HRSA's Organ Procurement and Transplantation Network Modernization Initiative

 The Health Resources and Services Administration (HRSA) has announced a timeline for moving forward on the proposal to reorganize the system for obtaining and distribution deceased donor organs for transplant, aiming for a request for proposals in the Fall.

Organ Procurement and Transplantation Network Modernization Initiative   May 2023 Updates

"On March 22, 2023, the Health Resources and Services Administration (HRSA) announced a Modernization Initiative to strengthen accountability and transparency in the Organ Procurement and Transplantation Network (OPTN). The initiative is focused on five key areas: technology, data transparency, governance, operations, and quality improvement and innovation. As part of our commitment to transparency around the Modernization Initiative, HRSA is providing an update on our upcoming action steps.

The OPTN Modernization Initiative is centered on putting patients first, prioritizing information flow to clinicians, promoting innovation through continuous competition, and enhancing transparency and accountability. HRSA's planned approach and timelines for the first year of the multi-year modernization process focuses on design, implementation, and oversight, including contract solicitations that will be released Fall 2023 and Spring 2024. In addition, HRSA continues to pursue the legislative changes and increased funding included in the President's Fiscal Year 2024 budget to implement and advance the Modernization Initiative.

Summer 2023

Phase 1: OPTN Modernization Design & Strategy Development  

External Engagement and Design Planning Contract  – HRSA is currently conducting market research to inform the development of the upcoming Fall contract solicitations and will host an Industry Day for interested parties and vendors this Summer. Building on our outreach efforts over the past year, HRSA also will continue to ensure that patient, family, and clinician voices are engaged in this work, including through focus groups and other approaches. HRSA recently awarded a program management contract to support this stakeholder engagement as well as strategic and operational planning and change management.

Fall 2023

Phase 2A: OPTN Transition Management

HRSA recognizes the vital need to maintain uninterrupted access to the critical systems and functionality that support organ matching and transplantation during the modernization process. Working with the best technologists in the U.S. Government, HRSA expects to conduct this work on a dual track so that there are appropriate safeguards to ensure no disruptions in service as part of modernization implementation. Therefore, HRSA will support two significant multi-vendor solicitations between now and Spring 2024 – with the first solicitation to be issued this Fall 2023. This action will be followed by a Spring 2024 solicitation to further the next generation OPTN, as noted below. 

Competitive OPTN Transition Contracts – This Fall, HRSA plans to release a solicitation to establish new contracts that will support and enhance OPTN operations while the modernization process is underway. These contracts will ensure the continuation of critical OPTN support functions and enable appropriate upgrades on a parallel track with modernization. The Fall 2023 solicitation will seek multiple vendors for distinct functions – including supporting a separate OPTN Board of Directors – to ensure service continuity and increase oversight and accountability.

To ensure that the OPTN Transition contracts are developed in a way that meets the needs of all stakeholders, HRSA is committed to soliciting feedback from interested parties during the development and implementation of this work. By involving stakeholders in the process, HRSA can ensure that the Transition contracts advance the goals of the OPTN Modernization Initiative, provide optimal support to protect patient safety, and ensure the efficient functioning of the OPTN.

Spring 2024

Phase 2B: OPTN Modernization Implementation

In Spring 2024, HRSA intends to release a solicitation for multiple vendors to support the next generation of the OPTN, which will include enhancements in technology, governance, data transparency and operations. The separate Board of Directors contract and the deliverables from this next generation solicitation will form the foundation of a new, modernized OPTN. 

OPTN Next Generation Contracts – The proposed OPTN Next Generation contracts will represent a significant step forward in modernizing the OPTN’s foundational IT systems. In Spring 2024, HRSA expects to release a solicitation seeking multiple vendors for the OPTN Next Generation contracts to provide a comprehensive approach to modernizing the OPTN. The goal of this solicitation is to find contractors who will use innovative, best in class approaches to carrying out specific functions, including initial prototyping, testing, scaling, integration, deployment, and adoption support.  

HRSA is committed to transparency in the OPTN Modernization process and will continue to provide updates on our iterative approach toward achieving enhanced accountability, equity, and performance in the organ transplantation system, as appropriate, as this work moves forward."

***********

Here's a NYT story covering the announcement, with some background:

U.S. Organ Transplant System, Troubled by Long Wait Times, Faces an Overhaul The Biden administration announced a plan to modernize how patients are matched to organs, seeking to shorten wait times, address racial inequities and reduce deaths.  By Sheryl Gay Stolberg

Egg freezing in China and Hong Kong

 The FT has the story:

China’s fertility treatment rules push single women to Hong Kong

Beijing faces calls to ease access to egg freezing and IVF amid demographic crisis

By Eleanor Olcott and Chan Ho-him 

“Beijing has long banned access to egg freezing or IVF for single women. While unmarried men can freeze their sperm, single women such as Sophia, who declined to give her surname, are not allowed to freeze their eggs.

…

“As a result, more and more Chinese women travel abroad for the procedure, with Hong Kong a top destination given its proximity and strong healthcare system.

…

“While it is possible for single or gay women to freeze their eggs in Hong Kong, only married heterosexual couples can access IVF treatment. In practice, that means eggs are stored until women get married and begin the IVF process.”

Quarantine in Dubrovnik

 I’m traveling home today after a good work/vacation trip to Croatia, ending in Dubrovnik. Dubrovnik has a long history of quarantining foreign visitors to prevent the spread of disease 

Over 100 Nobel Laureates join PEN International in support of Nobel Peace Prize winner Ales Bialiatski

“PEN International, the literary and free expression organisation, has released a letter signed by 103 Nobel Laureates, expressing solidarity with writer, human rights defender, Nobel Peace Prize winner, and PEN member Ales Bialiatski, and condemning the Belarusian authorities’ brutal, relentless, and systematic crackdown on independent voices. Today marks the International Day of Solidarity with Prisoners of Conscience in Belarus. The solidarity action was featured in the Guardian.”

Drug Overdose Deaths Topped 100,000 Again in 2022

 

The WSJ has the story: the headline speaks for itself  

Drug Overdose Deaths Topped 100,000 Again in 2022 https://www.wsj.com/articles/drug-overdose-deaths-topped-100-000-again-in-2022-37cd1709

Defining death for deceased organ donation

 Here’s a story from Science, about donation of a heart from a donor declared dead after circulatory death, ie after heart stoppage:

GIVING HEART: A new procedure for donating hearts and other organs is saving lives. But for some it challenges the definition of death   By 

Jennifer Couzin-Frankel

"As is customary regardless of whether organs will be donated, physicians waited 5 minutes to ensure that the heart didn’t start beating again on its own. It did not, and the man was declared dead. The baton then passed to the organ recovery and transplant team. They clamped blood vessels running from the torso to the brain and reconnected his body to machines that circulated oxygenated blood, causing the heart to begin pumping again. "These two interventions—initiating a heartbeat after death is declared and taking steps to prevent blood flow to the brain—are at the core of a raging debate about the ethics of such donations. To some people, the approach risks disrupting the dying process; to others, it allows that process to continue as the family desires, while also honoring individual or family wishes for organ donation.

“The debate touches on the definition of death, Moazami says. “When the heart stops, we say, ‘time of death, 5:20 a.m.’” But, “The fact of the matter is, death is a process. Death is not a time point.” Cells can take hours to die. Sophisticated machinery can induce a heartbeat hours after death, but does that make a person “alive”?

More governments seek to limit TikTok over data concerns

The NYT has the story:

Why Countries Are Trying to Ban TikTok

Governments have expressed concerns that TikTok, which is owned by the Chinese company ByteDance, may endanger sensitive user data.  By Sapna Maheshwari and Amanda Holpuch

“In recent months, lawmakers in the United States, Europe and Canada have escalated efforts to restrict access to TikTok, the massively popular short-form video app that is owned by the Chinese company ByteDance, citing security threats.

The White House told federal agencies on Feb. 27 that they had 30 days to delete the app from government devices. A growing number of other countries and government bodies — including Britain and its Parliament, Canada, the executive arm of the European Union, France and New Zealand’s Parliament — have also recently banned the app from official devices. On April 4, Australia became the latest country to announce that it was prohibiting the TikTok app on government devices on advice from intelligence and security agencies.

On March 1, a House committee backed an even more extreme step, voting to advance legislation that would allow President Biden to ban TikTok from all devices nationwide. 

…

“Lawmakers and regulators in the West have increasingly expressed concern that TikTok and its parent company, ByteDance, may put sensitive user data, like location information, into the hands of the Chinese government. They have pointed to laws that allow the Chinese government to secretly demand data from Chinese companies and citizens for intelligence-gathering operations. They are also worried that China could use TikTok’s content recommendations for misinformation.

…

“India banned the platform in mid-2020, costing ByteDance one of its biggest markets, as the government cracked down on 59 Chinese-owned apps, claiming that they were secretly transmitting users’ data to servers outside India.”

Is an End to Child Marriage within Reach? Not yet... Unicef report, and Lancet summary

 Unicef has issued the following report focused on the continued prevalence of child marriage, particularly in the poorest communities:

Is an End to Child Marriage within Reach? Latest trends and future prospects. May 2023

"The practice of child marriage has continued to decline globally. Today, one in five young women aged 20 to 24 years were married as children versus nearly one in four 10 years ago. Yet progress has been uneven around the world, and in many places the gains have not been equitable, leaving the most vulnerable girls behind.

"This year marks the halfway point to the deadline for achieving the Sustainable Development Goals, and when it comes to ending child marriage, a number of challenges loom large. Despite global advances, reductions are not fast enough to meet the target of eliminating the practice by 2030. In fact, at the current rate, it will take another 300 years until child marriage is eliminated."

***********

And here's an article in the Lancet:

Child marriage could be history by 2030, or last 300 more years, by Claudia Cappa, Colleen Murray and Nankali Maksud 

"UNICEF's analysis reveals only slight declines in child marriage in west and central Africa, which is the region with the highest prevalence of child marriage.1 There has been no change in Latin American and the Caribbean, which, if the current trajectory continues, would have the second highest prevalence of child marriage worldwide by 2030.1 After steady progress between 1997 and 2012, the Middle East, north Africa, eastern Europe, and central Asia regions have all seen stagnation in reducing child marriage in the past decade.

...

"Countries in sub-Saharan Africa with the highest projected population growth have the highest levels of child marriage, meaning the number of marriages is expected to increase there.

...

"declining child marriage prevalence is concentrated among girls from wealthier households. Girls from the richest quintile are less likely to become child brides and are the first to benefit from progress in averting child marriage, resulting in a widening gap in child marriage prevalence between rich and poor.1 In south Asia, wealthier households had three times more averted cases of child marriages than poor households in the past 25 years.1 If the rate of success in the richest quintile of south Asian families had been achieved globally, only 9% of girls would be married in childhood, far less than the current 19% worldwide prevalence of child marriage.1 Further progress in reducing child marriage largely depends on reaching girls who are otherwise left behind, including girls from the poorest households living without the resources and opportunities of their wealthier peers."

The Comstock Act returns from the dead, post Roe

 While there's no agreement about whether life begins at conception, it appears that the Comstock Act has risen from the dead to play a role in contemporary legal duels about abortion.

CNN brings it all back:

The 150-year-old chastity law that may be the next big fight over abortion By Tierney Sneed

"A law passed 150 years ago that banned the mailing of contraceptives, lewd materials and drugs that induce abortions could provide a pathway for effectively banning abortion nationwide – even in states where the procedure is legal.

"When the Supreme Court last summer reversed Roe v. Wade and eliminated constitutional protections that guaranteed abortion rights nationwide, the conservative majority fashioned its ruling as returning the matter of abortion policy-making to elected officials, particularly in state legislatures.

"But the battle lines now being drawn around the Reconstruction-era federal law – the Comstock Act – are an example of how the picture after Roe v. Wade is far more complicated as abortion opponents are challenging the means of abortion, such as the drug mifepristone, in court.

"The most sweeping Comstock Act arguments from anti-abortion activists could at the very least end the availability of medication abortion, which make up the majority of abortions in the US today, and could have the effect of eliminating surgical abortions as well by restricting the shipment of medical instruments and supplies used in the procedure.

...

"The Comstock Act, first passed in 1873, is named after Anthony Comstock, who was a special agent of the US Postal Service and an anti-vice crusader.

...

"Prosecutions under the law were bought in the first few decades after its passage, but by the 1930s, courts began whittling down some of its provisions and enforcement of the law ceased. Congress meanwhile amended it in the 1970s to remove its ban on mailing birth control.

...

"The Biden administration, in an internal advisory opinion released by the Justice Department’s Office of Legal Counsel, argues that the law does not apply to the mailing of abortion pills if they’re not being sent with the intent of unlawful use. The opinion pointed to how 20th century courts had interpreted it narrowly as excluding drugs mailed with legitimate intent."

*********

Earlier:

Monday, April 10, 2023

Comstockery and abortifacients, on the way to the Supreme Court

Pushback against high prices in academic publishing: open access fees and e-textbooks to libraries

 The Guardian has the story:

‘Too greedy’: mass walkout at global science journal over ‘unethical’ fees. Entire board resigns over actions of academic publisher whose profit margins outstrip even Google and Amazon  by Anna Fazackerley

"The entire academic board of the journal Neuroimage, including professors from Oxford University, King’s College London and Cardiff University resigned after Elsevier refused to reduce publication charges.

Academics around the world have applauded what many hope is the start of a rebellion against the huge profit margins in academic publishing, which outstrip those made by Apple, Google and Amazon.

Neuroimage, the leading publication globally for brain-imaging research, is one of many journals that are now “open access” rather than sitting behind a subscription paywall. But its charges to authors reflect its prestige, and academics now pay over £2,700 for a research paper to be published. The former editors say this is “unethical” and bears no relation to the costs involved.

...

"Elsevier, a Dutch company that claims to publish 18% of the world’s scientific papers, reported a 10% increase in its revenue to £2.9bn last year. But it’s the profit margins, nearing 40%, according to its 2019 accounts, which anger academics most. The big scientific publishers keep costs low because academics write up their research – typically funded by charities and the public purse – for free. They “peer review” each other’s work to verify it is worth publishing for free, and academic editors collate it for free or for a small stipend. Academics are then often charged thousands of pounds to have their work published in open-access journals, or universities will pay very high subscription charges.

...

"Meanwhile, university libraries are angry about the cost of the online textbooks they say students now overwhelmingly want to read – often many times more expensive than their paper equivalent. Professor Chris Pressler, director of Manchester University Library, said: “We are facing a sustained onslaught of exploitative price models in both teaching and research.”

"According to a spreadsheet of costs quoted to university librarians, Manchester University gave a recent example of being quoted £75 for a popular plant biology textbook in print, but £975 for a three-user ebook licence. Meanwhile Learning to Read Mathematics in the Secondary School, a textbook for trainee teachers published by Routledge, was £35.99 in print and £560 for a single user ebook.

"A spokesperson for Taylor and Francis, which owns Routledge, said: “We strive to ensure that book prices are both affordable and a fair representation of their value.” He said a print book could be checked out for weeks at a time whereas ebooks could be checked in and out rapidly and had a much wider distribution."

Human trafficking conviction in England, in kidney case-""the consent of the person trafficked is no defense."

 The BBC has the story, which is apparently the first such conviction for kidney trafficking under Britain's anti-slavery law. Reading the previous stories, it sounds like the young man in question was being deceived.  But even informed consent apparently wouldn't be a defense under British law...

Kidney-plot politician Ike Ekweremadu jailed By Tom Symonds

"A wealthy Nigerian politician, his wife and their "middleman" have been jailed for an organ-trafficking plot, after bringing a man to the UK from Lagos.

"Senator Ike Ekweremadu, 60, and his wife Beatrice, 56, wanted a new kidney for their 25-year-old daughter Sonia, the Old Bailey heard.

"The pair and Dr Obinna Obeta, 50, were previously convicted of conspiring to exploit the man.

"It is said to be the first such case under modern slavery laws.

...

"Lynette Woodrow, deputy chief crown prosecutor and national modern slavery lead at the Crown Prosecution Service (CPS), said it had been "our first conviction for trafficking for the purposes of organ removal in England and Wales".

"She said it highlighted an important legal principle which made it irrelevant whether the trafficking victim knew he was coming to the UK to provide a kidney.

"With all trafficking offences," Ms Woodrow said, "the consent of the person trafficked is no defence. The law is clear; you cannot consent to your own exploitation."

HT: Dr. Jlateh Vincent Jappah

“DESIGN FOR THE NEXT GENERATION” May 17-19, Bol, Island Brač, Croatia

 This should be an eclectic conference:

Challenges of Europe  “DESIGN FOR THE NEXT GENERATION”

14th International Conference

Faculty of Economics, Business and Tourism,
University of Split
Cvite Fiskovića 5
HR-21000 Split, Croatia

17th - 19th May, 2023 / Bol, Island Brač, Croatia

Bluesun Hotel Elaphusa

“The content of this conference has not been approved by the United Nations and does not reflect the views of the United Nations or its officials or Member States”

Keynote Speakers

Prof. Eric Maskin, Adams University Professor at Harvard University, Nobel Laureate in Economics 2007, Lecture title: “A Resolution of Arrow’s Impossibility Theorem”

Prof. Alvin Roth, Craig and Susan McCaw Professor of Economics at Stanford University, Nobel Laureate in Economics 2012, Lecture title: “Controversial markets”

Prof. EDWARD ALTMAN, Max L. Heine Professor of  Finance, Emeritus, New York University, USA, Lecture title: “Global Zombies: a new type of corporate resiliency”

Prof. DAVID REIBSTEIN William S. Woodside Professor of Marketing, University of Pennsylvania, USA  Lecture title: “Nation Branding - How the Image of a Country Affects Its Economy

Prof. ÖZGE ÖNER  Associate Professor in Spatial Economics and Real Estate, University of Cambridge, UK Lecture title: “It’s the geography, stupid!”

"Over the last two decades, this biennial conference has become an important place of encounter between scholars and practitioners from different countries, cultures and backgrounds discussing contemporary economic issues regarding Europe as an important global player as well as the issues within the European economic system itself, facing various changes in a dynamic environment."

Eliminating Hepatitis C, now that there's a cure (even though it's expensive)

 There's growing discussion about eliminating Hep C in the U.S., doing appropriate deals with the two drug companies whose patents still run for another six years.

Fleurence RL, Collins FS. A National Hepatitis C Elimination Program in the United States: A Historic Opportunity. JAMA. 2023;329(15):1251–1252. doi:10.1001/jama.2023.3692

"One of the most dramatic scientific achievements of the last few decades has been the development of direct-acting antivirals (DAAs) that can cure hepatitis C in more than 95% of people infected. But 9 years after the first such treatment was approved in the United States, the simple 8- to 12-week oral cure is not reaching a significant fraction of the more than 2.4 million US residents chronically infected with hepatitis C.1 More than 15 000 US residents die of hepatitis C every year unnecessarily. In its fiscal year 2024 budget proposal, the Biden-Harris administration has put forward a bold 5-year program to put the nation on course to eliminate hepatitis C in the United States.

"The consequences of untreated hepatitis C can be severe: cirrhosis, liver failure, hepatocellular cancer, and death. Curative treatment stops transmission, prevents liver cancer and liver failure, and saves lives. It is even likely to be cost-saving, by avoiding expensive medical treatments for liver failure and liver cancer. So why is this not a public health success story? One major reason is that many people with hepatitis C have poor access to health care and experience other chronic health and social inequities. Hepatitis C disproportionately affects individuals without insurance, American Indian and Alaska Native persons, non-Hispanic Black persons, justice-involved populations, and people who use illicit drugs.2

...

"Among those diagnosed, hepatitis C treatment coverage is far below what is needed to achieve elimination goals. Only about one-third of people diagnosed with hepatitis C who have private insurance, Medicare, or Medicaid get treated, and the proportion is probably even lower for those without insurance.4 This is in part due to current restrictions, such as requirements for patient sobriety, requirements to document evidence of liver fibrosis, and the restriction of access to treatment only to those seen by specialists, that have been put in place by public and private insurers in reaction to the high cost of DAAs ($90 000 per patient initially, still around $20 000). Low rates of treatment may also reflect the complexity of traversing the full cascade of care in our health care delivery system.

"Addressing this missed opportunity can save both lives and money. A national effort can build on lessons from programs launched by jurisdictions such as the states of Louisiana and Washington, the Cherokee Nation, the Veterans Health Administration, and the Federal Bureau of Prisons. For example, the Veterans Health Administration has treated more than 92 000 veterans with hepatitis C virus since 2014, with cure rates exceeding 90%.5 A key lesson from these initiatives is that success requires both managing the cost of the medications and developing a comprehensive public health effort to identify persons with hepatitis C and link them to care.

...

"the program aims to provide broad access to curative hepatitis C medications. A key element will be a national subscription model to purchase DAAs for those who are particularly underserved today: Medicaid beneficiaries, justice-involved populations, people without insurance, and American Indian and Alaska Native individuals who are treated through the Indian Health Service. With this approach to drug purchasing pioneered in Louisiana,7 the federal government will negotiate with manufacturers to purchase as much treatment as needed for all individuals in the designated groups. The pharmaceutical industry can expect more revenue for DAAs for these populations than it is receiving today, but at a much lower per-patient cost. That’s a win-win. Beyond the subscription model, the program will seek to provide additional co-pay assistance to Medicare beneficiaries. Private insurers will also be strongly encouraged to increase coverage for hepatitis C testing and treatment and limit out-of-pocket costs where possible."

Morality in Economics, as viewed from Sociology (Georg Kanitsar in European J. of Sociology)

Georg Kanitsar, a young sociologist, undertakes the task of looking at how economists think about morality (with a focus on experimental and behavioral econ, and market design). His view of how economists think may shed some light (for economists) on how sociologists think. (I quote below from near the beginning and near the end of his paper.)

Kanitsar, G. (2023). Putting Morals into Economics: From Value Neutrality to the Moral Economy and the Economization of Morality. European Journal of Sociology / Archives Européennes De Sociologie, 1-30. doi:10.1017/

"Abstract: The economic discipline plays a performative role in constructing the moral order of market society. Yet, little attention has been paid to what economists explicitly regard as moral or how they conceive of morality. This article reflects a recent attempt to put morals into economics, that is, to introduce morality as a research topic in behavioural and experimental economics. It maps three research programs that theorize the moral economy. The programs emphasize the moral foundations of market society, the moral limits of market expansion, and the moral consequences of market trading and, thus, appear irreconcilable with classifications of economists as market enthusiasts or moral agnostics. At the same time, however, the literature centres on an “economized” form of morality that is corrective to market inefficiencies, attributed to the responsibility of the individual, and expressed in rational terms. In doing so, this literature contributes to redefining moral problems in economic terms."

"I consider efforts to incorporate morality into an economic framework advanced by two influential branches of the discipline—behavioural economics and market experiments. To gain an overview of relevant research in these branches, I assemble a database of 39 recent articles and identify 20 key articles among them.

...

" I explore the “economization of morality” by elucidating the moral arguments and the moral background of two authoritative programs in present-day economics: behavioural economics/experiments and market design/experiments. While many renowned economists have produced notable work on morality, these two research programs currently exert a unique influence on the economic discipline and are highly industrious in exporting its findings to policy making.

...

"Discourse in the economic mainstream was long dominated by market enthusiasts and moral agnostics, but the recent surge of behavioural and market experiments has again drawn attention to morality as a research topic in economics. At the argumentative level, the reviewed literature reveals a genuine break with market fundamentalism in the narrow sense. I have identified three strands that shed light on the moral economy and emphasize the moral foundations, limitations, and consequences of markets. Thus, economics has not been deaf to appeals to “put morals into markets” [Amable Reference Amable2011]. At the background level, however, the integration of morality is steered by the discipline’s theoretical and methodological underpinnings. In consequence, a very specific understanding of morality lies at the heart of these research efforts; a form of morality that is functional to market efficiency and attributed to utility-maximizing individuals.

...

"Behavioural economics thus strikes out in the opposite direction as scholarship in economic sociology. On the surface, both disciplines take as a starting point a view of market society as divided in arm’s-length transactions and social ties, and both disciplines have rediscovered morality as their subject matter. Yet, behavioural economics addresses the social sphere with tools that were tailor-made for the neoclassical analysis of markets. The field maintains the analytical primacy on efficiency and rationality, which it inherited from its parent discipline. In experiments, social exchanges are represented as contractual, anonymous, and temporary encounters, and money is regarded as a neutral tool used to express valuations. Conversely, economic sociology views markets as diverse “arenas of social interaction” [Beckert Reference Beckert2009: 245]. Market transactions are considered as far from universal, arelational, and disembedded [Aspers Reference Aspers, Beckert and Zafirovski2005], and the cultural meanings of money rarely reduce it to a qualityless, neutral, and homogenous medium of exchange [Zelizer Reference Zelizer1989]. Thus, the “moral economy” of behavioural economics is situated next to the “amoral economy” of neoclassical economics [Bowles Reference Bowles2016], echoing the traditional opposition between separate spheres of the economic and the moral [Thompson Reference Thompson E1971]. By contrast, economic sociology is increasingly devoted to identifying the multiple moralities underlying economic processes [Beckert Reference Beckert2012; Zelizer Rotman Reference Zelizer Rotman2017], convinced that “all economies are moral economies” [Fourcade Reference Fourcade2017: 665]."

Organ donation in the U.S.: some background information

Here's a background piece from a few weeks ago about the organ donation system in the US, focusing on California (and passing quickly over political controversies) from the LA Times:

Millions of Californians are willing to donate organs, but relatively few do. Here’s why BY JON HEALEY

"You don’t have to die to be an organ donor — you can donate one of your two healthy kidneys and a big chunk of your liver, among other body parts. But even though the total number of living and deceased donors is about 50% higher now than in 2016, a wide gap still remains between the demand for organs and the supply.

...

"The first successful organ transplant on record took place more than 150 years ago, when a Swiss-born physician grafted small pieces of a patient’s skin into a wound in the patient’s arm to speed healing. (Yes, your skin is an organ. In fact, it’s the body’s largest organ.) But transplanting an organ from one person to another is significantly harder because the recipient’s immune system tries to reject the foreign tissue as if it were an invader, not a potential savior.

...

"In 1984, the National Organ Transplant Act brought the regional efforts together into a national Organ Procurement and Transplantation Network. Among other duties, the network was tasked with creating a list of individuals who need organs, developing a computerized system for matching them with donors, and helping organ procurement organizations distribute organs “equitably among transplant patients” nationwide.

"The network is currently operated by a single contractor: the United Network for Organ Sharing, usually referred to by its initials, UNOS.

...

"Perhaps the biggest limit on organ donation is how quickly organs deteriorate in the body after the heart stops beating. When organs are deprived of oxygenated blood for more than 20 to 30 minutes, they become too damaged to be transplanted, Mone said, adding, “Nobody’s solved that medical riddle yet.” (The clock ticks more slowly for bone and tissue, which can be recovered up to 24 hours after the donor’s time of death, Mone said.)

"As a consequence, kidneys, livers and other vital organs are taken only from patients who die in a hospital while on a ventilator. Only 1% of the roughly 2.8 million people who die in the U.S. each year fit into that category, Mone said, and of that group, less than half of the organs available are fit to transplant.

...

"According to Mone and Sellers, properly packaged kidneys ordinarily last for 24 to 36 hours outside the body, while a healthy liver can typically last six to eight hours, and a heart or lungs only three to four hours. Given the short shelf life, Mone said, OPOs typically won’t remove organs other than kidneys if no recipients have been lined up.

...

"White and Latino patients and their survivors authorize donations at a significantly higher rate than Black or Asian patients and survivors, a situation that Mone said reflects distrust of the system and cultural opposition to organ donation. Although the organ donation authorization rate in OneLegacy’s region was 87% for white and 73% for Latino patients from 2017 to 2020, it was only 58% for potential Black and Asian donors, the organization says. The rates for the U.S. as a whole follow a similar pattern.

...

"According to OneLegacy’s statistics for 2021, nonwhite people in its region receive a share of the transplants that’s proportionate to their numbers, but not to their need. Making matters worse, Mone said, Black Americans suffer from kidney failure at three times the rate of white Americans, yet they aren’t getting on the waiting list for transplants at that rate."

HT: Frank McCormick

Market Shaping at the University of Chicago: Promoting needed innovation

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

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

"Accelerating Innovation

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

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

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

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

Rachel Glennerster speaking about market shaping

Telehealth restrictions and medical aid in dying/death with dignity

 Medical aid in dying (MAID) is now available to some extent in eleven U.S. jurisdictions (10 States and the District of Columbia), mostly with the requirement that eligible patients are within six months of dying naturally.  So these patients are pretty ill, which makes it difficult for some of them--particularly rural patients--to schedule in-person final appointments with their physicians, to receive the drugs that they will take.  Telehealth appointments and prescriptions have been important for these patients, and those may be going away.

Statnews has the story:

Dying patients protest looming telehealth crackdown By JoNel Aleccia 

"Online prescribing rules for controlled drugs were relaxed three years ago under emergency waivers to ensure critical medications remained available during the COVID-19 pandemic. Now, the U.S. Drug Enforcement Agency has proposed a rule that would reinstate most previously longstanding requirements that doctors see patients in person before prescribing narcotic drugs such as Oxycontin, amphetamines such as Adderall, and a host of other potentially dangerous drugs.

"The aim is to reduce improper prescribing of these drugs by telehealth companies that boomed during the pandemic. Given the ongoing opioid epidemic, allowing continued broad use of telemedicine prescribing “would pose too great a risk to the public health and safety,” the proposed rule said. It also cracks down on how doctors can prescribe other less-addictive drugs, like Xanax, used to treat anxiety, and buprenorphine, a narcotic used to treat opioid addiction.

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"The proposal has sparked a massive backlash, including more than 35,000 comments to a federal portal and calls from advocates, members of Congress and medical groups to reconsider certain patients or provisions.

“They completely forgot that there was a population of people who are dying,” said Dr. Lonny Shavelson, a California physician who chairs the American Clinicians Academy on Medical Aid in Dying, a coalition of doctors who help patients access care under so-called right-to-die laws.

"Among the biggest complaints: The rule would delay or block access for patients who seek medically assisted suicide and hospice care, critics said. Many of the comments — including nearly 10,000 delivered in person to DEA offices — came from doctors and patients protesting the effect of the rule on seriously ill and dying patients."