Organ shortages for transplantation: Pig kidneys won't be transplanted into people soon

 Here's an article in Medpage Today by the chief medical officer at UNOS, pointing out that xenotransplantation is not going to substitute in the near term for other efforts to increase organ transplants. (The article goes on to discuss recent progress in other directions.)

A Look at Pig Kidneys in the Broader Transplantation Puzzle— Advancements across the field are accelerating in real time  by David Klassen, MD November 29, 2021

"Last month's breaking news that the kidney of a pig functioned normally when attached for 54 hours to the body of a brain-dead patient was hailed as an eventual solution for more than 100,000 people nationwide who are waiting for life-saving organs. While xenotransplantation, or animal-to-human transplantation, has been undergoing study and experimentation for quite some time, this was a huge step in the right direction.

As first reported on October 18, the team at NYU Langone Health obtained consent from the ventilated donor's family to attach a pig kidney to her upper leg and monitor the results. They reported that the organ, which came from an animal whose genes had been modified to avoid early rejection by a human host, began to work almost immediately and produce urine and function as would a human kidney. The pig kidney functioned normally throughout the 54-hour trial.

...

"Unfortunately, the next steps remain incredibly complex. Routine xenotransplantation of non-human organs into human bodies is many years away. One of the greatest hurdles is immunological: getting non-human organs to survive long-term, not just for a 54-hour trial. Due to the need for additional research and testing, it is unlikely that xenotransplantation will arrive in time to help most of those currently on the transplant waitlist, including more than 90,000 kidney transplant candidates."

Morse lecture at INFORMS next year: market design and the study of operations

 In 1974, the year I received my Ph.D. from Stanford's (then) Department of Operations Research, it was unclear in what discipline game theory would best thrive.   As disciplinary boundaries shifted, I found that I was an economist.  But I've kept open my professional ties to OR, and indeed I think of market design as the engineering part of game theory, and very concerned with the operational detail of markets and marketplaces. So I was glad to accept an offer to compose a lecture on this for an OR audience, since market design is now a multi-disciplinary field that draws many students of operations.

Here's an announcement that includes the following:

Philip McCord Morse Lectureship Award

The Lectureship is awarded in honor of Philip McCord Morse in recognition of his pioneer contribution to the field of operations research and the management sciences. The award is given in odd-numbered years at the Annual Meeting if there is a suitable recipient. The term of the lectureship is two years. The award is $2,000, a certificate, a travel fund of $5,000, a copy of Morse's autobiography, In at the Beginnings: A Physicist's Life, and a copy of Morse and Kimball's Methods of Operations Research. Learn more about the Philip McCord Morse Lectureship Award and how to be nominated on the INFORMS website.

This year, the lectureship is awarded to:

Alvin E. Roth, Stanford University

Who exemplifies the true spirit of Professor Morse and who, like Morse, has been an outstanding spokesperson for the operations research profession in operations research tools and ideas in designing efficient markets for a range of applications. This award is given by the Institute for Operations Research and the Management Sciences in honor of Philip McCord Morse, in recognition of Professor Morse's pioneering contributions to the field of operations research and of his devoted service to the field's professional societies.

***********

See also

Tuesday, January 17, 2017

Market Design and Operations Research: an interview by the journal Mathematics of Operations Research

Sale of dinosaur fossils

 National Geographic has the story:

The controversial sale of 'Big John,' the world's largest Triceratops. The fossil's $7.7-million sale has some experts worried that ancient bones' rising prices will put more scientifically valuable fossils out of reach.  BYMICHAEL GRESHKO

"The founder of a South Dakotan firm called PaleoAdventures, which digs up fossils for commercial sale, Stein nicknamed the fossil “Big John” after the owner of the ranch where he found it. For six years, he held on to the Triceratops in hopes that a U.S. museum would purchase it—but none came forward. Then, in 2020, he sold the fossil to an Italian firm that prepared it for auction. With much fanfare and a jaw-dropping sale price of $7.7 million (6.65 million euros) to an anonymous buyer last month, Big John became a big deal—and added fuel to an ongoing, thorny debate among scientists, auctioneers, commercial paleontologists, and private landowners.

...

"Big John is one of more than 100 known fossils of Triceratops, one of the most common dinosaurs found in western North America’s Hell Creek Formation, which snakes through parts of Montana, North Dakota, South Dakota, and Wyoming.

"In the United States, only researchers with government permits can collect fossils on the millions of acres of federal lands, and these remains must be held in the public trust at institutions such as museums. However, fossils found on private land—including Big John—belong to the landowner and can be bought and sold legally.

"The U.S. is one of only a few countries that allows this sort of trade. In Alberta, Canada, for instance, fossils found in that province can’t be exported according to a 1970s law that designates fossils as part of Alberta’s natural heritage—a legal response to decades of foreign museums removing exquisite dinosaur fossils from the province. Other fossil-rich countries, such as Brazil, China, and Mongolia, have similar laws, though black markets dealing in fossils from these countries persist.

"Academic paleontologists have a range of views on the legal fossil trade, from begrudging acceptance to steadfast opposition. University of Calgary paleontologist Jessica Theodor, president of the Society of Vertebrate Paleontology (SVP), which represents paleontologists around the world, says she’s worried that auctions turn fossils into luxury collectibles and further legitimize the global fossil trade."

Supervised drug injection sites open in NYC

 The NY Times has the story:

Nation’s First Supervised Drug-Injection Sites Open in New York. During the first official day in operation at the two Manhattan facilities, trained staff reversed two overdoses, officials said.  By Jeffery C. Mays and Andy Newman

"New York, the country’s most populous city, became the first U.S. city to open officially authorized injection sites — facilities that opponents view as magnets for drug abuse but proponents praise as providing a less punitive and more effective approach to addressing addiction.

"Other cities including Philadelphia, San Francisco, Boston and Seattle have taken steps toward supervised injection but have yet to open sites amid debate over the legal and moral implications of sanctioning illegal drug use.

...

"Mayor Bill de Blasio began championing safe injection sites in 2018, citing their use and success in European and Canadian cities. The decision to officially allow the sites to open comes during the mayor’s last few weeks in office and as he considers a run for governor. He said in a statement that the decision will show other cities that “after decades of failure, a smarter approach is possible.”

"The mayor also sent a letter to the providers promising “not to take enforcement action” against their operations. Four of the city’s five district attorneys — excluding only the Staten Island district attorney, Michael McMahon — support supervised drug sites."

School choice using deferred acceptance algorithms increases competition for selective schools, by Terrier, Pathak and Ren

 Here's a working paper from the LSE which concludes that making it safe for parents to truthfully report their preferences increases the competition for selective schools (called grammar schools, which prioritize students based on admission tests), with the unintended consequence of disadvantaging poorer families in England. The paper contains a good description of past and present school assignment regimes in England.

From immediate acceptance to deferred acceptance: effects on school admissions and achievement in England by Camille Terrier Parag A. Pathak and Kevin Ren,  Centre for Economic Performance Discussion Paper No.1815, November 2021

"Abstract: Countries and cities around the world increasingly rely on centralized systems to assign students to schools. Two algorithms, deferred acceptance (DA) and immediate acceptance (IA), are widespread. The latter is often criticized for harming disadvantaged families who fail to get access to popular schools. This paper investigates the effect of the national ban of the IA mechanism in England in 2008. Before the ban, 49 English local authorities used DA and 16 used IA. All IA local authorities switched to DA afterwards, giving rise to a cross-market difference-in-differences research design. Our results show that the elimination of IA reduces measures of school quality for low-SES students more than high-SES students. After the ban, low-SES students attend schools with lower value-added and more disadvantaged and low-achieving peers. This effect is primarily driven by a decrease in low-SES admissions at selective schools. Our findings point to an unintended consequence of the IA to DA transition: by encouraging high-SES parents to report their preferences truthfully, DA increases competition for top schools, which crowds out low-SES students."

And here are the paper's concluding sentences:

" In England, selective schools pick students based on test scores, which favors high-SES parents. After the transition to DA, high-SES parents enroll at these schools at higher rates. Selective admissions are widespread throughout education, so our results provide an important caution to equity rationales for DA over IA in settings where selective schools have large market share."

Interview with Ido Erev

 Here's a short interview with Ido Erev, the great behavioral scientist at the Technion, from whom I learned a lot about learning:

Interview with Ido Erev

Here is his closing comment:

"When I started  studying the effect of experience, in the 90s, I asked several famous  researchers why they have stopped studying this effect. Here are some of  the answers that affected me the most (as I remember them): Duncan Luce: Now that I am old, I am more interested in my own mistakes.  In particular, I try to understand why I exhibit the Allais paradox.  Herb Simon: I got more reinforcements from studying bounded rationality.  Amos Tversky: It is clear that if you hit subjects with a 5Kg “feedback hammer” they will learn to be rational. I  want to study what people learn before they arrive at the lab. Alvin E.  Roth: There is no good answer, let's study it."

An experimental study whose participants are compensated donors in the legal Iranian market for kidneys, by Kelishomi and Sgroi

 A recent working paper from Warwick reports an experiment and survey study whose participants are compensated kidney donors (and prospective donors) in the legal Iranian monetary market for kidneys.

Kelishomi, Ali Moghaddasi, and Daniel Sgroi. A Field Study of Donor Behavior in the Iranian Kidney Market. No. 1381. University of Warwick, Department of Economics, October 2021.

Abstract: Iran has the world’s only government-regulated kidney market, in which around 1000 individuals go through live kidney-removal surgery annually.  We report the results of the first field study of donor behavior in this unique and controversial market. Those who enter the market have low income, typically entering to raise funds.  They have lower risk tolerance and higher patience levels than the Iranian average.  There is no difference in rationality from population averages.  There is evidence of altruism among participants.  This might shed light on the sort of people likely to participate if other nations were to operate suchmarkets.

From the introduction:

"There is no doubt that the notion of paying for a kidney raises ethical concerns and some see this form of market transaction as incompatible with the “sacred value” of human life (Elias et al., 2015). However, given the apparent success of the Iranian kidney market and the existence  of long waiting lists, patient suffering and significant loss of life elsewhere, there has also been something of a re-evaluation of the potential for regulated organ markets in the developed world

...

"Given the nature of the debate it seems important to consider the characteristics of those likely to  come  forward  as  donors  if  a  market  is  established  and  to  ask  what  special  features  they may possess.  Since there is only one existent regulated market, this must involve a controlled examination of participants in the Iranian kidney market.  Our paper reports the outcome of an unprecedented first study of patient behavior in the Iranian kidney market in which we obtained direct access to donors before and after surgery. We provided full incentives where appropriate during our experimental treatments, providing incentive payments of around $50 (in terms of purchasing power parity) on top of a show-up fee of roughly $15.2 We also collected data that is similar to existing generic data on the Iranian population. This allows us to not only provide comparisons within our sample but also between our sample and Iranian averages where data is available.

...

" The study started in August 2017 (shortly after the end of sanctions between the UK and Iran) and live sessions continued until May 2019,with further telephone interviews and follow-up sessions continuing until February 2021.  78 subjects were first interviewed post-donation while the remaining 137 were interviewed pre-donation.  Of the pre-donation group 91 were contacted a second time to confirm their final status in February 2021.  35 had donated by this point with the remaining 56 dropping out of the market (30 for medical reasons and 26 through choice).  Following this process we were able to measure behavioral variables such as risk aversion, time preference (patience), altruism, rationality (consistency with GARP, the generalized axiom of revealed preference), and a wide variety of demographic and socioeconomic data.  Where feasible we incentivized answers and used the most prominent measures available.  We also examined why these patients enter the market and what alternatives might have been available to them.  We are able to compare our patient data with available data for typical Iranians to provide a benchmark (Falk et al., 2018)

...

"While the typical donor is in considerable financial difficulty, they are significantly more patient and exhibit lower tolerance for risk than an average Iranian (though conditional on entering the market those with lower patience are more likely to have donated during our study).   Those who go through with the process exhibit higher levels of altruism than those who drop out.   We find no difference in rationality between participants in the market and the subjects in a leading study of rationality from which we take our core measure  (Choi  et  al.,  2014).   We  would  argue  that  alternative  options  for  those  in  financial difficulty such as approaching a loan shark might be more appealing to the risk-loving (and perhaps more impatient) since this offers an immediate solution but replaces it with a serious and risky long-term liability, while the organ market is a difficult short-term prospect but does not result in higher levels of debt in the long run. Our findings on altruism are consistent with the idea that, while donors are being paid, they are nevertheless taking part in a difficult process that has the potential of saving a life, and this may also be important when considering alternatives."

#####

Update: here's the published paper

Kelishomi, Ali Moghaddasi, and Daniel Sgroi. A Field Study of Donor Behavior in the Iranian Kidney Market. European Economic Review, Volume 170, 2024

The Elements of Choice (Architecture) by Eric Johnson

Eric Johnson's new book is about choice architecture, and how when choices are presented in a confusing way, we may make bad decisions.

The Elements of Choice. WHY THE WAY WE DECIDE MATTERS  By ERIC J. JOHNSON

One of the points the book makes is that having too many choices may impede the quality of your decision: you might do better if the choice architect had narrowed or better organized your choice set to make it easier for you to fluently understand the choices presented, which would enable you to make a more accurate decision.

Here is a picture of the first search result that appeared when I searched for the book, which I surmise is an ad composed by the publisher:

I read with interest his discussion of school choice, in which he argues that much of the potential welfare improvement produced by market design could potentially be undone by confused decision making by participants, and that welfare could be improved if market designers did a better job of actively curating and organizing the choices offered.

He writes "Increasing the number of options increases the probability that families will be presented with the best school for them, but it does not mean they will see it."

Some of his recommendations suggest that market designers should get involved at all level of detail: e.g. easier to read fonts may increase fluency and allow more choices to be presented effectively.

Others of his recommendations seem to me to be further removed from the actual practice of school choice: e.g. "If we can remove any terrible schools from the set, choosers, even if they were picking randomly, would on average get better outcomes." Closing underperforming schools (e.g. by not admitting new students) is much more complicated than that.

I haven't finished reading the book yet (Eric pointed me first to the section on school choice), and I'm looking forward to it.  Choice architecture is certainly an important part of market design.

Deceased donor sperm recovery and conception

I guess it's a case of deceased donor transplantation of sorts. Above the Law has the story:

Posthumous Conception: It Happens More Often Than You Think by Ellen Trachman

 "In the latest high-profile controversy over posthumous conception, last month, we learned of the birth of a baby girl to an Australian woman named Ellidy Pullin, the widow of Olympic snowboarder Alex “Chumpy” Pullin. The Olympian died tragically in a diving accident in 2020.

"Ellidy Pullin turned to their fertility doctor, Andrew Davidson, and asked that her spouse’s sperm be harvested from his body after his death. Davidson described how he entered fertility medicine never expecting to do posthumous sperm retrievals, but now, those requests are becoming more common. The doctor noted that he has done two other posthumous sperm retrievals since the Olympian’s death.

"The process was successful for Pullin — as Davidson notes, it usually is, so long as the sperm is successfully retrieved within 48 hours of death.

...

"In the United States, the hospital itself is the most frequent obstacle that prevents a surviving loved one from having a chance to conceive with the DNA of their deceased spouse or partner. Many hospitals are unwilling to permit the retrieval of reproductive material without specific written consent. And by specific consent, that frequently means not just that the deceased wanted to have children with the survivor. The bar is often set higher. The consent must be that the deceased specifically agreed for their sperm or eggs to be harvested and used for reproductive purposes after their death."

NRMP Statement On Interviewing

 The National Resident Matching Program (NRMP) has a statement on interviewing, which precedes the NRMP match for new American doctors, and that reflects concerns that the interviewing process has become congested.

NRMP Statement On Interviewing

"The National Resident Matching Program® (NRMP®) has heard the concerns of learners and programs in the medical education community about the interview process and wants to encourage equitable practices among applicants and programs. As such we have developed the following recommendations. Although especially true during the enduring times of the pandemic, the recommendations align with the NRMP’s long-standing commitment to maintaining a fair, efficient, reliable, and transparent process for all. Recommendations also foster well-being among all parties.

"NRMP Recommendations for Programs:

1. Programs should conduct all interviews virtually for the 2021-2022 cycle.

2. Programs should extend interview offers that equal, not exceed, the total number of available interview slots.

3. Applicants should be given a minimum of 48 hours to respond to an interview offer.

"NRMP Recommendations for Applicants:

1. Applicants should make timely decisions about interview offers and promptly notify programs in which they are no longer interested, freeing up interview slots.

2. Applicants should give ample, adequate (e.g., one week) notice to programs in the event they change their minds and decline accepted interviews."

Promoting Quality in Research: the inaugural Einstein Foundation Awards, 2021

 I had the privilege of being a member of the jury for the Einstein Foundation Awards, which were awarded yesterday for the first time.

Here's the award booklet: 

EINSTEIN FOUNDATION AWARD 2021 PROMOTING QUALITY IN RESEARCH

Individual Award 2021:  Paul Ginsparg

"Preprints have been shared in the physics community since the early 1950s but mostly among well established professors. Physicist Paul Ginsparg, who receives the Einstein Foundation’s Individual Award, set out to democratize access to scientific results. Today, his preprint server arXiv has spread to many other fields—and made science progress more efficient and fairer."

Institutional Award 2021: The Center for Open Science

"Open research is on the rise, but a lot of research information still remains behind closed doors. The Center for Open Science, recipient of the Institutional Award, advocates for more transparency and open access, training scientists, publishers and funders, providing technology and policy recommendations. With this multi pronged approach, it has helped create an open science community which is becoming ever more self-sustaining."

Early Career Researcher Award 2021: "ManyBabies5: Teaming up for Developmental Science → manybabies.github.io/MB5

"Unlike adult subjects, babies cannot tell you what they are thinking. Therefore, researchers studying infant development use looking patterns to understand how babies think and feel about the world. “An overwhelming majority of studies use looking time to make inferences about infant cognition,” comments Martin Zettersten from Princeton University in the United States. But what exactly is it that drives babies to pay attention to different things? To come up with a statistically sound answer to this question, he and his colleague Jessica Kosie initiated ManyBabies5, a large international consortium of infant researchers. “We aim to increase diversity amongst researchers and test subjects alike and collaboratively want to come up with the best test possible on how different factors matter in infant looking time,” Jessica Kosie explains. To that end, the ManyBabies team will put together a diverse and sizeable sample of infants around the world. “To me, team science is a useful tool for producing high quality, robust science,” says Martin Zettersten. “Embracing this approach as a field as many groups are doing right now—that feels revolutionary to me.”

THE JURY The Einstein Foundation Council has convened an outstanding group of scholars representing the natural sciences, the humanities, and the social sciences. The international jury is presided over by Dieter Imboden and both defines the objectives of the award and selects the awardees. The following jury members have been appointed for the first three year term: DIETER IMBODEN (President), PhD, Theoretical Physics; Professor Emeritus of Environmental Physics, ETH Zürich; DOROTHY BISHOP, PhD, Neuropsychology; Professor of Developmental Neuropsychology, Oxford University; ALASTAIR BUCHAN, MD, PhD, Medicine; Professor of Stroke Medicine, Oxford University; MICHEL COSNARD, PhD, Computer Science; Professor Emeritus of Informatics, Université de Côte d’Azur; LORRAINE DASTON, PhD, History of Science; Director Emerita of the Max Planck Institute for the History of Science Berlin; MOSHE HALBERTAL, PhD, Philosophy; Professor of Jewish Thought and Philosophy, Hebrew University; LENA LAVINAS, PhD, Economics; Professor of Welfare Economics, Universidade Federal do Rio de Janeiro; JULIE MAXTON, PhD, Law; Executive Director of the Royal Society, London; MARCIA MCNUTT, PhD, Geophysics; President of the National Academy of Sciences of the United States; EDWARD MIGUEL, PhD, Economics; Professor of Environmental and Resource Economics, University of California, Berkeley; ALVIN ROTH, PhD, Economics; Professor of Economics, Stanford University; SOAZIC ELISE WANG SONNE, Economist, World Bank Group; PhD Fellow, United Nations University; SUZY STYLES, PhD., Psychology; Professor of Psycholinguistics, Nanyang Technological University; E. JÜRGEN ZÖLLNER, Dr. Dr. h.c. mult., Medicine; Chairman of the Board of Trustees of the Stiftung Charité, Senator (ret.), Berlin

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

Here's my earlier description of the award:

Saturday, December 12, 2020

The Einstein Foundation Award for Promoting Quality in Research (apply or nominate now...)

Mail order catalogs, downtown department stores, suburban malls, and modern home delivery

 Here's a 10 minute video in which I discuss how retail markets have changed over the last century and more, with the invention of mail order catalogs, and the growth of downtown department stores (in part as a result of urban public transportation), and then suburban shopping malls, before our current age of digital commerce and home delivery.

This was my discussion of talks by Rob Townsend and David Autor at the October zoom conference

Technology and Equality in the Digital Era--Luohan Academy

An IVF mixup of babies

 Here are the stories, from the Guardian, and the NY Times:

Guardian:

California women gave birth to each other’s babies after IVF mix-up. Couples to sue clinic after raising girls for months that were not theirs, says lawsuit, before babies were swapped back

"Two California couples gave birth to each other’s babies after a mix-up at a fertility clinic and spent months raising children that were not theirs before swapping the infants, according to a lawsuit filed in Los Angeles.

"Daphna Cardinale said she and her husband, Alexander, had immediate suspicions that the girl she gave birth to in late 2019 was not theirs due to the child’s darker complexion.

"They suppressed their doubts because they fell in love with the baby and trusted the in vitro fertilisation process and their doctors, she said. Learning months later that she had been pregnant with another couple’s baby, and that another woman had been carrying her child, caused enduring trauma, she said.

...

"The two other parents involved in the alleged mix-up wish to remain anonymous and plan a similar lawsuit in the coming days, according to the attorney Adam Wolf, who represents all four parents.

"The lawsuit claims CCRH mistakenly implanted the other couple’s embryo into Daphna and transferred the Cardinales’ embryo – made from Daphna’s egg and Alexander’s sperm – into the other woman.

"The babies, both girls, were born a week apart in September 2019. Both couples unwittingly raised the wrong child for nearly three months before DNA tests confirmed that the embryos were swapped, according to the filing.

“The Cardinales, including their young daughter, fell in love with this child, and were terrified she would be taken away from them,” the complaint says. “All the while, Alexander and Daphna did not know the whereabouts of their own embryo, and thus were terrified that another woman had been pregnant with their child – and their child was out in the world somewhere without them.”

"The babies were swapped back in January 2020.

"Mix-ups like this are exceedingly rare, but not unprecedented. In 2019, a couple from Glendale, California, sued a separate fertility clinic, claiming their embryo was mistakenly implanted in a New York woman, who gave birth to their son as well as a second boy belonging to another couple.

*******

NY Times:

‘We Had Their Baby, and They Had Our Baby’: Couple Sues Over Embryo ‘Mix-Up’  Daphna and Alexander Cardinale, the plaintiffs in a lawsuit against a Los Angeles-area fertility clinic, say they endured a painful custody exchange after DNA testing.  By Neil Vigdor

...

"Peiffer Wolf Carr Kane & Conway, the law firm representing the Cardinales, estimated that the couple had paid $50,000 to the fertility clinic for the treatments.

...

"Mr. Cardinale, 41, said during the news conference on Monday that the most upsetting aspect of the ordeal had been breaking the news to the couple’s older daughter, who begged her parents to keep the baby.

“How do you explain that to a 5-year-old?” Mr. Cardinale said."

A naturally occurring deceased-donor-initiated kidney exchange chain, by Maghen and Veale

 Here's an interesting case report, from the innovative UCLA transplant center, about a kidney exchange chain actually, if not officially, initiated by a deceased donor.

With “reverse engineering” were some living donor kidney chains in actuality triggered by deceased donors?  by Ariella Maghen and Jeffrey Veale, Clinical Transplantation, First published: 21 September 2021 https://doi.org/10.1111/ctr.14491

"Mr. M is a 58-year-old polycystic kidney disease patient waiting for a kidney transplant in the United States (US). Although his wife Mrs. M offered to donate her kidney to him, they were not a compatible match. While waiting to be “exchanged or swapped” with another donor/recipient pair facilitated by the National Kidney Registry (NKR), Mr. M received a rare offer for a “perfectly-matched” (zero-mismatch) deceased donor (DD) kidney. Only 5% of candidates receive a perfectly matched kidney from a DD; Mr. M accepted the offer and underwent transplantation in February 2020. Currently, his allograft is functioning beautifully, and he states never feeling better. 

"One may think Mrs. M feels relief now and that she is “off-the-hook” to donate. But au contraire as she has completed the extensive donor evaluation and remains in the mindset to donate. Mrs. M's gratitude towards the DD family's gift to her husband motivated her to “pay-their-generosity-forward” and now donate her kidney.

"Mrs. M's donation performed on October 21, 2020, brings greater awareness to the concept of a DD triggered kidney chain, a relatively novel phenomenon in the United States.

...

"This case elucidates how transplant chains, believed to be initiated by non-directed living donors, when reverse-engineered may in actuality have been triggered by DDs who were at the pole position. Although this may be one of the first reported cases, it is possible that other transplant centers have been encouraging the allocation of donors in this fashion. There are likely more living donors who may still want to donate their kidney even after their intended recipient received a DD transplant via “zero-mismatch” or “high-PRA” offers."

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

Italy seems to be among the first places to formally follow up on the idea of deceased donor chains. See:

Transplant InternationalVolume 33, Issue 10 p. 1177-1184, Kidney exchange strategies: new aspects and applications with a focus on deceased donor-initiated chains, by Lucrezia Furian,Antonio Nicolò,Caterina Di Bella,Massimo Cardillo,Emanuele Cozzi,Paolo Rigotti  First published: 09 August 2020  https://doi.org/10.1111/tri.13712

Summary: Kidney paired donation (KPD) is a valuable way to overcome immunological incompatibility in the context of living donation, and several strategies have been implemented to boost its development. In this article, we reviewed the current state of the art in this field, with a particular focus on advanced KPD strategies, including the most recent idea of initiating living donor (LD) transplantation chains with a deceased donor (DD) kidney, first applied successfully in 2018. Since then, Italy has been running a national programme in which a chain-initiating kidney is selected from a DD pool and allocated to a recipient with an incompatible LD, and the LD’s kidney is transplanted into a patient on the waiting list (WL). At this stage, since the ethical and logistic issues have been managed appropriately, KPD starting with a DD has proved to be a feasible strategy. It enables transplants in recipients of incompatible pairs without the need for desensitizing and also benefits patients on the WL who are allocated chain-ending kidneys from LDs (prioritizing sensitized patients and those on the WL for longer).

...

"Melcher et al. [10] suggested merging DD programmes with KPD programmes in 2016, an idea explored more recently in a concept paper issued by the Organ Procurement and Transplantation Network (OPTN) [11]. 

...

10 M. L. Melcher, J. P. Roberts, A. B. Leichtman, A. E. Roth, M. A. Rees Utilization of deceased donor kidneys to initiate living donor chains. Am J Transplant 2016; 16: 1367.

11Rock Haynes C, Leishman R. Allowing deceased donor-initiated kidney paired donation (KPD) chains. OPTN/UNOS Kidney Transplantation Committee. Concept Paper; July 31–October 2, 2017.

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

Earlier:

Tuesday, August 7, 2018

Deceased donor chains: Market design language is entering transplantation

Monday, April 11, 2016

Using deceased donor kidneys to start living donor kidney exchange chains

Online and Matching-Based Market Design (forthcoming in 2022), edited by Echenique, Immorlica, and Vazirani

 What to read in 2022? Here's a teaser...

Online and Matching-Based Market Design, forthcoming in 2022 from Cambridge University Press

Editors: Federico Echenique, Nicole Immorlica, Vijay V. Vazirani  

With a Foreword by Alvin E. Roth

The publisher's leaflet describes the book this way:

"The field of matching markets is, due to a unique confluence of circumstances, at the same time mature and yet in its infancy. Its birth goes back to the seminal 1962 paper of Gale and Shapley on stable matching. Over the decades, this field has become known for its highly successful applications, having economic as well as sociological impact. Its recent resurgence, with the revolutions of the Internet and mobile computing, has opened up altogether new avenues of research and novel, path-breaking applications. The distinctive feature of this book lies in treating this field in its true interdisciplinary spirit --- the field veritably sits at the intersection of economics, computer science, operations research and discrete mathematics, and this viewpoint has already led to a sequence of fundamental research results. Comprised of chapters written by over 50 top researchers, it still has the clarity, cohesiveness and organization of a textbook."

CONTRIBUTORS: Atila Abdulkadiroglu, Nikhil Agarwal, Samson Alva, Itai Ashlagi, Mariagiovanna Baccara, Gabriel Carroll, Hector Chade, Jiehua Chen, Yan Chen, Nikhil Devanur, Federico Echenique, Lars Ehlers, Matthew Elliott, Michal Feldman, Zhe Feng, Tamas Fleiner, Alfred Galichon, Renato Gomes, Aram Grigoryan, Guillaume Haeringer, Hanna Halaburda, John Hatfield, Zhiyi Huang, Nicole Immorlica, Ravi Jagadeesan, Philipp Kircher, Bettina Klaus, Robert Kleinberg, Scott Kominers, Soohyung Lee, Jacob Leshno, Shengwu Li, Irene Lo, Brendan Lucier, David Manlove, Aranyak Mehta, Paul Milgrom, Jamie Morgenstern, Thanh Nguyen, Alexandru Nichifor, Michael Ostrovsky, David Parkes, Alessandro Pavan, Marek Pycia, Aaron Roth, Bernard Salanie, Aleksandrs Slivkins, Paulo Somaini, Sai Srivatsa Ravindranath, Eduard Talamas, Alexander Teytelboym, Thorben Tröbst, Vijay Vazirani, Andrew Vogt, Rakesh Vohra, Alexander Westkamp, Leeat Yariv

Oocyte ethics: financial compensation for human eggs

 New ethical guidance on egg donation, following an antitrust settlement regarding price fixing.

Financial compensation of oocyte donors: an Ethics Committee opinion.  by The Ethics Committee of the American Society for Reproductive Medicine, American Society for Reproductive Medicine, Birmingham, Alabama, Fertility and Sterility® Vol. 116, No. 2, August 2021

"Financial compensation of women donating oocytes for reproductive or research purposes is justified on ethical grounds and should acknowledge the time, inconvenience, and discomfort associated with screening, ovarian stimulation, oocyte retrieval, and postretrieval recovery and not vary according to the planned use of the oocytes or the number or quality of oocytes retrieved. This document replaces the document of the same name published in 2016. (Fertil Steril
2021;116:319-25. 2021 by American Society for Reproductive Medicine.)

"ESSENTIAL POINTS:

Financial compensation of women donating oocytes for reproductive or research purposes is justified on ethical grounds.

Compensation is in accord with principles of fairness, occurring within the framework of a professional relationship.

Compensation should acknowledge the donor’s time, inconvenience, and discomfort associated with screening, ovarian stimulation, oocyte retrieval, and postretrieval recovery. Compensation should not vary according to the planned use of the oocytes (reproductive or research) or the number or quality of oocytes retrieved.

Compensation should be fair and should not be an undue enticement that negatively impacts a donor’s ability to make an informed decision about the donation process and the risks involved with donation.

All oocyte-donor recruitment programs, including agencies, egg banks, and fertility clinics, should individually adopt and implement effective processes for information disclosure and counseling in order to promote informed decision-making by prospective donors.

Treating physicians owe the same professional duties to oocyte donors as to all other patients.

Programs should ensure equitable and fair provision of services to oocyte donors.

Programs should individually adopt and disclose policies regarding coverage of an oocyte-donor’s medical costs should she experience complications associated with the oocyte retrieval process."

...

" Because the burdens of donation are similar regardless of the ultimate use of the oocytes, compensating donors of oocytes for research is also ethically justified. There has been some movement at the state level to permit compensation to research donors, which stands in contrast to the approach articulated by the National Academy of Sciences with respect to compensation for oocyte donation for stem-cell research (21). In 2009, New York became the first US state to implement a policy permitting researchers to use public funds to reimburse women who donate oocytes directly and solely for stem-cell research, not only for the woman’s outof-pocket expenses, but also for the time, burden, and discomfort associated with the donation process (22). A law enacted in California in 2019 likewise requires women who provide human oocytes for research to be compensated for their time, discomfort, and inconvenience in the same manner as other research subjects, removing a previous prohibition of compensation of research donors (11).

...

"It is ethically permissible for a program to refuse to accept a prospective oocyte donor if they become aware that a prospective oocyte recipient or recruiting agency has offered gifts or payments that the program, in the exercise of its own ethical judgment, believes compromise the donor’s free choice or are otherwise ethically inappropriate. Programs should not assume that known donors, such as family or friends, are not being financially compensated. In one study of recipients using both known and anonymous donors, 19 of 20 of the known donors had been compensated, and there were no differences in the amounts provided to known and anonymous donors (27).

...

"This report was developed under the direction of the Ethics Committee of the American Society for Reproductive Medicine (ASRM) as a service to its members and other practicing clinicians. Although it reflects appropriate management of a problem encountered in the practice of reproductive medicine, it is not intended to be the only approved standard of practice or to dictate an exclusive course of treatment. Other plans of management may be appropriate, taking into account the needs of the individual patient, available resources, and institutional or clinical practice limitations. 

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

That last paragraph may be a bow to the antitrust settlement discussed in the post below:

Friday, May 3, 2019

Donating eggs for fertility: an update

Can it be made safe for drug users to call for help when a friend overdoses?

There are lots of ways that drug laws contribute to the design of the black market for drugs, and the behavior of its participants. Here's a recent post from the blog Bill of Health:

New Data Highlights Complexity of Good Samaritan Overdose Law Landscape, By David Momjian

 "To combat the rising death toll from drug overdoses, 47 state legislatures and the District of Columbia have passed Good Samaritan laws (GSLs) to protect bystanders from criminal prosecution if they call for medical assistance during a drug overdose. Bystanders to a drug overdose are often worried that by calling for help, they could be arrested for drug possession or evicted by the police, who often arrive first at the scene of a 911 call, even if it is a medical emergency.

A new dataset built by the Center for Public Health Law Research at Temple University’s Beasley School of Law and funded by Vital Strategies, covers the evolution of GSLs in the United States from January 1, 2007, to June 1, 2021."

Drug overdose deaths between April 2020 and 2021 reach 100,000

 The Washington Post has the story:

100,000 Americans died of drug overdoses in 12 months during the pandemic  By Dan Keating and Lenny Bernstein

"The U.S. drug epidemic reached another terrible milestone Wednesday when the government announced that more than 100,000 people had died of overdoses between April 2020 and April 2021. It is the first time that drug-related deaths have reached six figures in any 12-month period.

...

"The new data shows there are now more overdose deaths from the illegal synthetic opioid fentanyl than there were overdose deaths from all drugs in 2016."

We should be thinking about harm reduction...

John Morgan (1967-2021)

 Here's his obituary from Berkeley Haas, that I learned of only recently:

‘A giant of a person’: Economist John Morgan dies at 53 OCTOBER 29, 2021| BY LAURA COUNTS

"Professor John Morgan, an economist who found elegant new ways to analyze the world through the lens of game theory, and whose popular classes and sage mentorship made a deep impression on his students, passed away Oct. 6 at age 53. He died peacefully at his Walnut Creek home.

"During his nearly two decades at Berkeley Haas, Morgan left his mark through his prolific and wide-ranging research, his unconventional teaching that drew on strategy games he invented, and his generous leadership. He had been struggling with a painful autoimmune disease that put him on medical leave, but he continued with his research and had planned to resume teaching in the spring."

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

A paper of his that springs to mind is this one:

... plus shipping and handling: Revenue (non) equivalence in field experiments on ebay, by Tanjim Hossain and John Morgan, 2006, The B.E. Journal of Economic Analysis & Policy, https://doi.org/10.2202/1538-0637.1429

Abstract: Many firms divide the price a consumer pays for a good into two pieces---the price for the item itself and the price for shipping and handling. With fully rational customers, the exact division between the two prices is irrelevant---only the total price matters. We test this hypothesis by selling matched pairs of CDs and Xbox games in a series of field experiments on eBay. In theory, the ending auction price should vary inversely with the shipping charge to leave the total price paid constant. Contrary to the theory, we find that charging a high shipping cost and starting the auction at a low opening price leads to higher numbers of bidders and higher revenues when the shipping charge is not excessive. We show that these results can be accounted for by boundedly rational bidding behavior such as loss-aversion with separate mental accounts for different attributes of the price or disregard for shipping costs.

Here's his Google Scholar page: John Morgan

Freakonomics MD on deceased donor organs for transplants

 Freakonomics MD has a podcast focusing on the scarcity of deceased donor kidneys for transplant, and why recovered organs are sometimes discarded. They interview (separately) Dr. Sumit Mohan at Columbia, and me. (I was in fact interviewed by Jessica Wapner, not by the narrator, Dr. Bapu Jena, using a fancy microphone which they FedExed to me beforehand and I FedExed back to them afterwards...so my snippets probably sound like me...)

You can listen to it right below, or at the link...

x  x

Why Do So Many Donated Kidneys End Up in the Trash? (Freakonomics, M.D. Ep. 11)

November 11, 2021 @ 11:00pm

by Dr. Bapu Jena
Produced by Jessica Wapner

  

LISTEN NOW:

Every year, thousands of people in the U.S. die while they’re waiting for a new kidney, yet thousands of available organs get thrown away. Bapu talks to a kidney doctor and an economics Nobel laureate about why this happens and how the system could improve.

Follow Freakonomics, M.D. on Apple Podcasts, Spotify, Stitcher, or wherever you get your podcasts.

Market design course for health policy and medical students, at Stanford, taught by Alex Chan and Kurt Sweat

 Starting tomorrow, a short course in market design:

BIOS 203, Fall 2021: Market Design and Field Experiments for Health Policy and Medicine 

Primary Instructor: Alex Chan chanalex@stanford.edu | Office Hours: By appointment

Secondary Instructor: Kurt Sweat kurtsw@stanford.edu | Office Hours: By appointment

Description. Market design is an emerging field in economics, engineering and computer science about how to organize systems to allocate scarce resources. In this course, we study (1) the theory and practice of market design in healthcare and medicine, and (2) methods to evaluate the impact of such designs. Students will be provided with the necessary tools to diagnose the problems in markets and allocation mechanisms that render them inefficient, and subsequently develop a working toolbox to remedy failed markets and finetune new market and policy designs.

With a practical orientation in mind, we will learn how to construct rules for allocating resources or to structure successful marketplaces through successive examples in healthcare and medicine: medical residency matching, kidney exchange, allocation of scarce medical resources like COVID vaccine and tests, medical equipment procurement, online marketplace for doctors, and, if time permits, reward system for biopharmaceutical innovation. Guest lectures by practicing market designers and C-suite healthcare executives (CEO, CFO) would feature in the course as well.

An important goal of the class is to introduce you to the critical ingredients to a successful design: a solid understanding of institutions, grasps of economic theory, and well-designed experiments and implementation. In the final sessions, students will also learn how to design and deploy one of the most powerful tools in practical market design: A/B testing or randomized field experiments. These techniques are widely used by tech companies like UBER, Amazon, eBay, and others to improve their marketplaces.

At the end of the course, students should have acquired the necessary knowledge to become an avid consumer and user, and potentially a producer, of the market design and field experimental literature (recognized by 4 recent Nobel Prizes in Economics: 2007/2012/2019/2020).

Time & Location.

● Tue, Thu 6:30 PM - 8:00 PM (beginning November 16, 2021) at Encina Commons Room 119

Course Webpage. ● https://canvas.stanford.edu/courses/145148

Schedule and Readings

(* required readings, others are optional)

Session 1. Market design and Marketplaces – November 16

1. * Roth, A. E. (2007). The art of designing markets. harvard business review, 85(10), 118.

2. Kominers, S. D., Teytelboym, A., & Crawford, V. P. (2017). An invitation to market design. Oxford Review of Economic Policy, 33(4), 541-571.

3. Roth, A. E. (2002). The economist as engineer: Game theory, experimentation, and computation as tools for design economics. Econometrica, 70(4), 1341-1378

Session 2. Matching Markets: Medical Residents and the NRMP – November 18

1. * Chapter 1 in Gura, E. Y., & Maschler, M. (2008). Insights into game theory: an alternative mathematical experience. Cambridge University Press.

2. * Fisher, C. E. (2009). Manipulation and the Match. JAMA, 302(12), 1266-1267.

3. * National Resident Matching Program. (2021). Feasibility of an Early Match NRMP Position Statement

4. Roth, A. E., & Peranson, E. (1997). The effects of the change in the NRMP matching algorithm. JAMA, 278(9), 729-732.

5. Gale, D., & Shapley, L. S. (1962). College admissions and the stability of marriage. The American Mathematical Monthly, 69(1), 9-15.

Session 3. Kidney Exchange and Organ Allocation – November 30

1. * Wallis, C. B., Samy, K. P., Roth, A. E., & Rees, M. A. (2011). Kidney paired donation. Nephrology Dialysis Transplantation, 26(7), 2091-2099.

2. * Chapter 3 in Roth, A. E. (2015). Who gets what—and why: The new economics of matchmaking and market design. Houghton Mifflin Harcourt.

3. Gentry, S. E., Montgomery, R. A., & Segev, D. L. (2011). Kidney paired donation: fundamentals, limitations, and expansions. American journal of kidney diseases, 57(1), 144-151.

4. Salman, S., Gurev, S., Arsalan, M., Dar, F., & Chan, A. Liver  Exchange: A Pathway to Increase Access to Transplantation.

5. Sweat, K. R. Redesigning waitlists with manipulable priority: improving the heart transplant waitlist.

6. Agarwal, N., Ashlagi, I., Somaini, P., & Waldinger, D. (2018). Dynamic incentives in waitlist mechanisms. AEA Papers & Proceedings, 108, 341-347.

Session 4. 1 st Half: Repugnance as a Constraint on Markets – December 2

1. * Roth, A. E. (2007). Repugnance as a Constraint on Markets. Journal of Economic perspectives, 21(3), 37-58.

2. * Minerva, F., Savulescu, J., & Singer, P. (2019). The ethics of the Global Kidney Exchange programme. The Lancet, 394(10210), 1775-1778.

3. Chapter 11 in Roth, A. E. (2015). Who gets what—and why: The new economics of matchmaking and market design. Houghton Mifflin Harcourt.

2 nd Half: Market Design and Allocation during COVID-19 – December 2

1. * Emanuel, E. J., Persad, G., Upshur, R., Thome, B., Parker, M., Glickman, A., ... & Phillips, J. P. (2020). New England Journal of Medicine. Fair allocation of scarce medical resources in the time of Covid-19.

2. Piscitello, G. M., Kapania, E. M., Miller, W. D., Rojas, J. C., Siegler, M., & Parker, W. F. (2020). Variation in ventilator allocation guidelines by US state during the coronavirus disease 2019 pandemic: a systematic review. JAMA network open, 3(6), e201

3. Schmidt, H., Pathak, P., Sönmez, T., & Ünver, M. U. (2020). Covid-19: how to prioritize worse-off populations in allocating safe and effective vaccines. British Medical Journal, 371.

4. Schmidt, H., Pathak, P. A., Williams, M. A., Sonmez, T., Ünver, M. U., & Gostin, L. O. (2020). Rationing safe and effective COVID-19 vaccines: allocating to states proportionate to population may undermine commitments to mitigating health disparities. Ava

5. Neimark, J. (2020). What is the best strategy to deploy a COVID-19 vaccine. Smithsonian Magazine.

Session 5. 1 st Half: Auction Design and Procurement in Medicine – December 7

1. * The Committee for the Prize in Economic Sciences in Memory of Alfred Nobel. (2020). Improvements to auction theory and inventions of new auction formats. Scientific Background on the Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel 20

2. * Song, Z., Cutler, D. M., & Chernew, M. E. (2012). Potential consequences of reforming Medicare into a competitive bidding system. Jama, 308(5), 459-460.

3. Newman, D., Barrette, E., & McGraves-Lloyd, K. (2017). Medicare competitive bidding program realized price savings for durable medical equipment purchases. Health Affairs, 36(8), 1367-1375.

4. Cramton, P., Ellermeyer, S., & Katzman, B. (2015). Designed to fail: The Medicare auction for durable medical equipment. Economic Inquiry, 53(1), 469-485.

5. Ji, Y. (2019). The Impact of Competitive Bidding in Health Care: The Case of Medicare Durable Medical Equipment.

6. Thaler, R. H. (1988). Anomalies: The winner's curse. Journal of economic perspectives, 2(1), 191-202.

7. Chapter 2 in Haeringer, G. (2018). Market design: auctions and matching. MIT Press.

2 nd Half: (GUEST LECTURE) Ralph Weber, CEO, MediBid Inc. on “The Online Marketplace for Medicine” – December 7

Session 6. A/B Testing and Field Experiments to Test Designs – December 9

1. * Chapters 1, 4 in List, John. (2021). A Course in Experimental Economics (unpublished textbook, access on course website)

2. * Gallo, A. (2017). A refresher on A/B testing. Harvard Business Review, 2-6.

3. Chan, A. (2021). Customer Discrimination and Quality Signals – A Field Experiment with Healthcare Shoppers.

4. Kessler, J. B., Low, C., & Sullivan, C. D. (2019). Incentivized resume rating: Eliciting employer preferences without deception. American Economic Review, 109(11), 3713-44.

5. Chapters 3, 5, 6, 7, 8 in List, John. (2021). A Course in Experimental Economics (unpublished textbook, access on course website)

6. The Committee for the Prize in Economic Sciences in Memory of Alfred Nobel. (2019). Understanding development and poverty alleviation. Scientific Background on the Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel 2019.

Bonus Session (optional). (GUEST LECTURE) Donald Lung, CFO, Antengene on “Designing Markets to Access Biopharmaceutical Intellectual Property Across Regulatory Regimes – the Case of China” – Date TBD

Bonus Session (optional). (GUEST LECTURE) TBD – Date TBD

Nervousness and confusion about residency applications

 Medpage Today has the story, which has been active on medical twitter for a while--some residency candidates are finding that their applications are incomplete, and blame the common application service ERAS, which in response reports that incomplete applications are the result of errors by the candidates.

Is ERAS Glitch Impeding Residency Interviews?  — Several students are missing letters of recommendation, but AAMC calls reports "unsubstantiated"

"MedPage Today spoke to several residency applicants who believe they experienced ERAS tech issues when submitting their applications. A majority of these applicants requested anonymity due to fear of retribution.

While many say a potential bug is not surprising, students are frustrated that they cannot pin down when "their documents went missing -- and whether or not it jeopardized their chances of matching with some programs.

"In each case, the glitch is almost identical: an applicant's letters of recommendation (or other documents) were uploaded to ERAS, and the applicant was certain they assigned the right materials to each program before they hit submit. But weeks later, applicants checked the platform to see that these documents had never been assigned nor delivered to the right programs -- rendering their applications incomplete."

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

Related:

Med Students Filed Nearly 70 Residency Applications Each— "I don't think this is sustainable at all" by Amanda D'Ambrosio, MedPage Today October 27, 2021

"Across all medical specialties, this cycle MD applicants submitted an average of 68 applications, DO applicants submitted 92, and international medical graduates submitted 139, according to data provided to MedPage Today by the Association of American Medical Colleges (AAMC).

"Medical graduates applying to orthopedic surgery in the 2022 cycle submitted an average of 88 applications -- the highest across all medical specialities. Candidates to urology, otolaryngology, and dermatology -- some of the most competitive specialties -- all applied to around 80 programs each.

"More than 46,000 medical graduates have applied for the 2022 residency match so far: approximately 23,000 MDs, 8,000 DOs, and 15,000 international graduates. The preliminary data from ERAS -- the centralized system that medical graduates use to apply to residency -- includes all applications submitted through the beginning of October."

Non-fungible tokens (NFTs), in Harvard Business Review, by Kaczynski and Kominers

 Can a new form of property rights created by blockchains also create valuable new kinds of markets? Or even communities?  

How NFTs Create Value, by Steve Kaczynski and Scott Duke Kominers, Harvard Business Review November 10, 2021

Summary.   How much could a cluster of pixels possibly be worth? More pointedly, why is it worth anything at all? The explosion of NFTs and their accompanying marketplaces have left many baffled, incredulous, and deeply skeptical. But while NFTs may be fetching eye-popping, eyebrow-raising valuations, there is a logic to how — and when — they create value. By creating a system of verifiable digital ownership NFTs fundamentally changed the market for digital assets, creating the possibility for new types of transactions. Amidst a flood of new ventures, however, it can be hard to tell which are creating value and which are just riding the hype. The companies that have been most successful on this new frontier have a few things in common: They make meaningful use of the NFT technology itself, leverage a community of users, generate confidence that they can continue executing on the project to maintain ongoing community engagement, offer accessible “on-ramps” for new users, and are able to weather crypto market swings.

...

"Many emerging NFT applications, meanwhile, are seeking to more explicitly blend online NFT ownership with offline use cases. A few restaurants, for example, have started using NFTs for reservations. And the ticketing industry has a major opportunity here: By issuing tickets as NFTs, venues can give a variety of benefits to purchasers, creating more of an incentive to buy, as well as providing the venues an opportunity to collect royalties on secondary sales.

"Other companies are exploring how NFTs could be used in establishing and recording people’s identity and reputation online. MIT recently started offering blockchain-based digital diplomas, which are effectively non-transferable NFTs. Meanwhile, both established players like Facebook (now Meta) and new ventures like POAP and koodos are providing ways for individuals to create and share NFTs around activities, affinities, and interests."