Recent innovations in organ donation

Here's a quick summary of novel (and sometimes controversial) ways to organize kidney exchange (global kidney exchange, and advanced donation vouchers), and liver transplantation (including liver exchange, and including kidneys and livers in the same exchange). It's published under the heading "CONTROVERSIES IN ORGAN TRANSPLANTATION".

Evolving  swaps  in  transplantation:  global  exchange,vouchers,  liver,  and  trans-organ  paired  exchange
Alexis  L.  Lo,  Elizabeth  M.  Sonnenberg,  and  Peter  L.  Abt
Current Opinion in Organ Transplantation
Issue: Volume 24(2), April 2019, p 161-166

Purpose of review
With the ongoing organ shortage, several mechanisms to facilitate organ exchanges and expand thescope of living kidney or liver donation have been proposed. Although each addresses at least one barrier to transplantation, these innovative programs raise important ethical, logistical, and regulatory considerations.

Recent findings
This review addresses four recent proposals to expand living donor transplantation. For kidney transplantation, we discuss global paired exchange and advanced donation programs (’vouchers’) and for liver transplantation, liver paired exchange. Lastly, this review considers trans-organ exchange. We explore the conceptual framework of the exchange, current status, benefits, and concerns for  each of these evolving pathways.

Summary
Through highlighting novel mechanisms in organ exchange, greater awareness, discussion, or support can occur to create more avenues for transplantation. These innovative mechanisms require regulations and safeguards for donors to ensure informed consent, and proper follow-up is maintained."

Foie gras off the menu (again) in California

The SF Chronicle had the story (and I missed it until now...)

California’s foie gras ban upheld, though chefs vow to fight on
Jonathan Kauffman, Jan. 7, 2019

"After six years of legal battles, California’s ban on foie gras is still in effect.

"The U.S. Supreme Court announced Monday it would not hear a challenge to California’s 2004 ban on the production and sale of foie gras, leaving in place a 2017 ruling upholding it.
...

"The California law, which went into effect in 2004 but delayed enforcement of the ban until 2012, forced California’s only foie gras producer to close. Some California restaurants continued to serve foie gras, however, claiming they were giving it away to guests. Starting in 2012, groups such as the Coalition for Humane and Ethical Farming Standards, backed by the French Laundry’s Thomas Keller and dozens of other chefs, have supported a series of efforts to overturn the ban, leading to a legal back-and-forth.

"In 2015, U.S. District Judge Stephen Wilson ruled that the ban violated the federal Poultry Products Inspections Act,which prohibits states from imposing their own conditions on the sale of poultry. The ruling put foie gras back on Bay Area menus.

"The California state attorney general appealed the ruling, however, and two years later, the Ninth U.S. Circuit Court of Appeals in San Francisco reversed it. However, the court put a stay on the ban so the plaintiffs — two out-of-state foie gras producers and a Los Angeles area restaurant group — could petition the U.S. Supreme Court to take up the case.

That challenge is now effectively dead."

Dead pigs and live brain cells--with implications still to be understood

Dramatic scientific announcements get press coverage before they are well (or at all) understood, but that can still be exciting.  Here's some press coverage of an article that was published yesterday in Nature about restoring some cellular activity in the brains of pigs which had been slaughtered and decapitated.  It may eventually have implications for brain injuries, brain death and (hence) deceased organ donation.
(The Nature article and two commentaries published with it are also linked below.)

NY Times:
‘Partly Alive’: Scientists Revive Cells in Brains From Dead Pigs
In research that upends assumptions about brain death, researchers brought some cells back to life — or something like it.

"In a study that raises profound questions about the line between life and death, researchers have restored some cellular activity to brains removed from slaughtered pigs.

"The brains did not regain anything resembling consciousness: There were no signs indicating coordinated electrical signaling, necessary for higher functions like awareness and intelligence.

"But in an experimental treatment, blood vessels in the pigs’ brains began functioning, flowing with a blood substitute, and certain brain cells regained metabolic activity, even responding to drugs. When the researchers tested slices of treated brain tissue, they discovered electrical activity in some neurons."
***********

Washington Post:
Scientists restore some brain cell functions in pigs four hours after death
Ethicists advise caution with research that blurs the line between life and death.

"The researchers are mindful that this is controversial territory with great potential to stoke outrage or, simply, the heebie-jeebies. Such a head-snapping experiment inevitably generates nightmarish scenarios involving live brains in vats, brain transplants, the Zombie Apocalypse, and other mad-scientist story lines (brilliantly crafted, somehow, by neurons firing away inside the skulls of conventionally living human beings).
"The findings also lead to ethical quandaries, some of which are outlined in two commentaries simultaneously published by Nature. The ethicists say this research can blur the line between life and death, and could complicate the protocols for organ donation, which rely on a clear determination of when a person is dead and beyond resuscitation."
*************

Guardian:
Researchers 'reboot' pig brains hours after animals died
Scientists say ability to revive some brain functions will not change definition of death



************
And here's the article in Nature:
Published: 17 April 2019

Restoration of brain circulation and cellular functions hours post-mortem
Zvonimir Vrselja, Stefano G. Daniele, John Silbereis, Francesca Talpo, Yury M. Morozov, André M. M. Sousa, Brian S. Tanaka, Mario Skarica, Mihovil Pletikos, Navjot Kaur, Zhen W. Zhuang, Zhao Liu, Rafeed Alkawadri, Albert J. Sinusas, Stephen R. Latham, Stephen G. Waxman & Nenad Sestan
Naturevolume 568, pages336–343 (2019) | Download Citation

Abstract
The brains of humans and other mammals are highly vulnerable to interruptions in blood flow and decreases in oxygen levels. Here we describe the restoration and maintenance of microcirculation and molecular and cellular functions of the intact pig brain under ex vivo normothermic conditions up to four hours post-mortem. We have developed an extracorporeal pulsatile-perfusion system and a haemoglobin-based, acellular, non-coagulative, echogenic, and cytoprotective perfusate that promotes recovery from anoxia, reduces reperfusion injury, prevents oedema, and metabolically supports the energy requirements of the brain. With this system, we observed preservation of cytoarchitecture; attenuation of cell death; and restoration of vascular dilatory and glial inflammatory responses, spontaneous synaptic activity, and active cerebral metabolism in the absence of global electrocorticographic activity. These findings demonstrate that under appropriate conditions the isolated, intact large mammalian brain possesses an underappreciated capacity for restoration of microcirculation and molecular and cellular activity after a prolonged post-mortem interval.
*********
Here are two commentaries published in the same issue of Nature:
COMMENT  17 APRIL 2019
Part-revived pig brains raise slew of ethical quandaries
Researchers need guidance on animal use and the many issues opened up by a new study on whole-brain restoration, argue Nita A. Farahany, Henry T. Greely and Charles M. Giattino.
^^^^^^^^^

COMMENT  17 APRIL 2019
Pig experiment challenges assumptions around brain damage in people
The restoration of some structures and cellular functions in pig brains hours after death could intensify debates about when human organs should be removed for transplantation, warn Stuart Youngner and Insoo Hyun.

A wedding while expecting "twiblings"

The NY Times has a very 21st century wedding announcement, of two husbands who both wanted to be fathers. Read it all here and feel proud to be human:
And You Thought Your Family Was Modern

Here's the surrogacy bit:

"Dr. Luo, 40, known for his meticulous organizational skills, created a database to track the multiple agencies, fertility doctors, legal issues, egg donors and surrogates involved in fulfilling the couple’s dream of having children.

"However comprehensive, Dr. Luo’s document could not calculate the many emotional ups and downs on the San Francisco couple’s journey to parenthood.

"Yet if all goes as planned, come September, after three years, the involvement of three women, and a significant financial investment — about $300,000 — the couple will be changing diapers for two babies. A boy and a girl, conceived with eggs from the same donor, will each be tied biologically to one of the men. In today’s parlance, they’ll be “twiblings.”

“We’re living our version of our parents’ American dreams,” said Dr. Luo..."

Glitch in NYC high school admissions this year

An alert NYC parent points me to this account in the WSJ:

Top New York City School Makes Big Admissions Error
NYC Lab School had to rerank applicants after an error; no offers were rescinded
By Leslie Brody, Updated April 9

"A mistake in the city’s high-anxiety admissions process has led the New York City Department of Education to inform 144 students that they had erroneously been denied spots in a sought-after high school and that they have been admitted after all.
...
", a selective school, made an isolated error in ranking applicants and had to rerank them, a department spokesman said by email. He said no offers were being rescinded.
...
"The problem comes at a time of wrenching debate over the city’s admissions system for desirable schools and fair access to opportunity. Supporters say selective admissions enable strong students to attend rigorous schools. Chancellor Richard Carranza and many families have questioned the rationale for sorting students by academic ability in hundreds of public programs.

"Many parents also complain that the city’s method for matching students to schools lacks transparency, and many schools don’t publicize exactly how they rate students or the cutoff scores for admission.
...
"Mr. Goldberg, a member of District 2’s Community Education Council, an elected parent body, said the admissions mishap had ripple effects: Students mistakenly denied offers to Lab took spots at other high schools, edging out other students, who in turn ended up at choices lower on their preference lists. “You can’t really just have a surgical correction because everything is connected,” he said.

The department spokesman disputed that assertion, saying any one school had only a small number of students newly getting offers to Lab, and initial offers assumed there would be some attrition.

The department uses a computer algorithm to match students’ choices with schools’ rankings of applicants. Selective schools rank students by a mix of factors, such as course grades, state test scores and attendance records.

The problem at Lab came to light as some parents questioned why their children didn’t get spots, while peers with weaker academic records were admitted. The school’s principal didn’t respond to requests for comment.
...
"Last year, more than 3,300 students applied for 103 ninth-grade seats at Lab, by city data."
*****
Update: see also this story, which gives some clues to how the NYCDOE is planning to patch up school assignments in light of the error.
 APR. 10, 2019
WRONG ENVELOPE: STUDENTS ACCEPTED TO COVETED LAB SCHOOL AFTER REJECTION SNAFU
"Eric Goldberg, a parent and member of District 2’s Community Education Council, said he was notified Monday afternoon that his daughter was one of the students who had been accepted to Lab, her first choice, after she thought she hadn’t received that match and had already accepted an offer to another school.

"An education department employee called Goldberg to inform him of the admissions error, and that his daughter has until Friday to decide whether she’s going to stick with her original choice or opt for Lab. Goldberg said he has heard from at least 25 other families who received the same phone call that he did.

"He said he’s aware of students who were also newly accepted to Lab but had already accepted offers to Frank McCourt, School of the Future, and Baruch College Campus high schools next year.
“I think the larger implications are first around the transparency of the high school admissions process,” Goldberg said. “There’s limited information available about how schools rank and screen students, and without that transparency, it’s impossible for oversight to identify any issues, you know, with the process.”
**********

It's been at least a decade since I was up to date on operational developments in the NYC choice process, so I'm observing this from a distance. But, back in the day, the NYCDOE was surprisingly well staffed, so in trying to understand what's happening here, I'm inclined to give them the benefit of the doubt.

If I had been asked for advice (and I was not--but the natural people to ask for advice at this point would be  Parag Pathak and Atila Abdulkadiroglu, who were involved in the beginning, and are today the world's greatest authorities on school choice mechanisms), I might have recommended that they rerun the algorithm with the correct inputs, and see which students had been adversely affected by the error.  That number might not be too large, because in a big city like NYC, with hundreds of high school programs to apply to, but with applicants listing no more than a dozen, the "rejection chains" have a tendency to be short.   If that turned out to be the case, then calling the adversely affected families and giving them a chance to go where they should have might well be feasible, given the somewhat arbitrary nature of schools' capacity constraints.  The story above suggests that they may have done something like that.

But algorithms need inputs, and I hope that in years to come some procedures will be introduced to check the inputs before the outputs are announced.

Interview with Preston McAfee on market design in tech firms

Econ focus, from the Richmond Fed, has an interview with Preston McAfee:

Fourth Quarter 2018, INTERVIEW
R. Preston McAfee
Article by: David A. Price

Here are two questions and answers, the first about market design, and the second about when it might be wise to avoid getting involved in it...

EF: In both your academic work and in your published work as a corporate economist, you've done a lot of research on market design, including auction design. And of course, you collaborated on the design of the FCC wireless spectrum auctions. What are some of the main things you've learned about designing markets?

McAfee: First, let's talk about just what market design is. It's a set of techniques for improving the functioning of markets. Specifically, it uses game theory, economic theory, experimental research, behavioral economics, and psychology, all of those disciplines, to make markets work better.

In politics, you have people who don't want to use markets, and then you have people who say just let the market do it — as if that didn't have any choices attached to it. But in fact, often how you make a market work determines whether it works well or poorly. Setting the rules of the game to make markets more efficient is what market design is all about. Thus, whether to hold an auction, whether to sell or lease, who bears responsibility for problems, and what information is communicated to whom are all questions answered by market design. At least four Nobel Prizes have gone for developments in this area.

One thing we learned is to design for mistakes by participants. People will make mistakes, and to encourage participation and efficient outcomes, it is desirable that those mistakes not be catastrophic.

Moreover, there is a trade-off between the potential efficiency of a market and the generation of mistakes. Give people the ability to express complex demands, for example, and the potential efficiency rises, because people can express exactly what they want. But the number of mistakes will rise as well, and the actual performance can decline. I often find myself supporting a simpler design for this reason; I push back on complexity unless that complexity buys a lot of efficiency.

When we designed the PCS [personal communications services] auctions, the spectrum auctions, we were aware that if you made them complicated, people weren't likely to function that well. We had empirical evidence of that.

Take a situation where you have seven properties up for auction. One regime is that I bid independently on each of the properties, and if I am the winning bidder on all seven, I get the seven. Another is to allow the bidder to submit a contingent bid — to say I only want all seven. That's called package bidding or combinatorial bidding. We were aware that in practice those don't work so well, because it winds up taking a long time to figure out who should win what.

But there is some potential loss from not having a package. Because if, let's say, I'm selling shoes, most people don't have much use for a single shoe. So you would not want to sell the shoes individually, even though there are a few people who want only the left shoe or the right shoe. And in fact, I am a person who would like to get different sizes in a left shoe and a right shoe. So there's this trade-off between simplicity, which makes it easier for most, and expressiveness. There is value in that simplicity not only in terms of getting to an answer more quickly, but also in helping bidders avoid mistakes.

Another example is a second-price auction, where you don't pay what you bid; if you're the highest bidder, you pay the second-highest bid, as opposed to paying your own bid. It has a certain resilience to it. There was a guy who actually submitted a bid that was 1,000 times higher than he intended. Just added three zeroes by accident. But in that auction, if you're paying not your bid but the next highest bid, it takes two to make the mistake in order for that to actually cause him to go broke. He wouldn't have gone broke under the second-price auction, whereas he would under the first-price auction. In that specific instance, we had put in a withdrawal rule that allowed him, at some penalty but not a ruinous penalty, to withdraw.

EF: Much of the economic research that has been publicly discussed by technology companies has focused on outward-facing decisions such as pricing and, as we discussed, market design. Are tech companies also using research to structure the incentives of their employees, and is there more they can be doing?

McAfee: I've hired a lot of people over the years, more than 50 anyway, probably more than 60. And among those have been several people, some quite distinguished economists, who decided that the first thing they wanted to do was get involved in compensation.

Your leverage regarding compensation is greatest in the sales force. If you've got a salaried engineer, let's say, there's not as much you can do. But in sales, the financial incentives are large and strong. I try to prevent economists on my teams from ever messing with sales force compensation, because there's no quicker way to be fired. The sales force is very persuasive. That's their job; they're supposed to be persuasive.

There was a case where we had an executive vice president come to us and say, "We really want to run some experiments and learn about the sales force." As I said, I did my best to keep my team out of such matters, but when management comes to me and asks for help, I feel I have to oblige. Not only that, I had people chomping at the bit wanting to get involved. We designed some incentives and then what happened next was fully predictable, which is that the EVP got fired. Fortunately, my team was safe because it hadn't come from them.

My teams have worked with HR on other issues. There's always some ongoing work with HR. It can be on promotion, recruiting, collaborating — anything but compensation.

Marketplace Innovation Workshop at Stanford, June 4-5

Here's the call for papers:

The Fifth Marketplace Innovation Workshop will take place at Stanford University on June 4 (afternoon) and June 5 (all day), 2019. The event is co-located with the INFORMS Revenue Management & Pricing Conference, which will take place on June 6 and 7.

Registration is now open, and will remain open until May 1. To register, please visit the event website at http://marketplaceinnovation.net. On our website, you will also find the list of plenary speakers and information about the Academia-Industry Forums we are piloting this year.

We hope to see you there,
Itai Ashlagi, Ramesh Johari, Ilan Lobel, Costis Maglaras and Gabriel Weintraub

--

Ilan Lobel
Associate Professor
Stern School of Business
New York University

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

Fifth Marketplace Innovation Workshop (MIW)

Stanford University, Stanford, California

Co-located with the INFORMS Revenue Management and Pricing Conference

June 4-5, 2019

Abstract submission deadline: March 1, 2019
Workshop registration deadline: May 1, 2019

Organizers

Itai Ashlagi, Management Science and Engineering, Stanford University
Ramesh Johari, Management Science and Engineering, Stanford University
Ilan Lobel, Stern School of Business, New York University
Costis Maglaras, Columbia Business School, Columbia University
Gabriel Weintraub, Graduate School of Business, Stanford University 

....

Plenary speakers

The workshop will have several invited distinguished plenary speakers from academia and industry, including:

• Dirk Bergemann (Yale University)
• Yash Kanoria (Columbia Business School)
• Kevin Leyton-Brown (University of British Columbia)
• Daniela Saban (Stanford Graduate School of Business)
• Eva Tardos (Cornell University)
• Adam Wierman (Caltech)
• Catherine Williams (Xandr)

...

Auctions and Market Design Plenary Session

We are pleased to announce that the INFORMS Auctions and Market Design Section has organized a plenary session for the workshop with three distinguished speakers spanning a range of interests across auctions, market design, and the themes of the workshop:

• Shmuel Oren (University of California, Berkeley)
• David Pennock (Microsoft Research)
• Rakesh Vohra (University of Pennsylvania)

Nova Scotia moves towards presumed consent for organ donation

The CBC is following the story:
Nova Scotia's opt-out organ donation move sparks mixed reaction
Bioethicist wonders whether rule would fit Canada's multicultural society

"Nova Scotia's decision to make all adults in the province potential organ donors unless they opt out has sparked a backlash from some Canadians.

"The goal is to increase organ donations from deceased donors to save lives of more recipients. Nova Scotia is striving to raise donation rates above 20 per cent, levels found in European countries such as Spain, officials said. About 90 per cent of Canadians say they support organ and tissue donation but less than 20 per cent have made plans to donate.

"Under presumed consent, the default decision is to donate organs on death. But families would continue to be approached to confirm the donor's wishes, said Dr. Stephen Beed, medical director for Nova Scotia's critical care organ donation program.
...
"The question is whether it's a good fit for Canadian society, said Kerry Bowman, a bioethicist at the University of Toronto.

"My first concern would be, this is a multicultural society and there are cultures and religions that really have a lot of concern about either organ donation or the steps before organ donation or the definition of death," Bowman said.

"For instance, Bowman said, the Catholic Church is very supportive of organ donation but sees presumed consent as problematic because it reduces the autonomous decision to give."
*******

Earlier from CBC:
Nova Scotia to become 1st in North America with presumed consent for organ donation.  Province will take 12 to 18 months after bill passes to prepare for changes
************

A related post

Saturday, April 6, 2019

Deceased organ donation: comparison of opt-in versus opt-out countries

"Abortion as a moral good" Opinion piece in the Lancet

The Lancet recently ran the following opinion piece, by a bioethicist at Northwestern University's medical school. It gives a sympathetic account of both the pro- and anti- abortion arguments, as she presents them to her medical students.

Abortion as a moral good
Katie Watson
PERSPECTIVES|THE ART OF MEDICINE| VOLUME 393, ISSUE 10177, P1196-1197, MARCH 23, 2019

Here's the first paragraph:

"My medical students first hear from a family physician who describes himself as pro-life. He's Christian, and his faith is “a large part of the reason” he refuses to perform abortions. “Christ says things like do to others what you want them to do to you, or love your neighbour as yourself, and when I'm in the room with a pregnant patient I think I have two neighbours in there”, he tells the second years. Then they hear from an obstetrician who specialises in abortion care. She too is a Christian, and some students look surprised when she says her religious beliefs are one reason she sought fellowship training in abortion. “Do unto others as you want done to you, always take care of your fellow man. When a woman needs help, I want to help her. So I take those sayings and teachings to mean that God would be very proud of me”, she explains. These two physicians then take questions together, interacting in a friendly way as each commends the other's deep commitment to patient care. Once they leave, I use the case studies they provided to focus attention on the medical ethics of conscientious refusal and conscientious provision of health care."

Adoption, interracial adoption, and repugnance

The Washington Post looks back on the history of adoption. (Even adoption can arouse repugnance...):

A white couple, a mixed-race baby and a forbidden adoption
In 1966 in the nation’s capital, what Kara and Frank Speltz wanted to do simply wasn’t allowed.

"Longing for a child, the white couple, who were involved in the city’s civil rights struggles, began to research how they could adopt an African American child instead. A year after their wedding, they contacted D.C.’s Department of Public Welfare and Junior Village, the city’s overcrowded home for orphaned and destitute children. Both organizations turned them down, saying it was against their policies to allow adoptions between whites and blacks.
...
"In segregated, post-World War II America, children of color and mixed-race children were considered “hard to place” in adoption agency parlance. Most agencies at the time used a policy of “matching,” which required that children be placed with families who looked like them or came from the same racial, religious or ethnic backgrounds, according to Matine T. Spence, professor of history at the University of Iowa.

"Some white couples adopted Asian or Native American children, but whites officially adopting African American children were much rarer, Spence said. The first recorded case occurred in 1948 in Minnesota.

“Originally, the main impulse behind race matching in adoption was a white-supremacist, segregationist impulse,” Harvard Law School professor Randall Kennedy said in a 2003 Harvard Magazine interview.

"At the time, many states had miscegenation laws barring interracial marriage. Maryland even had a law until 1957 that said it was illegal for “a white woman to bear a child fathered by a negro.”

"Still, formal statewide bans on interracial adoption were rare, Kennedy told the magazine: “It was thought to be beyond discussion — it was so obviously wrong that there was no need for a law.”

"The District did not have an official law on the books. either. But because interracial adoption was considered so taboo, private and public agencies and judges, which had the authority to approve or reject adoptions, enforced an unwritten policy to bar it, Spence said.
...
"n 1969, there were 4,336 black children placed for adoption in the United States, with 1,447 of them placed with white families. In 1971, 7,420 African American children were adopted, with 2,574 placed with white families.

Interracial adoption was — and remains — controversial in the United States.
In 1972, the National Association of Black Social Workers asserted that such arrangements constituted a form of “cultural genocide.”

“With that condemnation, the number of white-black adoptions quickly plummeted, according to Kennedy’s 2003 book, “Interracial Intimacies: Sex, Marriage, Identity, and Adoption.”
***********

What can museums do with their excess art?

The NY Times has the story:
Clean House to Survive? Museums Confront Their Crowded Basements

"Fueled by philanthropic zeal, lucrative tax deductions and the prestige of seeing their works in esteemed settings, wealthy art owners have for decades given museums everything from their Rembrandts to their bedroom slippers.

"It all had to go somewhere. So now, many American museums are bulging with stuff — so much stuff that some house thousands of objects that have never been displayed but are preserved, at considerable cost, in climate-controlled storage spaces.
...
"“There is this inevitable march where you have to build more storage, more storage, more storage,” said Charles L. Venable, the director of the Indianapolis Museum of Art at Newfields. “I don’t think it’s sustainable.”

"His museum was so jammed with undisplayed artwork that it was about to spend about $14 million to double its storage space until he abruptly canceled the plan.

"Instead, it embarked on an ambitious effort to rank each of the 54,000 items in its collection with letter grades. Twenty percent of the items received a D, making them ripe to be sold or given to another institution.
...
"Part of the problem is that acquiring new things is far easier, and more glamorous, than getting rid of old ones. Deaccessioning, the formal term for disposing of an art object, is a careful, cumbersome process, requiring several levels of curatorial, administrative and board approval. Museum directors who try to clean out their basements often confront restrictive donor agreements and industry guidelines that treat collections as public trusts."
***********

Earlier related posts:

Sunday, January 7, 2018

More on the repugnance of selling art, if you're an art museum

Sunday, September 10, 2017

Why don't museums sell art (except to buy more art)?

Federal government contests safe injection facility in Philadelphia, where the overdose rate is four times the homicide rate

When will they ever learn? The Washington Post updates us on Federal efforts to prevent exploration of ways to cut down on drug overdose deaths.

Philadelphia plans to open supervised opioid injection facility despite federal lawsuit

"Though the plan for what is known as a safe injection site has garnered local support, the city now finds itself in the middle of a major legal fight with the federal government.

"The Justice Department sued the nonprofit Safehouse in February, arguing that opening the facility in Philadelphia — the first supervised consumption facility in the United States — would violate federal law. Likening the idea to a crack house, federal officials say allowing the use of illicit drugs with impunity enables and exacerbates the in­trac­table opioid problem; the U.S. attorney for the Eastern District of Pennsylvania argued that opening Safehouse would violate the Controlled Substances Act, which makes it illegal to open or run a place where illegal drugs are knowingly used.
...
"The overdose rate in Philadelphia is four times the homicide rate; were the statistics reversed “there’d be absolute citizen outcry, they’d have National Guard in the streets,” said former Pennsylvania governor Ed Rendell, who is on the Safehouse board and said the organization plans to move forward even with federal opposition."
*************

see earlier posts

Thursday, February 7, 2019

Philly and Feds at odds over reducing opioid overdoses

Sunday, September 2, 2018

The DOJ argues against harm reduction measures for drug addicts

An Israeli gay couple recount their American surrogacy experience

Twins, no less, after a journey through U.S. surrogacy by a gay Israeli couple, from Haaretz:

Two for the Price of One: An Israeli Gay Couple's American Journey to Fatherhood By Hilo Glazer

"From the moment surrogacy for Israeli gay men swung away from Asia and landed in the American kingdom of capitalism, having a baby became a complex spreadsheet in which every row carries a price tag.
...
"We continued shopping in the most experienced agency in the gay fathers’ realm in Israel, which was founded by a marketing man. He mentioned two options: an American route and a Canadian route. The Canadian path is at least 100,000 shekels cheaper because there’s no need to pay the surrogate mother. How so? In Canada, surrogacy is, by law, completely altruistic, the marketing man explained, and the women are good Christians who want “to grant people the right to raise a family.” He added, with a thin smile, that these surrogate mothers receive “enlarged reimbursement of expenses,” and hinted that this was a way to get around the Canadian ban on paid surrogacy.
...
"The first step is to find an egg donor. In this field, America really is the land of opportunity – with a price range to match. We paid the low rate ($8,000) because we made do with the database of candidates that’s attached to the clinic and for which there’s “no charge” to access. It’s a pretty limited database, with about 15 candidates at any given moment.

"But hey, this is America, so there’s no upgrade that money can’t buy. An additional payment of $8,500 to $20,000 provides access to premium databases. There’s one consisting of donors who are models (they call it “donors who look like you,” and you can select the desirable physical qualities), while there’s another of donors who are Ivy League graduates. Unfortunately, there’s no overlap between the databases. An egg from a Jewish donor will cost more – around $20,000 (half to the agency, half to the donor). All told, if you go with the select databases, the cost of the egg donation can reach $35,000.
...
"The next stage, then, is to find the surrogate. The clinic put us in touch with five agencies for surrogates, each of which controls a different region of the country.

Because demand for surrogate mothers exceeds supply, hooking up with an agency doesn’t ensure an available woman when the contract is signed. The average waiting time is between four months and a year and a half. We were ready to pay in order not to lose momentum, and we went for the fastest option. The supply of surrogates available in Oregon, where the clinic was situated, had run out, so we had to expand into new territory...
...
"After two weeks, we were informed that a suitable candidate had been found...24, married and the mother of an 18-month-old girl, a part-time preschool teacher living in Oklahoma City. (Motherhood is a condition for surrogacy so that there are no known complications preventing the woman from giving birth.) Oklahoma is considered part of the Bible Belt, but Tiffany, for one, wasn’t put off by the fact that we were a gay couple.
...
"Spreading out the surrogate’s salary over nine months is liable to cause a conflict of interest with her. The classic dilemma is whether to have amniocentesis (generally performed at the start of the second trimester). It’s the most reliable indicator of the embryo’s health but also increases the risk of a miscarriage – a scenario we would obviously not want, but one more fraught with problems for the woman. She, after all, would have endured a rigorous selection process, taken medications, undergone invasive medical procedures, and in the case of a miscarriage, would be rewarded for only a few weeks of work.
...
"American agencies now customarily offer clients a “guarantee to baby” option: In return for a fixed price, the clinic undertakes “to provide” a baby, no matter how many attempts this entails. The deal is also valid for unsuccessful embryo transfer and in case of a miscarriage. Guided by fear of failure and of the need to make a double payment, we – and pretty much all the other couples who face a similar dilemma – opted for the “all inclusive” rate.
...
"The bonus of the visit to Portland was a meeting with the egg donor ...
Into the room came a delicate young woman of 21...accompanied by her fiancé ... She’s a nursing student, he’s starting med school, and both aspire to do volunteer work in plague-ridden regions of Africa.
...
[The surrogate] Tiffany’s life story, which we heard about during her hospitalization, raised a host of ethical questions that had been pushed aside once we’d opted for First World surrogacy over one in India.
... Was her economic plight fundamentally different from the distress of an imagined Indian surrogate mother? Wasn’t the medical risk she took the same? Could we be certain that she had volunteered for the process and not been pushed into it by a relative? Wasn’t her basic salary – about $30,000 – too small compared with the payments received by the doctors and the mediators?  "
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Here's a subsequent story from Haaretz (not related to the particular couple above):

Jewish Agency offers loans to staff seeking surrogacy abroad
For the first time in history, a state entity is offering its employees support for the extremely expensive procedure, which is denied to gay men in Israel by law

Upcoming market design conferences in May and July, in Switzerland and Russia

Here are announcements to two conferences:

MATCH-UP 2019
5th International Workshop on Matching Under Preferences
Congressi Stefano Franscini, Monte Verità, Ascona, Switzerland
26-29 May 2019

MATCH-UP 2019, the 5th International Workshop on Matching Under Preferences, will be held in the Congressi Stefano Franscini, Monte Verità, Ascona, Switzerland from Sunday 26 May – Wednesday 29 May 2019. It is the fifth in the series of interdisciplinary and international workshops on matching under preferences.

Matching problems with preferences occur in widespread applications such as the assignment of school-leavers to universities, junior doctors to hospitals, students to campus housing, children to schools, kidney transplant patients to donors and so on. The common thread is that individuals have preference lists over the possible outcomes and the task is to find a matching of the participants that is in some sense optimal with respect to these preferences.

The remit of this workshop is to explore matching problems with preferences from the perspective of algorithms and complexity, discrete mathematics, combinatorial optimization, game theory, mechanism design and economics, and thus a key objective is to bring together the research communities of the related areas."

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Economic Design and Algorithms in St. Petersburg (July 8-10, 2019)

"We are pleased to announce the international conference Economic Design and Algorithms in St. Petersburgorganized by the International Laboratory of Game Theory and Decision Making of Higher School of Economics, Russia.

OVERVIEW
The conference will bring together economists and computer scientists. It will focus on design problems where the methodologies of these two communities interact successfully, including but not limited to:
●    Market design
●    Matching and assignment
●    Voting rules
●    Fair division
●    Information design
●    Auctions
●    Networks
The conference will be preceded by a 2-days Summer School(July 5-6, 2019) which will be announced soon."

Deceased organ donation: comparison of opt-in versus opt-out countries

From Kidney International

Article in Press

Comparison of organ donation and transplantation rates between opt-out and opt-in systems

Adam Arshad1

,

Benjamin Anderson2

,

Adnan Sharif2,3,∗,Correspondence information about the author Adnan SharifEmail the author Adnan Sharif

DOI: https://doi.org/10.1016/j.kint.2019.01.036

Article Info

• Abstract

• Full Text

• Images
• References
• Supplemental Materials

Article Outline

1. Results
   1. Opt-out versus opt-in country stratification
   2. Differences between opt-out versus opt-in country profiles
   3. Organ donation rates (all figures per million population)
   4. Organ-specific solid organ transplantation activity (all figures per million population)
   5. Multivariate analysis
   6. Sensitivity analysis (all figures per million population)
2. Discussion
3. Methods
   1. Country selection
   2. Variables and data sources
   3. Ethics and transparency
   4. Statistical analysis
4. Disclosure
5. Supplementary Material
6. References

Studies comparing opt-out and opt-in approaches to organ donation have generally suggested higher donation and transplantation rates in countries with an opt-out strategy. We compared organ donation and transplantation rates between countries with opt-out versus opt-in systems to investigate possible differences in the contemporary era. Data were nalysed for 35 countries registered with the Organisation for Economic Co-operation and Development (17 countries classified as opt-out, 18 classified as opt-in) and obtained organ donation and transplantation rates for 2016 from the Global Observatory for Donation and Transplantation. Compared to opt-in countries, opt-out countries had fewer living donors per million population (4.8 versus 15.7, respectively) with no significant difference in deceased donors (20.3 versus 15.4, respectively). Overall, no significant difference was observed in rates of kidney (35.2 versus 42.3 respectively), non-renal (28.7 versus 20.9, respectively), or total solid organ transplantation (63.6 versus 61.7, respectively). In a multivariate linear regression model, an opt-out system was independently predictive of fewer living donors but was not associated with the number of deceased donors or with transplantation rates. Apart from the observed difference in the rates of living donation, our data demonstrate no significant difference in deceased donation or solid organ transplantation activity between opt-out versus opt-in countries. This suggests that other barriers to organ donation must be addressed, even in settings where consent for donation is presumed.

Repugnance watch: romantic relationships between faculty and graduate students

Forty plus years ago, I met and married my wife when I was an assistant professor and she was a graduate student in another department. Since then I've paid attention to changes in norms that might have made our relationship illicit, such as this recent change of policies at Princeton.

Princeton updates its policy regarding sexual and romantic relationships between faculty and graduate students
by the Office of Communications
"Princeton University has strengthened its policy regarding sexual and romantic relationships between faculty and graduate students.

"During the Faculty Meeting on Monday, April 1, faculty voted to approve a policy that prohibits all faculty from initiating or engaging in romantic or sexual relationships with graduate students. Previously, faculty were prohibited only from initiating or engaging in romantic or sexual relationships with graduate students over whom they had advising, instruction or supervisory responsibilities. The new policy includes exemptions for pre-existing relationships.

...

"Existing University policy already prohibits all romantic or sexual relationships between faculty and undergraduates.

“It is important to note that this prohibition, and therefore any disciplinary consequences, fall entirely on the faculty. That is, this policy change will not result in any disciplinary consequences for graduate students,” Dean of the Graduate School Sarah-Jane Leslie said in a statement emailed to graduate students.
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Here is the relevant paragraph from
Rules and Procedures of the Faculty of Princeton University and Other Provisions of Concern to the Faculty
As of 2019-04-03

"1. Prohibition of Consensual Relations with Students: Faculty members shall not initiate or engage in romantic or sexual behavior with undergraduate or graduate students. This prohibition encompasses both enrolled and prospective students, and includes students from other institutions who come to Princeton for pre-baccalaureate, post-baccalaureate, visiting, summer, or other programs or courses of study. For purposes of this policy, faculty members include members of the University community whose primary appointment is one of the following: tenured faculty, tenure-track faculty, nstructors, all ranks of lecturers, and visiting faculty. "

A new repugnant use of DNA information--'clarifying' Who is a Jew

The Jerusalem Post has the story:
CHIEF RABBINATE ADMITS USING DNA TESTS TO HELP DETERMINE JEWISH STATUS
Orthodox organizations denounce the use of DNA testing as contrary to Jewish law

"Chief Rabbi David Lau has admitted for the first time that the Chief Rabbinate and the state Rabbinical Courts use DNA testing in certain circumstances to help determine whether a person is Jewish.

The admission is likely to generate outrage among mainstream religious-Zionist and Modern Orthodox groups, given that Jewish law does not recognize the validity of DNA testing to prove Jewishness."

Brioni Legendary Minds: interviews and suits, and economists as clothing models

Brioni, the men's suit maker, has a series of video interviews called Legendary Minds, of unusually well dressed men. The videos are a bit unusual too, as the camera lingers on the suit at least as much as the speaker. You can watch me below:




The interview is also here:
https://www.brioni.com/us/legendary-minds-alvin-roth_section.

 Here are some of the accompanying stills:

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And here is the full set of Brioni Legendary Minds interviews to date:
https://www.brioni.com/us/legendary-minds_section

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As you might imagine, econ profs do fashion shoots all the time. Here are the stills from a slightly different one, involving clothing crafted by and for Stanford students, organized by Nina Buchmann, and featuring Muriel Niederle and myself, and Doug Bernheim.

Podcast on non-directed kidney donation as an act of effective altruism

Here's a very personal discussion  about becoming a non-directed donor.

The Neoliberal Podcast

Donating a Kidney with Dylan Matthews

"Jeremiah sits down with Dylan Matthews of Vox.com to discuss his decision to donate a kidney to a stranger, and Jeremiah's plans to do the same.  While our previous episode with Nobel prize winner Alvin Roth explored the economics of kidney markets and the details of kidney policy, this episode dives more deeply into the medical and personal side of deciding to donate a kidney."
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Dylan Matthews has his own podcast, called Future Perfect.

Stanford Urology Grand Rounds

I'll be speaking this evening at the medical school, to urologists, about kidney exchange.