Unraveling of Forensic Psychiatry fellowships makes participants paranoid on both sides of the market

 Where lawyers speak naturally about rules, psychiatrists don't shy away from talking about feelings, and the current disorder in the market for forensic psychiatry fellowships is making many participants miserable.

The Fellowship Application Process Must Be Reformed  by Octavio Choi, Journal of the American Academy of Psychiatry and the Law Online September 2021, 49 (3) 300-310; DOI: https://doi.org/10.29158/JAAPL.210088-21

"These are unhappy days in the world of forensic psychiatry fellowship programs. Here is the crux of the problem: too much product, not enough customers. Agapoff and colleagues report that for the 2016–2017 academic year, forensic psychiatry fellowships achieved a 56 percent fill rate, with 65 residents spread over 44 programs offering a total of 116 positions.1 Since then, the number of forensic programs has continued to grow, up to 48 ACGME-accredited programs offering 127 positions in 2018–2019. Seventy-three of those positions were filled, equating to a 57.5 percent fill rate.2 Things were better in the older days. According to ACGME records, in 2012–2013 there were about the same number of active residents (70) in just 36 programs.3

"The implications are clear: forensic fellowship programs are increasingly desperate to recruit a small number of applicants. From the perspective of program directors such as me, the rational strategy to pursue in this situation is to identify promising applicants early and try to sign them up before anyone else can get to them. Indeed, in recent years, fierce competition has led programs to make earlier and earlier offers that are time-limited (also known as the “exploding offer”). Paranoia is high. Given the nontransparent nature of most transactions in the applications process (no one really knows what anyone else is up to), and lack of objective referees, it only takes the slightest hint of malfeasance for outrage and fear of missing out to amplify.

"The overriding fear of many program directors is that they will not fill their available positions. In addition to bruised egos, being left with open positions means contracts will be left unfilled, possibly leading to cancellation and, ultimately, reduction or elimination of programs. Literally, to not fill risks death (of the program). The imperative, then, is to avoid not filling at all costs.

"On the other side is a paradox. For applicants, low fill rates should translate into a buyer's market, yet because the market is unregulated, the current system inflicts much suffering on them. As one recent applicant succinctly described the process: “it's a hot mess.” Competition by programs for the limited number of applicants has led to earlier and earlier offers being made with shorter and shorter times to decide; too short to adequately assess and receive offers from other programs. Indeed, the whole point of an exploding offer, from the program's point of view, is to curtail assessment of other programs by forcing applicants to make decisions before they might otherwise be ready. In marketing parlance, the idea is to pick up a bargain by taking a good off the market before it can be fairly priced.

...

"The failure of the current system is not about program directors being bad people. It is about the fragile nature of voluntary agreements during difficult times. The math is simple. If each program director has a 95 percent chance of behaving ethically over the course of the applications cycle, and there are 48 programs, there is only a .95 to the forty-eighth power probability (=8.5% chance) that all 48 directors will behave ethically in any given year. A single program director acting less-than-fully ethically is enough to kickstart a paranoid feedback loop that devolves into chaos: “If program X isn't playing by the rules, I don't see why I need to keep playing by the rules, especially if it's going to hurt me.”

"But note that system failure does not even require any actual unethical behavior; all that is required is the perception that others are behaving unethically, a perception that is encouraged to flourish in the context of desperation and lack of transparency"

Market design in Tokyo

 Fuhito Kojima and Hiroaki Odahara report on some of the projects presently underway at the University of Tokyo Market Design Center (UTMD), which include matching for child care, for medical residencies, and for internal labor markets.

Kojima, F., Odahara, H. Toward market design in practice: a progress report. Japanese Economic Review, (2021). https://doi.org/10.1007/s42973-021-00103-w

Abstract: In recent years, many developments have been made in matching theory and its applications to market design. This paper surveys some selected topics from this research area and describe our own work. We also describe the newly established University of Tokyo Market Design Center (UTMD), which works as a vehicle for practical implementation.

Muriel Niederle receiving the Morgenstern Medal: intro and speech (video)

Here's the video of Muriel Niederle receiving her  2021 Oskar Morgenstern Medal.

Starting at minute 25:45 you can hear Jean Robert Tyran introducing Muriel and her work. She is honored for her work in market design and her studies of gender in economic environments. The introduction is well worth listening to.  Muriel's talk begins at minute 52, and is called "A Gender Agenda." (She begins by noting "A lot of economists are not female.")

The United Arab Emirates and the Alliance for Paired Kidney Exchange formalize their relationship

 From the Abu Dhabi Government Media Office, this Oct. 7 announcement:

SEHA, Alliance for Paired Kidney Donation Formalize Partnership to Promote Paired Kidney Donation

"Abu Dhabi Health Services Company, (SEHA), the UAE’s largest healthcare network, and Alliance for Paired Kidney Donation (APKD), a non-profit organization based in Ohio, U.S, have signed a Memorandum of Understanding (MoU) following their recent collective success in facilitating paired kidney donations.

"With both organizations sharing a common goal to elevate opportunities for donation and transplants for both local and international patients with kidney disease, this strategic agreement will see SEHA and APKD working closely together to build a paired kidney donation program in the UAE, as well as facilitate transplant opportunities for patients with kidney failure seeking the right match kidney from the UAE or abroad.

"Dr. Tarek Fathey, Group Chief Executive Officer, SEHA, said: “A fundamental element of our constant growth and development as SEHA is building fruitful partnerships and relationships with global pioneers. Collaborating with APKD strengthens our position to significantly add to the UAE’s healthcare ecosystem and will introduce ample opportunities for us to transform kidney care locally, regionally and internationally.”

"As part of the agreement, SEHA Kidney Care (SKC), part of the SEHA network and Abu Dhabi’s go-to for kidney disease and treatment, will benefit from the opportunity to engage in training modules in health information technology systems applications (including Kidney Match – APKD’s paired organ exchange software), develop educational and scientific research papers and studies, and the exchange of medical, technical, and administrative experience.

"Dr. Ali Al Obaidli, Chief Medical Officer, SKC & Chairman of the UAE National Transplant Committee, said: “The key to the success of paired kidney donations is collaboration, locally and internationally. Thankfully, in the UAE, we boast a robust foundation of healthcare stakeholders and partners who will be integral in the build and roll-out of such a program. Building on our support, we are pleased to formalize a long-term partnership with APKD – by strengthening our relationship, we are unlocking pathways into countries across the world that will facilitate life-saving solutions for kidney disease patients across the globe, as well as build and bolster a paired kidney program here in the UAE that will benefit our citizens and residents.”

The APKD provides a powerful matching platform... that works with governments and hospitals around the world to match living kidney donors with patients in need within and across borders.

On a recent visit to the UAE, ... Dr. Alvin Roth, said: “Kidney disease is a global problem that requires a global solution. The UAE, with its diverse population and solid healthcare infrastructure, is well positioned to lead the charge. ....”

Dr. Michael Rees, MD PhD, Chief Executive Officer, APKD, said: “.... We are thrilled to partner with the UAE’s largest healthcare network in efforts to elevate the country’s infrastructure to not only heal its residents, but to contribute to the global healthcare landscape in terms of cross-country paired donations and transplants and research.”

Kidney donation and the strange, viral story of the "Bad Art Friend"

 A short story about a kidney donor prompted a long article in the NY Times Magazine last week, and that article has gone viral. Here's the article:

Who Is the Bad Art Friend? Art often draws inspiration from life — but what happens when it’s your life? Inside the curious case of Dawn Dorland v. Sonya Larson.   By Robert Kolker

Here are some paragraphs that set the stage for the drama described in the article.

"On June 24, 2015, a year after completing her M.F.A. in creative writing, Dorland did perhaps the kindest, most consequential thing she might ever do in her life. She donated one of her kidneys, and elected to do it in a slightly unusual and particularly altruistic way. As a so-called nondirected donation, her kidney was not meant for anyone in particular but instead was part of a donation chain, coordinated by surgeons to provide a kidney to a recipient who may otherwise have no other living donor. 

...

"Several weeks before the surgery, Dorland decided to share her truth with others. She started a private Facebook group, inviting family and friends, including some fellow writers from GrubStreet, the Boston writing center where Dorland had spent many years learning her craft. After her surgery, she posted something to her group: a heartfelt letter she’d written to the final recipient of the surgical chain, whoever they may be."

***********

The NYT article goes on to tell a sad story about how some of the "fellow writers" took a dislike to the kidney donor, feeling that her good deed was inspired by nothing more than attention seeking.  One of them published a short fiction called "The Kindest," about just such a supposed donor (depicted as a racist or at least racially insensitive "white savior").  It contained a letter vey much like the one the real kidney donor shared.  Some but not all of the dispute that followed involves the question about whether this met the legal definition of plagiarism.

********

This is a good place to (re)state my own view, as someone with a long interest in kidney exchange, that kidney donors, especially nondirected donors, are heroes whose donation does a world of good.  Thousands of kidney transplants have been facilitated by kidney exchange chains begun by nondirected donors.  I've met a number of such donors, and they seem to me to be by and large selfless people who did something wonderful that became a significant part of their lives, even though they don't generally regard themselves as heroes.

Listen to some of their stories here, in interviews of donors by a donor: Donor Diaries Podcast

Of course, they probably have to be a bit careful telling their stories, and discussions among donors might be safe spaces where they won't be misunderstood.  That's surely an experience that donors have in common with other people who have done or experienced something remarkable, such as military veterans who are Medal of Honor winners, and who give each other needed support when recognized as such.

********

But how about art?

Here's a story in the New Yorker reviewing the short story described in the NY Times Magazine article. It asks whether the short story in question qualifies as the kind of art that might justify the liberties the author took.

The Short Story at the Center of the “Bad Art Friend” Saga.  A Times Magazine feature has prompted feverish discourse about the ethics of artistic appropriation. Is the art in question any good?  By Katy Waldman

"This raises the question of whether Larson did any better of a job exploiting Dorland’s kidney donation for personal gain, insofar as exploiting existing material for personal gain is a pretty good working definition of being a writer.

"By my reading, she did not. Larson lifted an extremely potent premise—the needy organ donor, seeking connection and validation—and crafted a story that manages to diminish its built-in intrigue. In fact, “The Kindest” falls short in precisely the ways the saga laid out in the Times Magazine piece might lead us to expect: it makes a cartoon of the donor character, and it over-relies on identity-inflected hand-waving. Also, the prose is bad."

***********

I don't know how much of a larger lesson is contained in all this, aside from the observation that even acts of great generosity can be viewed with suspicion, by those who are so inclined.  This may have something to do with why the efforts against black markets in kidneys have turned into an obsessive campaign against compensation for donors and  repugnance to any transactions that resemble rewarding donors for their generosity.

I think this is a shame. To put it another way, even if some donors were to be motivated by attention seeking, isn't it better for society if they seek attention by behaving heroically in such beneficial ways? (Just think about all the wasteful or destructive ways that attention seekers sometimes seek attention...)

I'm sticking to my view of donors as heroes. 

(I even have a paper about heroism and kidney donation:

Niederle, Muriel and Alvin E. Roth, “Philanthropically Funded Heroism Awards for Kidney Donors?, Law & Contemporary Problems, 77:3, 2014, 131-144.  )

Ryan Oprea wins the Exeter Prize for the paper "What Makes a Rule Complex?"

 The Exeter Prize Committee has circulated the cheerful announcement below, about the latest winner of that prize (which has a very distinguished history):

"We are happy to announce the winner of the 2021 Exeter Prize for the best paper published in the previous calendar year in a peer-reviewed journal in the fields of Experimental Economics, Behavioural Economics and Decision Theory.

"The winner is Ryan Oprea (University of California at Santa Barbara) for his paper “What Makes a Rule Complex”, published in The American Economic Review. 

"This paper offers a crisp experimental measurement of complexity. It offers a rich description of how complexity affects actual humans, which has tremendous potential for informing policy making as well as theoretical research across disciplines (from psychology, computer science, and cognitive science to economics). In the experiment the subjects are asked to implement various decision rules. Five dimensions of complexity are studied: the number of states and transitions, existence of absorbing states and redundant states, and a measure of working memory. The paper looks at three different measures of behaviour: the error rate, the implementation time, and the subjects' own willingness to pay to get the decision rule implemented by a computer. The experiment also measures how fast people learn various decision rules and how transferable this knowledge is. This paper offers a new impetus for research, getting us outside of our comfortable box of constrained optimization. This is a risky and challenging attempt, with a high upside potential.

"The winning paper was selected by the panel of Nina Mazar (Boston University), Rosemarie Nagel (ICREA-UPF-Universitat Pompeu Fabra), and Tomasz Strzalecki (Harvard University). "

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

Here's the paper:

What Makes a Rule Complex?  AMERICAN ECONOMIC REVIEW, VOL. 110, NO. 12, DECEMBER 2020  (pp. 3913-51  "By Ryan Oprea*

"We study the complexity of rules by paying experimental subjects to implement a series of algorithms and then eliciting their willingness-to-pay to avoid implementing them again in the future. The design allows us to examine hypotheses from the theoretical “automata” literature about the characteristics of rules that generate complexity costs. We find substantial aversion to complexity and a number of regularities in the characteristics of rules that make them complex and costly for subjects. Experience with a rule, the way a rule is represented, and the context in which a rule is implemented (mentally versus physically) also influence complexity"

Natural experiments win a Nobel in Economics: Angrist, Card and Imbens

 Congratulations to David Card, Josh Angrist, and Guido Imbens. Natural experiments and their statistical analysis join laboratory experiments and randomized control trials in the pantheon of modern empirical tools in economics celebrated in Stockholm:

The Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel 2021

The Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel 2021 was divided, one half awarded to David Card "for his empirical contributions to labour economics", the other half jointly to Joshua D. Angrist and Guido W. Imbens "for their methodological contributions to the analysis of causal relationships."

Death with dignity in Colombia, and a last minute reversal (Updated)

 The Washington Post has the story (followed by new developments at the very last minute):

She’s 51, a mother and a devout Catholic. She plans to die by euthanasia on Sunday.   By Samantha Schmidt and Diana Durán 

"In November 2018, a doctor gave Martha Sepúlveda her diagnosis: amyotrophic lateral sclerosis, the progressive neurological disease known in the United States as Lou Gehrig’s disease. In the months that followed, the Colombian woman lost control of the muscles in her legs — and she knew it would only get worse.

...

"Sepúlveda started reading about an option that could relieve her fear of what was to come: Euthanasia. Colombia, she learned, is the only country in Latin America — and one of only a few worldwide — that permits patients to end their lives.

"Until this year, the option has been available legally only to those who are expected to live for six months or less. On Sunday, Sepúlveda, who considers herself a devout Catholic, plans to become the first person in Colombia without a terminal prognosis to die by legally authorized euthanasia.

"Colombia’s constitutional court ruled in July that the right to euthanasia — recognized here in 1997 — applies not only to terminal patients, but also to those with “intense physical or mental suffering from bodily injury or serious and incurable disease.”

"The ruling has divided the faithful in this majority-Catholic country. Church officials have described euthanasia as a “serious offense” to the dignity of human life; a member of the national bishops’ conference urged Sepúlveda to “calmly reflect” on her decision and invited all Catholics to pray that God will grant her mercy."

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

Update: some late breaking news:

They cancel euthanasia of the Colombian Martha Sepúlveda, who was going to die this Sunday

"The IPS Incodol (Colombian Institute of Pain) canceled the euthanasia of Martha Sepulveda, which was scheduled for this Sunday at 7 am

"The Interdisciplinary Scientific Committee for the Right to Die with Dignity “unanimously concluded to cancel the procedure.”

"The IPS added that “The request was reviewed and analyzed again in a comprehensive and sufficient manner”, then “it is defined that the termination criterion is not met, as was considered in the first committee ”.

"This 51-year-old woman was to become the first non-terminal patient to access euthanasia this Sunday. Sepúlveda did not know of the mass that was celebrated in his name, nor of the request that the Colombian Episcopal Conference for you to reconsider your decision.

"She was ready to die and had even turned off her cell phone. “Martha has no idea what the priests have said, so it’s really like the world is exploding outside and she has no idea what’s going on. If Martha’s cell phone were available, she would have no life, but we have been very careful that she is in her world, sheltered now and that no one interferes with her peace and tranquility “, said Camila Jaramillo Salazar, her lawyer, before meeting the IPS."

*********

Here's the Washington Post followup on this development:

She had canceled her phone plan and was ready to die. Now a surprise decision has halted her euthanasia bid.  By Samantha Schmidt and Rachel PanBOGOTÁ, Colombia — A 51-year-old woman was set to become the first person in this majority-Catholic country without a terminal prognosis to die by legally authorized euthanasia on Sunday. But a surprise 11th-hour decision by health officials has halted her bid.

"Martha Sepúlveda was awakened by her lawyers Friday night with the news of a letter announcing that her euthanasia procedure scheduled for 7 a.m. Sunday had been canceled, after a medical committee determined that she no longer met the conditions because her health had apparently improved.

"The decision to cancel the procedure came as a complete surprise, according to her lawyers. She had no idea health officials were even meeting to review her case. She had been quietly living out her final hours, and had tuned out media coverage of her case.

...

"“They’re obligating her to live a life that she is not willing to continue to live,” said Lucas Correa Montoya, a lawyer representing Sepúlveda alongside Jaramillo with DescLAB. “What has happened in the past few weeks is an example of the long road ahead for death with dignity in Colombia.”

*******

Update: here's the end of that story:

Colombian woman dies by euthanasia after historic legal fight. By Samantha Schmidt and Diana Durán  January 8, 2022

"A 51-year-old Colombian woman died by euthanasia on Saturday after a historic legal battle to exercise the right in this majority-Catholic country.

"The case of Martha Sepúlveda drew international attention last year when she planned to become the first person in Colombia without a terminal prognosis to die by legally authorized euthanasia. But less than two days before she planned to die in October, a medical committee determined she no longer met the conditions and canceled the procedure. A judge eventually cleared the way for Sepúlveda to move forward.

...

"Colombia was one of the first countries in the world to decriminalize euthanasia; its constitutional court recognized the right in 1997. But for many years, the country extended the right only to patients with a terminal prognosis of six months or less.

...

"Although ALS is a fatal disease with no cure, patients can survive from two to 10 years or more, depending on how their conditions progress. When Sepúlveda first sought out euthanasia, her prognosis did not qualify as “terminal.”

"But in July, the country’s constitutional court ruled that the right applies not only to terminal patients but also to those with “intense physical or mental suffering from bodily injury or serious and incurable disease.” The decision allowed Sepúlveda to schedule her euthanasia for Oct. 10.

"As her story circulated in Colombian news in early October, her decision drew a rebuke from local church leaders. A member of the national bishops’ conference urged Sepúlveda to “calmly reflect” on her decision and invited Catholics to pray that God would grant her mercy.

"Then, in an 11th-hour move, her euthanasia was abruptly canceled. The Colombian Institute of Pain, or Incodol, which had been scheduled to carry out the procedure, said Sepúlveda’s condition had improved between July and October.

...

"After her appeal, a judge from Medellín ruled on Oct. 27 that Sepúlveda was entitled to die by euthanasia.

"The judge confirmed that patients who endure intense physical or mental suffering — with diseases such as Lou Gehrig’s — are legally allowed to access euthanasia even if their prognosis is not terminal, and that Sepúlveda’s health provider was not justified in its denial of her request.

...

"On Friday, a day before Sepúlveda’s death, a different Colombian patient became the first person without a terminal prognosis to die by euthanasia. The patient, a man in Cali named Victor Escobar, suffered from end-stage chronic obstructive pulmonary disease.

“The fight to take control over the end of life continues and will not end until people in Colombia can access an assisted medical death according to their will and without barriers,” Sepúlveda’s lawyers said."

Peter Lorentzen interviews me about market design (podcast)

 Peter Lorentzen interviews me about market design, and my book Who Gets What and Why. (We have an interesting conversation on market design and my career, not closely related to the book...)

"In our interview, we range far beyond the examples from the book to discuss the implications of his work for the design of tech’s market-making “platform” businesses like Airbnb, Amazon, Lyft, or Uber, the challenges he faces when countries or people view some kinds of transactions as “repugnant” or morally unacceptable, and the reasons why San Francisco’s school district (unlike Boston’s or New York’s) chose not to implement the un-gameable school choice plan his team devised for them.

"Host Peter Lorentzen is an Associate Professor in the Department of Economics at the University of San Francisco, where he leads a new digital economy-focused Master's program in Applied Economics."

;

Repugnance watch: Dog (as) food in Korea--opposition from the President, amidst growing pet ownership

 Here's the story from the Guardian:

South Korean president suggests ban on eating dog meat. Moon Jae-in, a dog-lover, says ‘time has come’ for traditional practice to end. 

"The South Korean president, Moon Jae-in, has raised banning the eating of dogs in the country, his office said, a traditional practice that is becoming an international embarrassment.

"The meat has long been a part of South Korean cuisine with about 1 million dogs believed to be eaten annually, but consumption has declined as more people embrace the animals as companions rather than livestock.

"The practice is something of a taboo among younger generations and pressure from animal rights activists has been mounting.

“Hasn’t the time come to prudently consider prohibiting dog meat consumption?” Moon asked the prime minister, Kim Boo-kyum, during a weekly meeting on Monday, according to the presidential spokesperson."

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

And from the Washington Post:

South Korea considers ban on eating dog meat as pet ownership grows in the country  By Grace Moon  and Andrew Jeong

 "South Korea is considering a ban on dog meat consumption, officials said Tuesday, a day after President Moon Jae-in ordered the government to explore such a move.

"The news comes after years of public outcries against the roughly 3,000 dog farms still operating in South Korea. Animal rights activists have accused the farmers of holding dogs in horrid conditions.

"Criticism surrounding the consumption of dog meat has grown as more South Koreans adopt canine pets: About 27 percent of South Korean homes have pets, with the majority of them being dogs — up from 17 percent in 2010 — according to the agriculture ministry. (About half of American households reported having pets in 2018, according to the Census Bureau and Simmons National Consumer Study.)"

Market design in La Republica

 In anticipation of the Econometric Society meeting in Colombia later this month, I was interviewed by La Republica. The interview was in English, and is published in Spanish, but is fairly readable via Google Translate...)

"Migración será uno de los problemas más grandes del market design”: Alvin E. Roth

"Migration will be one of the biggest problems in market design": Alvin E. Roth

by Lilian Mariño Espinosa 

"The Universidad del Rosario, in its 367 years, has sought to be a pillar of knowledge, which is why it tends to generate spaces for dialogue that analyze and provide solutions to changes in society. In the midst of the current situation, in which the covid increased problems such as inequality, the institution will be the organizer of the Annual Meeting of the Latin American and Caribbean Economic Association (Lacea) and the Latin American chapter of the Econometric Society (Lames) , which will take place on October 20, 21 and 22, virtually.

"The event, which will feature policy makers, public and private officials and academics such as Alvin E. Roth, (from Stanford University and Nobel Prize in Economics in 2012), Pinelopi Goldberg (from Yale University and former Chief Economist of the Bank Mundial) and Oriana Bandiera (from the London School of Economics), will discuss and reflect on how Latin America can best cope with these difficulties, without losing sight of other economic challenges.

"As an appetizer for the event, at LR we spoke with Roth, who explained how market design can be an opportunity to solve several of the problems facing the region and the world..."

Indian Society of Organ Transplantation 2021 Annual Meeting, Oct 7-10

 31st Annual Conference of The Indian Society of Organ Transplantation 7th to 10th October 2021 GRAND HYATT LULU BOLGATTY CONVENTION CENTER in Kochi (Cochin)

My talk (via Zoom) tomorrow morning in CA/evening in India will be on 

"Kidney exchange, around the world and in India"

http://www.isot2021.com/images/pop1.jpeg?refresh=210923023039

ABOUT ISOT 2021 KOCHI  Virtual Conference

"It is our pleasure to invite you to the 31st Annual Conference of the Indian Society of Organ Transplantation, ISOT 2020 Kochi a programme organized by team of Transplant Professionals of Kochi to be held at hotel Grand Hyatt, Lulu Bolgatty Convention Centre from 07th to 10th of October 2021. We are fortunate to have renowned experts across the globe as speakers. This conference will also give you an opportunity to interact with the experts in the field. Wide range of topics, venue of International standard, best hospitality in the Gods own country of Keralam will be the highlights.

"Grand Hyatt Kochi is a Luxury 5 star deluxe waterfront hotel overlooking the serene waters of Vembanad lake with a range of dining, wellness and enriching experiences.

"With a large number of advanced tertiary/quaternary care facilities, Kochi has one of the best healthcare facilities in India. It is the prime destination for people seeking advanced healthcare facilities across Kerala. In recent times, it has attracted a large number of patients from all over India, Middle East, African nations as well as from Europe and United States looking for relatively inexpensive but advanced medical care. Kochi is the only city in Kerala that have carried out successful kidney, liver, heart, pancreas and composite tissue transplantation. VPS Lakeshore Hospital, Amrita Institute of Medical Sciences and Research Centre, Medical Trust Hospital, Lisie Hospital, AsterMedicity, Lourde’s Hospital are some of the advanced tertiary/ quaternary healthcare facilities in Kochi.

"Kochi also known as Cochin is the financial and industrial capital and the biggest city of Kerala that offers excellent airline connectivity with direct flights to 22 destinations including all the major cities of the country. It is also known for its salubrious climate particularly during the month of October attracting a large number of tourists from Europe, Americas and rest of Asia as well as domestic tourists. City also flaunts one of the finest natural harbours of the world. Finest beaches, tranquil back waters, luxurious houseboats, multi-cuisine restaurants, and numerous shopping malls are other attractions."

Fuhito Kojima and I will discuss improving social welfare with matching theory in a Nikkei Business webinar this evening

Fuhito Kojima and I will participate in a Nikkei Business Zoom webinar on The Future of Management 2030, in English and Japanese (I think translation will be available).

 "Nikkei Business LIVE will hold a webinar entitled "The Future of Management 2030: Rebuilding Capitalism and Revitalizing Innovation" for three days from October 5th to 7th. 

Our discussion, on "Creating a better society by implementing matching theory" will be at 11AM tomorrow in Japan (which is 7PM this evening in California).

"Creating a better society by implementing matching theory in society"

"Auction theory that was in the limelight at the 2020 Nobel Prize in Economics. It is one of the theories representing the new field of microeconomics, "market design," which seeks to design a market in which traders can satisfy each other, rather than analyzing the existing market as in the past. The pioneer who won the Nobel Prize in Economics for "market design" is "matching theory" by Professor Alvin Roth and others. He talks with Professor Fuhito Kojima of the University of Tokyo Graduate School of Economics, who is a direct pupil and a former colleague at Stanford University, about the future brought about by the social implementation of economic theory." (via Google translate)

More on the UAE-Israel kidney exchange

If you're just tuning in, you can follow the story of the kidney exchange between the UAE and Israel here. The pairs who exchanged kidneys were an Israeli Arab husband and wife, a Jewish Israeli mother and daughter, and a mother and daughter who wish to be identified only as Arab residents of the United Arab Emirates.  (I joined their family at their home for a meal when I was in Abu Dhabi, but won't say more about them.)

It isn't a surprise that the donor in each pair couldn't donate to the intended recipient, because in each pair the recipient was a highly sensitized mother ( i.e. for whom it was hard to find a compatible kidney, because she had many antibodies against human proteins). During childbirth, mothers can develop such antibodies to the father's proteins that the children inherited. So the father and the daughters were incompatible donors, since the mother had antibodies against the paternal proteins (human leukocyte antigens) in their kidneys. Together with the fact that the mothers were quite hard to match, and that Israel and the UAE are both small, each with populations of around ten million, they had to look across national borders.

Cross border kidney exchange requires some diplomacy, particularly when the countries involved are getting together for the first time (and don't necessarily have a long history of cooperation). The key medical diplomats were Dr. Tamar Ashkenazi* the director of Israel Transplant and Dr Ali Abdulkareem Al Obaidli, Chairman of the UAE National Transplant Committee.  (Other key collaborators in the complicated logistics were Itai Ashlagi at Stanford and Atul Agnihotri and Mike Rees of the Alliance for Paired Kidney Donation.)  

So this was the plan:

And here's a picture of the Abu Dhabi kidney packed for shipping (masked in the picture are Sue and Mike Rees, who have a lot of experience with packing and shipping kidneys, another nurse whose name I don't know, and Dr. Muhammad Badar Zaman the UAE transplant surgeon who transplanted the  kidney that was on the way.

The little box taped to the top of the shipping container allows the kidney to be tracked in transit, via an app that gives you a picture of where it is at it travels:

And here's the swap of the two kidneys in shipping containers in the airport in Abu Dhabi (Tamar Ashkenazi and Dr. Ali are in the center, Atul and Mike are at the two ends...). Dr Ashkenazi was on both legs of the flight above--she flew in with the Israeli kidney and flew out with the UAE kidney.

On my last night in Abu Dhabi I had dinner with a lot of the docs. Across from me in the picture below are the two surgeons most actively involved in this exchange on the UAE side, transplant surgeon Dr. Zaman and the nephrectomy surgeon Dr. Hamid Reza Toussi.  Next to me is the nephrologist Dr. Mohamed Yahya Seiari.

Below is that whole dinner party. If you've been following these posts up til now, you've met all of them except the gentleman second from the left, Dr. Gehad ElGhazali, who is the head of the HLA lab, which is responsible for the data that allows the matching algorithm to predict which kidneys are compatible, and is responsible for the final 'crossmatch' tests that verify compatibility. Like all the other docs I encountered, he has a multi-international background. This reflects the UAE's very international population, which is why it seems a natural global hub for kidney exchange.

I only met the Israel participants in the exchange later, by Zoom: Shani Markowitz is the donor from the Jewish pair, and Walaa Azaiza is the recipient from the Israeli Arab pair.

The Israeli transplant surgeons are Dr Tony Karam at Rambam Hospital and Dr. Eitan Mor at Sheba Medical Center.

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*As it happens, I've twice had the privilege of  being Dr. Ashkenazi's coauthor (concerning deceased organ donation):

1. Stoler, Avraham,  Judd B. Kessler, Tamar Ashkenazi, Alvin E. Roth, Jacob Lavee, “Incentivizing Authorization for Deceased Organ Donation with Organ Allocation Priority: the First Five Years,” American Journal of Transplantation, Volume 16, Issue 9, September 2016,  2639–2645. http://onlinelibrary.wiley.com/doi/10.1111/ajt.13802/full 

2. Stoler, Avraham, Judd B. Kessler, Tamar Ashkenazi, Alvin E. Roth, Jacob Lavee, “Incentivizing Organ Donor Registrations with Organ Allocation Priority,”, Health Economics, April 2016 online http://onlinelibrary.wiley.com/doi/10.1002/hec.3328/full ; doi: 10.1002/hec.3328. In print: Volume: 26   Issue: 4   Pages: 500-510   APR 2017

Technology and Equality in the Digital Era--Luohan Academy

 Last week I participated in a Luhohan Academy discussion called 

Boosting Shared Prosperity: Technology and Equality in the Digital Era

Speakers : David Autor, Erik Berglof, Long Chen, Hanming Fang, Ginger Jin, Alvin Roth, Tom Sargent, Michael Schwarz, Michael Spence, Steve Tadelis, Robert Townsend,

I discussed the presentations by David Autor and Rob Townsend.

Here's the video (on YouTube):

Here's a Symposium summary.

UAE as a natural hub for international/global kidney exchange

 There are excellent hospitals in the United Arab Emirates that can perform kidney transplants, and they are prepared to do kidney exchange, both domestically and internationally.  My post today is about why the UAE would be a natural international center for kidney exchange. 

International hubs for kidney exchange are needed because hard-to-match patient-donor pairs may need to find compatible exchanges outside the borders of their own countries. This is particularly true for citizens of countries with relatively small populations of potential compatible donors, and of countries that don't yet have widespread kidney exchange. But even a big country like the U.S., in which kidney exchange is a standard mode of transplantation, can sometimes be too small to find compatible kidneys for the hardest to match  patients. (The U.S. itself is a natural hub for global kidney exchange, about which I've written elsewhere. But so far, bureaucratic obstacles have prevented us from integrating kidney exchange even with Canada...)

The UAE itself is already quite international, as only about 10% of its approximately 10 million residents are Emirati citizens; the rest, largely foreign workers and their families, are citizens of other countries. The biggest of the Emirates, Abu Dhabi, provides medical care for its residents that includes dialysis and transplantation for kidney failure, which is prevalent there (perhaps due in part to the very hot weather and the perils of frequent dehydration in outdoor work). Most of those patients are on dialysis, although the national health insurance will pay for transplants for those who have willing donors either in the Emirates or in their home country. The UAE is wealthy, and many of the home countries are not, so my understanding is that the UAE is prepared to assume the costs of bringing family members to the UAE and providing the necessary medical care. This is cost effective as well as good for the patient, because in the UAE as elsewhere, transplantation is much cheaper than dialysis, as well as being the best treatment. So taking a UAE resident off dialysis via transplant saves a life and pays for itself.

Of course, sometimes the UAE resident's family member who is willing to donate a kidney isn't compatible with the UAE resident. So kidney exchange makes a lot of sense in this case. But with a resident population of only 10 million, there are severe limits on how much kidney exchange can do for hard-to-match patients. So international, global kidney exchange makes sense, in which patient-donor pairs from other countries could also be transplanted in the UAE through kidney exchange with UAE residents (or, eventually, with other international pairs).

It helps a lot that the UAE is also an air transit hub, with two international airlines. Emirates has a hub in the Emirate of Dubai, and Etihad has a hub in Abu Dhabi. So a big portion of the world's population is within a few hours of direct air travel to the UAE.  (When I went to the UAE this summer in connection with the UAE-Israel kidney exchange, I took a direct flight from San Francisco to Dubai, but that takes sixteen hours...)

My main goal in the UAE was to meet with various mostly government bodies engaged in an effort, in collaboration with the Alliance for Paired Kidney Donation, to make domestic and international kidney exchange a regular part of medical care there. To that end, we met with the Ministries of Health in Dubai and in Abu Dhabi, with the national health insurance, with the Red Crescent (which is able to get involved in care of patients and donors after they return home), and others.

The key player in organizing this collaboration, and in transplantation generally in the UAE is  Dr Ali Abdulkareem Al Obaidli, transplant nephrologist and Chairman of the UAE National Transplant Committee. Two other key figures from the APKD are Mike Rees and Atul Agnihotri. Many of our meetings ended in photos, and I'm with those three in all pictures below. 

I expect to write some more about this. In the meantime, here are related posts.

Thursday, September 30, 2021

Kidney Exchange between Israel and the UAE (in USA Today, yesterday)

Friday, October 1, 2021

Stanford celebrates Itai Ashlagi and the UAE-Israel kidney exchange

And this older one:

Friday, August 7, 2020

Global kidney exchange between Abu Dhabi and Kerala (India)

Here's a slide from a talk I'll be giving shortly at the annual conference of the Indian Society of Transplantation (ISOT) that provides some more information about this UAE-India exchange

Stanford celebrates Itai Ashlagi and the UAE-Israel kidney exchange

Here's a Stanford story celebrating Itai Ashlagi's role in this summer's UAE-Israel kidney exchange. (His matching software is embedded in the software suite of the Alliance for Paired Kidney Exchange (AKPD) which is a partner with a remarkable Abu Dhabi effort to further kidney exchange.)

Stanford engineers develop algorithm to aid kidney transplant exchanges. A historic and complex kidney exchange between Israel and Abu Dhabi put a spotlight on the Stanford algorithm that made it all possible. BY ANDREW MYERS.  AUGUST 12, 2021

"A historic kidney transplant exchange recently took place in the Middle East, but it might never have transpired without an algorithm developed at Stanford by Itai Ashlagi, a Stanford associate professor of management science and engineering, and his graduate student Sukolsak Sakshuwong. In all, three ailing recipients received life-sustaining transplants while three healthy donors gave kidneys.

...

"“One of the nice things in the software we developed is the user interface. We collect all the relevant patient data, but then we let the user play with the various thresholds that determine successful matches to see what works for them,” Ashlagi said as he explained the team’s game-like approach to matching. The software acts as a platform and allows different organizations to easily collaborate and create more possibilities for exchanges. “Just a few days ago, I was looking for matches and found an unexpected exchange between pairs from Israel and other European countries. Hopefully, this will lead to new collaborations.”

“Itai’s software was used on both sides of that historic exchange between Abu Dhabi and Israel,” said Alvin Roth, Nobel Laureate and Ashlagi’s mentor and frequent collaborator, who was in Abu Dhabi in connection with the exchange.

"Roth says Ashlagi exemplifies the concept of scientist-engineer and is now a driving force in contemporary kidney exchange through both his deep understanding of the immunological issues of matching kidneys to patients and his intimate appreciation of the needs of transplant centers.

“He’s turned those practical theoretical insights into widely deployed digital tools with the power to change lives,” Roth added. “Having the chance to collaborate with him has been among the best experiences of my intellectual career.”

Kidney Exchange between Israel and the UAE (in USA Today, yesterday)

 I spent a week in the UAE this summer, in connection with a three-pair kidney exchange between the UAE and Israel.  (The UAE is a natural hub for kidney exchange, something I'll say more about in subsequent posts.) Because there were some sensitivities about how it would be publicized, I've  refrained from blogging about it until now, but yesterday's front page story in USA Today met with just about everyone's approval, and so over the next few days I'll post some observations. Today I'll start with the USA Today story, which is gated, but can also be found ungated on Yahoo, here:

How three Jewish and Arab families swapped kidneys, saved their mothers and made history by Marco della Cava, USA TODAY, Wed, September 29, 2021 AM

"At a time when the world seems rife with division and discord, what happened on July 28 reminds how mutual survival often depends on shared humanity triumphing over historical differences.

"In this case, with the assistance of organ transplant experts in the United States, Israel and the United Arab Emirates, three pairs of kidney donors and recipients in Israel and the UAE saved each other in a series of choreographed, pay-it-forward surgeries known as a cyclic exchange.

...

"Just consider the logistics involved in the UAE-Israel exchange. A UAE daughter who was not a match for her mother volunteered to give her kidney to a stranger. An Israeli Arab woman was a match for that kidney, so her husband agreed to donate his kidney to save an Israeli Jewish mother – whose daughter in turn gave her kidney to the sick mother in UAE.

"“The reason we are excited about this is simply because the bigger the pool, the more likely you are to find matches,” says Dr. Michael Rees, a surgeon and founder of the Alliance for Paired Kidney Donation, a Toledo, Ohio-based nonprofit instrumental in making this politically groundbreaking kidney transplant chain a reality.

...

"Those communications, however, remain politically sensitive. When asked for comment, officials in the UAE focused less on the partnership with Israel and more on a general need for international cooperation.

"We are pleased that our innovative partnership with the Alliance for Paired Kidney Donation has allowed us to help our patients,” says Dr. Ali Al Obaidli, chairman of the UAE National Transplant Committee. He added that a collaborative spirit between countries can be used to “close the gap” for those in need of kidneys.

"The UAE donor daughter and recipient mother asked not to be identified by name or religion. Conversations with those involved in the cyclic exchange say kidneys donated outside the UAE generate negative reactions among some Emirati.

...

"This unique transplant chain began when the 60-something mother in the UAE found out in fall 2020 that she had kidney failure and would soon need to start dialysis or find a new kidney.

"Because her family members were not matches, Rees and his Alliance for Paired Kidney Donation team got to work finding a match, which also involved seeing where her daughter’s donor kidney might go.

"The first step was to plug all the relevant medical details into an algorithm ...

"Also crucial to the process was Roth's Israeli colleague Itai Ashlagi, who had developed software that could instantly mine his native country’s kidney database. While Israel had started to develop transplant relationships with Austria and the Czech Republic, he was excited about this new involvement with the UAE.

“Better to exchange kidneys than bombs,” says Roth, adding that using computers to search the world for medical solutions radically increases the chances of patients getting help. “International boundaries are artificial markers. Kidney disease doesn’t care about that.”

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Here's the picture on the USA TODAY front page: Tamar Ashkenazi flew from Israel to UAE with an Israeli kidney, and flew back with the UAE kidney...

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Here's a USA Today 1-minute video collage of pictures and video accompanying the story:

Daughters from the UAE and Israel put differences aside to save lives in kidney exchange. Three pairs of kidney donors and recipients in Israel and the UAE saved each other in a series of pay-it-forward surgeries known as a cyclic exchange. by Harrison Hill, USA TODAY

I'll have more to say soon, and will link back and forth between posts to make the whole story accessible.