselves, these terminal patients have frantically searched to find the required two physicians they must work with to terminate their lives.

"Add in the law’s mandated 15-day waiting period between the two oral requests they must make to the two doctors for the medication and it’s often too late to follow through with their plans.
...

“At this stage in the law, it’s a little bit of a hard road,’’ said Judith Geisser, a retired attorney who lives in Oakland.

"Geisser watched as her dying brother’s oncologists — one in Santa Rosa who had treated him for colorectal cancer, another in San Francisco who had diagnosed his subsequent brain cancer — politely declined to help him die, or even refer him to colleagues who would.

...
"Geisser offers this advice to anyone who wants to take advantage of the law: Start your search for the two physicians sooner rather than later.

“When you’re not healthy, and not at your best, that’s not the time to manage the path through this law,’’ said Geisser, who was forced to scramble to find a physician to help her 67-year-old brother Pat fulfill his last wish.
...
"Opponents of the law, including Californians Against Assisted Suicide, have watched its implementation with dread and cite a litany of concerns.

“It’s bad policy,’’ said the group’s spokesman, Tim Rosales.

"He said there are too many loopholes in the law, including the fact that the law doesn’t require those patients receiving lethal prescriptions to get any type of counseling beforehand from a mental health professional. In addition, he said, “there’s no requirement that somebody who stood to gain financially from that individual’s passing could not be involved in the process.’’
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see my earlier post:

Friday, June 10, 2016

Death in California isn't the same anymore

Alex Peysakhovich is thriving at Facebook

Here's Alex Peysakhovich, on a list of  top 30 thinkers under 30

ALEXANDER PEYSAKHOVICH'S THEORY ON ARTIFICIAL INTELLIGENCE

"Alexander Peysakhovich is technically a behavioral economist, but he bristles a bit at being defined that narrowly. He's a scientist in Facebook's artificial intelligence research lab, as well as a prolific scholar, having posted five papers in 2016 alone. He has a Ph.D. from Harvard University, where he won a teaching award, and has published articles in the New York Times, Wired, and several prestigious academic journals.

Despite these accomplishments, Peysakhovich says, "I'm most proud of the fact that I've managed to learn enough of lots of different fields so that I can work on problems that I'm interested in using those methods. I've co-authored with economists, game theorists, computer scientists, neuroscientists, psychologists, evolutionary biologists, and statisticians."

Peysakhovich's interdisciplinary work is driven by his deep interest in understanding decision-making—both human and machine—and by his desire to figure out how artificial intelligence can improve our decision-making processes. He builds tools that help people make better choices, and machines that can turn data into, as he puts it, "not just correlations but actual causal relationships."
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The photo in the article comes from Alex's dissertation defense at Harvard (in 2012, when I was already at Stanford, hence that particular picture...)

Frank Delmonico and the recent organ transplant meeting at the Vatican

When I was in Trento, I participated in a panel on markets for human organs, and had the chance to ask Dr. Ignazio Marino about the recent

Vatican statement on organ transplantation, which I pointed out seemed to conflate killing prisoners for their organs with much more ordinary attempts to increase voluntary organ donation.  Dr Marino replied that this had been part of the diplomacy involved with the Chinese delegation.

Here's an article about the backstory to some of that diplomacy, and the role played by my old friend Frank Delmonico

One doctor’s war against global organ trafficking
By Ryan Connelly Holmes And Dan Sagalyn May 29, 2017

"A controversy was brewing. Delmonico, a leading voice on ethical organ transplantation, had planned a February 2017 summit in Rome for representatives of more than 40 countries to discuss the ethics of transplanting organs and to sign a pledge to uphold high standards.

"But there was a hitch: A key invitee to the forum was Dr. Jiefu Huang, who has led reform of China’s organ donation practices. Critics, including some in the Vatican, wanted at the summit no representatives of China, which for years sold and transplanted organs from executed prisoners.

"Delmonico, however, saw the Chinese presence as a good thing. It was “an opportunity for them to proclaim a new day and be accountable” that the practice has stopped, he said. In fact, some of the Chinese old guard have attacked Huang because of his efforts to stamp out unethical and corrupt methods of obtaining organs.
...
"Pope Francis did not attend, but Marcelo Sánchez Sorondo, the chancellor of the Pontifical Academy of Sciences did. In a significant development, China signed the summit’s statement condemning the use of organs from prisoners and advocating the creation of national laws to prosecute transplant-related crimes. Beijing’s two delegates were joined by 75 other signatories representing more than 50 institutions and more than 40 nations at the conference. Delmonico called it a “seminal event” in the fight for global reform."
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I hope that this effort at diplomacy, aimed at ending the practice of using executions as the primary source of organs in China, will not be a source of confusion regarding attempts to increase the availability of organ transplants by ethical means.

More from the Festival of Economics Trento

I'm back home, after two exciting days in Trento (and two long days of travel). There are a bunch of videos, and some press coverage, for those of you who speak Italian or like to use Google Translate.

You can hear the videos in English if you click on the URL, then start the video by clicking on the arrow in the middle of the screen, and then clicking on the gear icon in the lower right hand corner to select English. (It isn't enough to just click on the English symbol in the upper right...)

Here's a 1 minute video in English, a sort of trailer for my talk on global kidney exchange:

*********

Here's a link to the full video of my first talk, on global kidney exchange.
Mercato e disuguaglianze nella salute

The questions and answer period begins at minute 44, with a question by the eminent transplant nephrologist Giuseppe Remuzzi about his concern (which he mentions is also Frank Delmonico's) that the Philippines and Mexico, where Global Kidney Exchange has begun, are places where there is not only transplant infrastructure, but also illegal, black market organ trafficking.  He ends by saying that he remains to be (but hopes to be) convinced that GKE is a good idea.
My answer begins at minute 46:40.
I replied in part "One reason people get kidneys in illegal black markets is that they don't have better opportunities.  We would like to provide them with a better opportunity..."


Here's a video of the panel on my book: Matchmaking. La scienza economica del dare a ciascuno il suo  Play Video  It begins with a talk about the book, by Professor Dino Gerardi.  Afterwards I spoke in reply to questions from the moderator and the audience, and you can hear me in Italian translation.


And here's the panel on markets for organs "exploitation or opportunity?" also in Italian:
Mercati per il corpo umano: sfruttamento o opportunità?
I very much enjoyed meeting Ignazio Marino, the transplant surgeon who was for a time Mayor of Rome.

Below are some news reports on these sessions

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Here's a news story right after my talk on global kidney exchange, which was introduced by Tito Boeri:
"Il sistema delle catene" per donare gli organi
Al Teatro Sociale il Nobel Roth descrive il suo progetto per incrociare pazienti e donatori di Paesi ricchi e poveri
G-translate: "The Chain" system for organ donation
Al Teatro Sociale Nobel Roth describes his project to meet patients and donors of rich and poor countries

and here:
Dai modelli matematici si possono salvare molte vite umane. Il Premio Nobel Alvin Roth a Trento
"From the mathematical models you can save lives. The Nobel Prize Alvin Roth in Trento
We die because we can not afford a transplant. Roth: "Our program intends to solve the problem by crossing supply and demand"

and here:
Reni, l’algoritmo che ridà speranza Il Nobel Roth: sgretolare le iniquità
Il Nobel Roth: il sistema si autofinanzia. Allo studio anche un’assicurazione

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Here's a story covering my "book talk," in which Prof Dino Gerardi talked about the Italian translation of Who Gets What and Why, and I answered questions:
Matchmaking. La scienza economica del dare a ciascuno il suo

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Here's a story about the panel discussion on markets for body parts, moderated by Mario Macis, with Nico Lacetera, me, and Ignazio Marino, the transplant surgeon who was  mayor of Rome:
Mercati per il corpo umano: sfruttamenti o opportunità
Il premio Nobel Roth ha dialogato con l'ex sindaco di Roma (e chirurgo) Marino su trapianti e denaro

************
Here's a pre-festival story:

Festival dell'economia, su il sipario

Oggi alle 16 l'inaugurazione al Palazzo della Provincia. Alle 18 al teatro Sociale l'apertura è affidata al Nobel Alvin Roth. Da domani anche la nostra emittente sarà in piazza S.Maria Maggiore 

And here are two article from the Italian Jewish press:
Festival Economia – Pagine Ebraiche
Salute diseguale, in cerca di una cura
Pubblicato in Attualità il ‍‍30/05/2017 - 5

Il Nobel Alvin Roth a Pagine Ebraiche
“L’economia può riparare il mondo”

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Updates:

Business Insider Italia has an interview with Ignazio Marino:
Ignazio Marino: “Il mercato nero dei trapianti si può mettere all’angolo salvando molte vite”
(Google translate doesn't seem to do a good job turning it into English, but the very last sentence is
"Quello che ci ha mostrato Roth è un sistema trasparente e può togliere ossigeno ai trafficanti”.
GT renders that as 'What showed us Roth is a transparent system and can remove oxygen to "traffickers.'


Here's a story with an inflammatory headline but a reasonable account, as near as I can tell from Google Translate:
L'economista che vuole legalizzare il traffico d'organi per salvare ricchi (e poveri) del mondo
"The economist who wants to legalize organ trafficking to save the rich (and poor) in the world
"In the US there are 100 thousand people on the waiting list for a kidney transplant but only 12 thousand a year. In the Philippines you do not pay you dialysis. In China they were using executed prisoners as donors. The organs of the problem is global and the Nobel Alvin Roth has the answer (maybe): scambiamoceli among us"
by Francesco Floris, June 7, 2017 

Old enough to drive, old enough to register to donate in Illinois

Here's the press release
Illinois Senate Unanimously Passes Legislation to Strengthen Organ Donor Registry
The "Drive for Life" Bill Would Allow 16- and 17-Year-Olds to Join State Registry

"SPRINGFIELD, Ill., May 16, 2017 /PRNewswire-USNewswire/ -- In an overwhelming bipartisan show of support, the Illinois State Senate unanimously passed (53-0) HB 1805, the "Drive for Life Bill".  Supported by the Secretary of State, a coalition of state legislators and Gift of Hope Organ and Tissue Donor Network and Mid-America Transplant, this critical legislation amends Section 6-117 of the Illinois Vehicle Code to allow Illinois residents 16 and older to join the organ donor registry. The bill will now be presented to Illinois Governor Bruce Rauner to sign into law.
...
"Illinois is one of only three states in the union that does not allow 16- and 17-year-olds to register their wishes to become organ donors. The "Drive for Life Act" would ensure all residents 16 and older may choose to officially join the First-Person Authorization Registry. While the law gives 16- and 17-year-olds the right to express their wishes, parents and legal guardians will maintain the right to give or revoke consent until the registered donors turn 18-years-old."

Online markets for prostitutes, including children are difficult to abolish

Illegal markets are hard to close down, and that goes double for advertisements for illegal markets, in which free speech issues and third-party issues ('we just post ads, we don't vouch for the advertisers') may also be in play.

In this regard, see some of my earlier posts about the website Backpage, which is in various sorts of legal battles.

Some followups:

In the Washington Post: A movie about online sex-trafficking might actually get laws changed

"It’s tough getting a consensus on anything these days, but child sex abuse and human trafficking are generally considered indefensible crimes. So who’s defending them?

According to “I Am Jane Doe,” that would be Google. And Microsoft. And Facebook. And Yahoo.

Directed by Mary Mazzio (“Lemonade Stories,” “Underwater Dreams”) and coming to Netflix May 26 after a theatrical run earlier this year, the documentary advocates for victims of online trafficking while taking principal aim at the classified-ad website Backpage.com, a notorious venue for sex ads and transactions, many involving children. In its indictment of Backpage.com and the tech companies that are indirectly supporting the website, the film may also give a public relations boost to members of Congress working to tighten laws surrounding Internet liability.
...

According to Section 230 of the 1996 Communications Decency Act, online service providers cannot be held liable for third-party content. But that means if someone sells a 13-year-old on its pages, Backpage says, it isn’t responsible. And so far, court after court has agreed — to the relief of First Amendment absolutists, and the Silicon Valley companies mentioned above, which support, financially, organizations defending Backpage’s position.

...
Backpage was once part of Village Voice Media and is now owned by a Dutch firm, although founders Michael Lacey and Jim Larkin and chief executive Carl Ferrer have been named in the suits. “I Am Jane Doe” picks up the Backpage saga in 2010 with lawsuits filed by girls who were trafficked on its pages, and continues through a Senate subcommittee investigation led by Sen. Rob Portman (R-Ohio) in January, as well as criminal charges of pimping and money laundering brought by then-California Attorney General Kamala D. Harris, now a Democratic senator. It also focuses on the effort that has thus far made the most headway — a civil suit that continues in Washington state, piloted by lawyer Erik Bauer. Backpage will try to get that case dismissed during a summary judgment hearing Wednesday. A jury trial is scheduled for Oct. 9.
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In the meantime, the closing of Backpage's "adult" ads section hasn't shut down other ads:

Fox News: Prostitution still thrives on Backpage despite site shutdown of 'adult' section

The NY Times : Backpage’s Sex Ads Are Gone. Child Trafficking? Hardly.

"In the midst of a Senate investigation, a federal grand jury inquiry in Arizona, two federal lawsuits and criminal charges in California accusing Backpage’s operators of pimping children, the website abruptly bowed to pressure in January and replaced its sex ads with the word “Censored” in red.

Even so, Tiffany — a street name — did not stop using the site, she said. Instead, her ads moved to Backpage’s dating section. “New in town,” read a recent one, using words that have become code for selling sex. “Looking for someone to hang out with.” Other recent dating ads listed one female as “100% young” and suggested that “oh daddy can i be your candy.”

In the fight against child sex trafficking, shutting down an epicenter like Backpage was a major victory, but one against a relentless foe that quickly unfurled new tentacles. The demise of Backpage’s adult ads undermined the trade, but it also illustrated how difficult it is to stamp out the practice of selling children for sex. The crime is rarely punished with the full force of the law — charges like rape or statutory rape — officials say; in many places it leads to just a citation, instead of an arrest.

For Tiffany, 18, the demise of Backpage’s adult listings has made things far more unpredictable — and dangerous, she said. The old ads allowed her to try to vet customers by contacting them before meetings, via phone or text message. With far fewer inquiries from the dating ads, she said, her first encounters with men now take place more often on the street as she gets into cars in red light districts around the Bay Area."

Who can be parents in Italy? (Adoption by same sex couples...)

In Italy, Confusion and Division Over Same-Sex Parenting
Court ruling highlights conflicting views over the rights of homosexual couples as parents

"An Italian court’s decision to recognize two homosexual men as the fathers of twin children has exposed confusion and a deep divide in the country over parenting rights of same-sex couples.

It was disclosed earlier this week that a court in the northern Italian city of Trento granted the men full rights as parents to their six-year-old twins, who were born in Canada through surrogacy.

The gay community hailed the decision—the first to accord full parental rights to a non-biological father—as historic in a country that last year became one of the last in Europe to approve civil unions for gay couples. But the ruling kicked up controversy right away, with the head of the main group opposing the civil-unions bill saying it marked a “sad day for Italy.”
...
"The 2016 legislation approving civil unions stopped short of addressing broader questions of parental rights and other family law issues for same-sex couples. Political opposition was so fierce that lawmakers scotched any reference to adoption or parental rights to get the bill passed. As a result, Italian law today recognizes only the biological parent, and joint adoption by gay couples isn’t allowed.

Italian courts have been left to fill that gap in a haphazard way, with some judges approving adoption requests by gay partners of a biological parent and others turning them down. The result: up to 1,000 children of gay couples are caught in a legal limbo.
...
"Riccardo and Lorenzo, the Trento couple who released only their first names, sought to break new ground. The pair, an entrepreneur and a civil servant in their 50s who have been together for more than 20 years, were married in Canada. Their twins were born in Canada via surrogacy, a practice that is illegal in Italy. Canadian law allowed both men to be listed as the twins’ fathers on the birth certificate.

Once back in Italy, the couple sought to have the Italian state recognize the Canadian birth certificate, seeking a parental status that affords more rights than adoption in Italy. An adoptive parent’s relatives have no legal relation with the adopted children, who therefore have no legal status when it comes, for instance, to inheritance from grandparents. The court granted the couple’s request, effectively recognizing both men as fathers.

“[We] sought no more than to see our children’s legal family rights protected, just as with other families,” they said in a statement.

Nichi Vendola, a gay Italian politician and leader in the fight for same-sex rights, hailed the decision. “When you raise, care for and love a child, you’re a father, mother, parent,” he said.

In Italy, however, court decisions don’t set legal precedent, so the legislative gap remains for parliament to fill. With Italy headed to elections this year or next, there is little political appetite to take up the bruising battle over parenting rights again."

Remembering when deceased donor transplantation was regarded as repugnant

From New Zealand, a story with several notable features:
the patient received a heart-lung transplant, and her heart was successfully donated to another patient, at a time when deceased donation (and brain death) gave rise to some repugnance:
 Kay Burnett celebrates 30 years of a ground-breaking heart-lung transplant

"Sir Magdi Yacoub calls Burnett an outlier. One of the few who broke the statistics.  The 81-year-old transplant surgery veteran speaks from Egypt, where he still teaches. These days, Sir Magdi is a globally revered transplant pioneer. He has a professorship, a knighthood and a membership of the Queen's exclusive Order of Merit. But back then, as Burnett sat in a London flat awaiting her only hope at life, some were calling him a murderer.

"It's easy to forget that transplanting organs from braindead patients was once deeply polarising. "The hate was abundant," Sir Magdi says. He won't repeat the hate mail's contents, but there was a lot of it – "a lot, a lot, a lot". ...
They said he was killing a living person to take their heart. "But the patient is not living. If my brain is dead – I'm not there."

...

"The domino-donor idea was born of Sir Magdi's frustration at wasting useable hearts. At the time, lung transplants were technically risky – even today they have lower survival rates. But transplanting a heart and lung together ensured the pressure generated by the heart was matched exactly by the lung. It also ensured an instant blood supply, helping the windpipe heal immediately.

"But for those, like Burnett, who needed only a new lung, that meant binning a potentially functioning heart.

"We were very short of donor organs. We still are. So I did not want to be sending it to the pathology department when I could be transplanting it."

"And so domino-donor transplants were born. While the domino-donor hearts were compromised, having been subjected to high blood pressure from the lung, or pulmonary hypertension, Sir Magdi realised that could be an advantage. Heart patients with severe pulmonary hypertension could receive a heart pre-conditioned to that high pressure, which then normalises over time.

"Burnett's was not the first domino-donor transplant – that was undertaken by Sir Magdi 11 days earlier, on April 28. The heart-lung recipient survived; the heart recipient did not.

History now mostly says the first successful domino transplant was conducted in the United States, but contemporary news reports say Burnett's transplant happened just hours earlier. Burnett was all over the British press, with The Sun once reporting her dead.

Who was first is not important, Sir Magdi insists. What matters is learning from people such as Burnett and Andrew Whitby – another Harefield patient, named the longest-surviving heart-lung transplant recipient when his 30-year anniversary ticked over in 2015.

HT: Frank McCormick

Kidney donation today on behalf of a future recipient

Here's a forthcoming article in Transplantation, interesting for both what it says and who says it.

The authors include prominent transplant professionals at UCLA (which is an important, innovative and productive kidney transplant center), and also the rising-star economist and matching theorist Marek Pycia.  I recall a time when collaborations between economists and transplant professionals was unusual, and so I'm glad to see new collaborations of that sort arise.

The paper itself is about taking future care of young kidney patients who may need a (second or third) kidney donation later in life. The NKR and UCLA are implementing a voucher system that would allow a donor (e.g. the young patient's grandparent, or parent) to donate as a non-directed donor today, on behalf of a specific, current kidney patient, in return for a commitment that best efforts would be made to end some future kidney exchange chain with a chain-ending kidney for the designated patient, when the need arises.


Vouchers for Future Kidney Transplants to Overcome ‘Chronological
Incompatibility’ Between Living Donors and Recipients
Jeffrey L. Veale, M.D., , Alexander M. Capron, Nima Nassiri, Gabriel Danovitch, H. Albin Gritsch, Joseph Del Pizzo, Jim C. Hu, Marek Pycia, Suzanne McGuire, Marian Charlton, and Sandip Kapur,

Transplantation Published Ahead of Print DOI: 10.1097/TP.0000000000001744

Abstract
Background: The waiting list for kidney transplantation is long and growing. The creation of :vouchers" for future kidney transplants enables living donation to occur when optimal for the donor and transplantation to occur later, when and if needed by the recipient.

Methods: The donation of a kidney at a time that is optimal for the donor generates a :voucher‘" that only a specified recipient may redeem later when needed. The voucher provides the recipient with priority in being matched with a living donor from the end of a future transplantation chain. Besides its use in persons of advancing age with a limited window for donation, vouchers remove a disincentive to kidney donation, namely, a reluctance to donate now lest one‘s family member should need a transplant in the future.

Results: We describe the first 3 voucher cases, in which advancing age might otherwise have deprived the donors the opportunity to provide a kidney to a family member. These 3 voucher donations functioned in a nondirected fashion and triggered 25 transplants through kidney paired donation across the United States

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See my earlier post: 

Thursday, August 4, 2016

Dr Jeff Veale in the WSJ on vouchers for living donor kidneys

Health inequality at the Trento festival of economics, June 1-4

The city of Trento hosts a festival of economics each year. I'll be participating. Here's an English announcement of this year's theme:
Trento Economics Festival 2017: “the Unequal Health”

And here: Festival dell'Economia: 1-4 giugno

Here's the web page and program in Italian and in English (click on the Union Jack)

Here's a page describing the three events that I'll take part in on June 1 and 2. In the first I'll speak about market design and kidney exchange, in the second about my book, which recently came out in Italian, and the third event will be a panel discussion of repugnant transactions:

Mercato e disuguaglianze nella salute

introduce Tito Boeri In che misura facilitare l'incontro tra domanda e offerta di organi può salvare vite umane e...

0118:00

Visions

Market design, kidney exchange, and health inequality

Alvin Roth

introduced by Tito Boeri

To what extent can facilitating the bringing together of supply and demand for organs save human lives and reduce health inequality? In particular, is it possible to organise the exchange of kidneys efficiently, taking into account ethical and regulatory restrictions? To what extent is this exchange between rich and poor countries manageable on a global scale?

Teatro Sociale

0215:00

Matchmaking. La scienza economica del dare a ciascuno il suo

a cura di Einaudi ne discutono Dino Gerardi, Matteo Motterlini coordina Tonia Mastrobuoni

0218:30

Mercati per il corpo umano: sfruttamento o opportunità?

coordina Mario Macis In Italia così come in molti altri paesi, il fabbisogno di organi per trapianti è superiore...

0218:30

Intersections

Markets for the human body: exploitation or opportunity?

Cinzia Caporale - Nicola Lacetera - Ignazio Marino - Alvin E. Roth

speaker and coordinator Mario Macis

In Italy, as in many other countries, the demand for transplant organs exceeds supply, and the gap is increasing over time. Is it possible to consider the idea that providing monetary payment for donors or other forms of exchange, as takes place in other countries, may contribute towards filling the gap between supply and demand? Is there not a risk of introducing unacceptable forms of exploitation and unfairness?

Palazzo della Provincia - Sala Depero

Matchmaking and market design: Italian interview

Here's an interview in Italian, largely on kidney exchange, published in advance of the Trento festival (which I plan to blog about tomorrow)
.
Scambio di reni e matching markets, le ricette di Roth
Roth rivela l’intuizione e presenta l’ultimo libro: «Nei matching markets scegliamo e veniamo scelti»

Corriere di Verona28 May 2017Marika Damaggio

Obstacles to Organ Donations: The Dire State of Kidney Transplantation--Cato Institute

Here's a panel discussion at the Cato Institute (pointed out to me in a comment on a previous post by Haksing Zimik):
Obstacles to Organ Donations: The Dire State of Kidney Transplantation

Featuring Ike Brannon, Visiting Fellow, Cato Institute; Jeremy Marcus, Legislative Director and Deputy Chief of Staff, Rep. Matt Cartwright; Sally Satel, M.D., Senior Fellow, American Enterprise Institute; Keith Melancon, M.D., Director, George Washington Transplant Institute; Kurt Schuler, Kidney Donor; moderated by Peter Russo, Director of Congressional Affairs, Cato Institute.

The video is 38 minutes of interesting, moderate discussion, and ends rather abruptly--I gather the discussion continued beyond the video.

Should historians of science adjudicate scientific awards?

Historian of Economics Beatrice Cherrier blogs about the two Golden Goose Awards that have been made for various parts of market design (in 2013 and 14), and suggests that more deserving topics could have been picked...

How about every historian of science nominates a candidate for the Golden Goose Award?

The big dialysis business

Here's an interesting report that goes well with the John Oliver video a little while ago:
Why DaVita is being regulated, investigated, and sued

In a business where individual patients may pay vastly different fees depending on whether they are being supported by Medicare or by private insurance, there is room for game playing.

Supporting science during the budget process--an op-ed in Alabama

Government funding of science is important, and at risk.  Here's an opinion piece that ran yesterday in Alabama, which seeks to bring some of the direct benefits in Alabama to the attention of Alabama's citizens and representatives in Washington (using the active kidney exchange program in Alabama as an example).

Trump budget puts future scientific advances at risk
By Alvin E. Roth, the Craig and Susan McCaw Professor of Economics at Stanford University
and Dr. Jayme Locke, Associate Professor at UAB School of Medicine and the Director of the Incompatible Kidney Transplant Program and Transplant Analytics, Informatics & Quality

Here are the final paragraphs:

"As the Director of the Incompatible Kidney Transplant Program at UAB and a Nobel Prize winning economic researcher, we have seen first-hand the power of science to connect those suffering with disease with vital cures.

We applaud Senator Shelby as a leader of the Senate Appropriations Committee, and Representatives Aderholt and Roby on the House Appropriations Committee, as well as all of the Alabama Congressional delegation on their work to support vital R&D investments in a bipartisan way.

We are hopeful that leaders will once again demonstrate that funding America's future innovation is a bipartisan imperative. "

School choice in Chile

La Tercera reviews the adoption of a deferred acceptance school choice system in parts of Chile:
Resultados y desafíos del nuevo sistema de admisión escolar

Google translate:
Results and challenges of the new school admission system

"The implementation of this new system counted on the participation of all the relevant actors. Schools actively informed parents about the various aspects of their educational programs and their vacancies. After accessing this information (either in person or via the web platform designed by Mineduc), the parents declared a list of preferences of the schools in which they wanted to enroll their children . The system is designed so that they express their preferences about different establishments in an honest and transparent way.

Many colleges have more applicants than quotas. To decide which students will be admitted to a facility, applicants are listed. This list respects the priorities indicated in the Law of Inclusion and guarantees equal opportunities by solving ties in a random manner.

Allocation mechanisms similar to those implemented in Magallanes are used in several countries around the world, highlighting the cases of the USA. (Boston and New York, among others), Holland and Finland. In each case, the DA algorithm must solve local demands that make each implementation unique and interesting. In Chile, for example, the law establishes priority criteria for applicants, so the allocation algorithm must give preponderance to siblings and children of officials, as well as those students considered to be priority because of their socioeconomic situation.

Our review of the 2016 process is positive. 3,580 students participated in two rounds of application: 3,147 exclusively in the main round, 222 in the second round and 211 in both. Of these applicants, in the main round, 1,959 (58.3%) were assigned to their first option, while in the second round this number reached 357 (82%). In the full process 3,107 students were assigned to one of their preferences, while 258 were withdrawn from the process. International experience shows that these numbers are positive. In New York, for example, in the process of admission to secondary education in 2006, about 40% of students were assigned to their favorite school.

One of the challenges for the next implementations is the simplification of the different stages of the process. Likewise, it is important to inform parents and guardians to motivate them to use the new admission system and, in this way, increase the chances of their children staying in a school that satisfies them. Our challenge is to scale this system to make the school assignment of all children in Chile."

Informed consent laws, memorialized in an obituary

The NY Times has the obituary, which recalls a long ago medical tragedy (he was left paralyzed by a surgery he had when he was 19) that gave rise to laws about informed consent:
Jerry Canterbury, Whose Paralysis Led to Informed Consent Laws, Is Dead at 78

"Yet by the time of his death, that surgery — with its horrific outcome — had taken its place in the annals of medical law. It had led to a landmark court ruling that fundamentally transformed how doctors deal with patients in evaluating the risks of potential treatment.

“This is probably one of the handful of most significant medicolegal cases in United States history,” said Jacob M. Appel, a doctor and bioethicist.

"The ruling, by a federal appeals court in Washington in 1972, declared that before a patient provided informed consent to surgery or other proposed treatment, a doctor must disclose the risks, benefits and alternatives that a reasonable person would consider relevant.

"Previously, the onus of soliciting that information had rested with the patient, and any description of risks was provided at the doctor’s discretion. A doctor had been considered negligent only when treatment was administered against the patient’s wishes.

“It would not be an exaggeration to say that the opinion is the cornerstone of the law of informed consent” to medical treatment, “not only in the United States, but in other English-speaking countries, too,” said Prof. Alan Meisel, who teaches law and psychiatry at the University of Pittsburgh School of Law."

Broken Chains and Reneging: A Review of 1,748 Kidney Paired Donation Transplants

Broken chains in non-simultaneous kidney exchange chains begun by non-directed donors are not a big problem at all.
Here's the article, forthcoming in  the American Journal of Transplantation:

Broken Chains and Reneging: A Review of 1,748 Kidney Paired Donation Transplants
Nick Cowan, H. Albin Gritsch, Nima Nisseri, Joe Sinacore, Jeffrey Veale
Accepted manuscript online: 10 May 2017
DOI: 10.1111/ajt.14343

Abstract: Concerns regarding the potential for broken chains and reneges within kidney paired donation (KPD) and its effect on chain length have been previously raised. While these concerns have been tested in simulation studies, “real world” data has yet to be evaluated. The purpose of this study was to evaluate the actual rate and cause of broken chains within a large KPD program. All patients undergoing renal transplantation through the National Kidney Registry from 2008 through May 2016 were included for analysis. Broken chains and loops were identified. A total of 344 chains and 78 loops were completed during the study period yielding a total of 1,748 transplants. Twenty broken chains and one broken loop were identified. The mean chain length (# of transplants) within broken chains was 4.8 compared to 4.6 of completed chains (p=0.78). The most common causes of a broken chain were donor medical issues incurred while acting as a bridge donor (n=8), donors electing not to proceed (n=6), and kidneys being declined by the recipient surgeon (n=4). All recipients involved in a broken chain have subsequently received a transplant. Based on the results broken chains are infrequent, rarely due to lack of donor motivation, and have no significant impact on chain length.

New York City school choice in the NY Times: Not all NYC high schools are good yet

The NY Times recently ran this story, largely critical of school choice in NYC:
The Broken Promises of Choice in New York City Schools
The city’s high school admissions process was supposed to give every student a real chance to attend
a good school. But 14 years in, it has not delivered.
By ELIZABETH A. HARRIS and FORD FESSENDEN MAY 5, 2017

Here's a paragraph that summarizes the main point:
"Ultimately, there just are not enough good schools to go around. And so it is a system in which some children win and others lose because of factors beyond their control — like where they live and how much money their families have."

The story follows several students at a  middle school in the Bronx:
"The Times spent months following the high school application process at Pelham Gardens, where families do not have the advantages that routinely open doors to the city’s best schools. Many families are new to the country, and most are poor."

Parag Pathak (who played a critical role in organizing the NYC high school match--see e.g. here and here) wrote a letter to the NY Times summarizing his reaction to the story. As it appears that the Times won't publish the letter, he gave me permission to reproduce it:

"May 5, 2017

In “The Broken Promises of Choice in New York City Schools,” Elizabeth Harris and Ford Fessenden miss a key point in describing the New York City High School choice system. The choice system does not create good schools.  It exists because there aren’t enough good schools.

I worked with NYC DOE to design the choice system described by authors.   By any objective measure, this system provided better access to schools than the one it replaced.  Without a comparison to the old system, Harris and Fessenden’s description of choice outcomes is misleading.  In the old system, half of applicants from Pelham Gardens (zip code 10469) were assigned to choices they did not rank; in 2003, that number drops to 23%. Under the new system, students from that neighborhood also travelled two miles further to schools they wanted.  Across the city, the new system allows more kids to go to schools they ranked and the benefits were largest for those most likely to be administratively assigned, like those in Pelham Gardens (see, http://economics.mit.edu/files/10633.   This is not to say the process is perfect and couldn’t be improved.  But it is foolish to expect the process to produce miracles, without changing the set of school options.

A broader premise of the article is that schools with highest test scores and graduation rates are indeed “the best.”  Our research, including on NYC’s exam schools (http://economics.mit.edu/files/9773), strongly suggests otherwise.  Naïve discussions of school quality and the role of school choice confuse efforts to improve school quality, where our attention should be devoted. 

Parag Pathak

Carlton Professor of Economics, MIT"

********************

For reference, here's the 2003 NY Times story that covered the school choice system when it was introduced:

REVISED ADMISSION FOR HIGH SCHOOLS

By DAVID M. HERSZENHORNOCT. 3, 2003 

Discovering Prices, by Paul Milgrom

Just published and well worth reading (here's a link at which you can discover its price:)
Discovering Prices  -- Auction Design in Markets with Complex Constraints
Paul Milgrom
Columbia University Press

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.”

School Choice in the District of Columbia: apparently not all according to algorithm

The Washington Post has the story: it seems that some politically connected families were able to get the schools they wanted without going through the school choice algorithm...

Secret report shows ‘special’ treatment for public officials in D.C. school lottery

"Former D.C. Public Schools chancellor Kaya Henderson routinely helped well-connected parents — including two senior aides to Mayor Muriel E. Bowser (D) — bend or break the rules of the District’s notoriously competitive school lottery to enroll their children at coveted schools, according to a confidential report obtained by The Washington Post.

The report, based on an investigation by the D.C. Inspector General’s Office, describes in remarkable detail how Henderson used her power as head of the school system to place the children of those with political clout at campuses they could not otherwise access through the random lottery, which every year leaves thousands of families on waiting lists for their desired schools.

Inspector General Daniel Lucas found that Henderson misused her authority by giving preferential treatment to seven of 10 people who requested special school placements for their children during the 2015 lottery season. The investigation did not examine the rest of Henderson’s tenure from November 2010 to September 2016.

[Read the confidential inspector general’s report obtained by The Post]

Henderson openly acknowledged in interviews with investigators that she gave special treatment to the children of government officials. Asked about the help she gave City Administrator Rashad M. Young, a top Bowser cabinet official whose salary is $295,000, Henderson said D.C. officials “do not necessarily get paid as much as we should.”

The former chancellor bestowed such favors even as she dismissed pleas for special consideration from those with less influence, such as a deaf Vietnamese immigrant whose request that her daughter be allowed to attend a school where she could practice sign language was rejected.

The findings could shake public confidence in the city’s school lottery, which has been held up as a national model. It also raises troubling questions for Bowser, whose defense of her cabinet officials’ roles in the scandal is undercut by details in the report."
...
"[This is how the D.C. lottery is supposed to work]".
*********
And here's a story from 2013 as the school choice system was introduced:
D.C. is preparing a unified enrollment lottery for its traditional and charter schools

IIPSC designed the algorithm, but not the politics.

Dialysis: Last Week Tonight with John Oliver (HBO)

Laughing through the tears...


The video briefly mentions a new living donor information source and database, Give and Live.