Kidney exchange chains between Israel and Cyprus

 Israel Hayom has the story. (Itai Ashalgi's software gets a shout-out):

Unprecedented Israel-Cyprus kidney exchange saves 8 lives. Cross-border medical collaboration showcases the power of organ donation and transplant innovation.    By  Eleanor Favriker/Makor Rishon

"In a remarkable display of international medical cooperation, eight kidney transplants have been performed across Israel and Cyprus as part of a pioneering cross-border organ exchange program. The intricate operation, involving multiple hospitals and a meticulously coordinated logistics effort, was made possible by two altruistic donors who approached the National Transplant Center, initiating a "transplant chain."

"The joint operation, conducted on Monday, saw five procedures taking place in Israel and three in Cyprus. The National Transplant Center matched the pairs using specialized computer software, drawing from an international database containing incompatible family member pairs.

"Starting at 5:00 a.m., kidneys harvested at Hadassah and Soroka hospitals were transported by ambulance to the airport and flown to Cyprus. Concurrently, another kidney from Hadassah was transferred to Soroka, while one from Beilinson was sent to Hadassah. At 2:00 p.m., two kidneys arrived from Cyprus, destined for Beilinson and Hadassah. By 6:00 p.m., all transplants were completed in both countries, with recipients in good condition and new kidneys functioning.

"In Israel, three transplants occurred at Hadassah, one at Beilinson, and one at Soroka, with an additional Hadassah transplant performed a day earlier. In total, Israel saw 10 surgeries: five kidney removals and five transplants.

"Professor Shlomo Mor Yosef, chairman of the Steering Committee, said, "I commend the cooperation between Israel and Cyprus. These exchanges provide solutions for patients with antibodies. I urge every family with a patient needing a kidney transplant to join the exchange database if no match is found among them."

"Dr. Tamar Ashkenazi commented, "This marks our first two-way kidney exchange with Cyprus. Their single transplant center in Nicosia performed six surgeries in one day, supported by a surgeon from England. I'd like to thank Ms. Rona Simon, who manages our exchange database, facilitating over 60 successful cross-transplants annually. Israel maintains similar programs with the Czech Republic, Austria, and the United Arab Emirates."

Anticipating kidney exchange in Germany in the Frankfurter Allgemeine Zeitung

  Here's an op-ed in the Frankfurter Allgemeine Zeitung, celebrating the anticipated beginning of kidney exchange in Germany.

Der Volkswirt Hoffnung durch Tausch  by Ágnes Cseh, Christine Kurschat, Axel Ockenfels und Alvin E. Roth

Here's the English translation (from a slightly earlier draft):

Hope through exchange

Germany's new draft law on kidney donation

Imagine this: Your child needs a kidney transplant, but due to tissue incompatibility you cannot be a donor yourself. And it's the same for me. What if you donated a kidney to my child and I donated a kidney to yours in return? Through this ‘cross-donation’ we could give our children the chance of a longer life with a better quality of life.

In Germany, such cross-donations are not usually permitted. Only people who are ‘obviously close in a special personal relationship’, such as relatives and spouses, are allowed to donate kidneys. This is now set to change. The Federal Cabinet has presented a draft bill to amend the Transplantation Act, which would allow cross-donations and other forms of living kidney donation. These include ring exchanges with more than two participating couples as well as longer donor chains initiated by a non-directed, anonymous donation.

People who hear about cross-donation for the first time are sometimes skeptical. However, these concerns can be dispelled on closer inspection. In our neighboring countries and in many other countries, such donations have long been successfully established in compliance with the highest ethical standards.

In cross-donation, no prices are paid for kidneys and there is no trading in kidneys. A system in which potential cross-donors are registered and referred centrally can be implemented in an abuse-proof manner, as experience abroad has shown. The Ministry of Health's draft calls for a close relationship to continue to exist between donor and recipient who register together in the kidney donation program, but no longer necessarily between the donor of an organ and the recipient of the same organ. The couples involved can be guaranteed anonymity, so that mutual influence can be ruled out and at the same time the altruistic motive for donating to the next of kin remains unchanged.

But what happens if the donor has already donated their kidney, but the cross-donor suddenly cancels? To avoid such situations, the two kidneys are removed from the two donors at the same time, and the two patients also receive the two organs at the same time. The four surgical teams communicate in order to coordinate the procedure safely.

The argument that authorizing cross-donation could increase the pressure on potential donors does not stand up to closer scrutiny either. The option of cross-donation does not create any additional pressure that is not already exerted on compatible donors. Instead, cross-donation merely expands the pool of potential donors. 

Incidentally, cross-donation also shortens the waiting list for post-mortem donations, so that patients without donors can also be helped. At the same time, cross-donation can protect the legitimate interests of those people who do not wish to donate if it is implemented in a suitable institutionalized manner and the best possible information is provided.

Germany now has the opportunity to learn from the existing systems in Europe in order to avoid mistakes in the regulations and their implementation for the benefit of organ recipients and donors. This applies, for example, to the establishment of a nationwide kidney donation program, from funding and equipment to biomedical expertise. The Federal Ministry of Health is making important proposals here. The large gaps in data on potential donors and recipients could soon be closed, the option of enabling international coordination of cross-donations is being considered from the outset, and the transplant centres are being encouraged to register all donor-patient pairs centrally for referral. Without such regulations, individual clinics could be incentivized to only selectively register pairs, with the result that fewer transplants can be carried out overall.

Other aspects of the draft should be reconsidered. For example, it is not advisable that couples can only participate in the kidney exchange program if donor and recipient are incompatible. Compatible couples can receive a more suitable kidney through participation and at the same time other patients can be helped, as more cross-donations are made possible through participation. This in turn can shorten the waiting list for all patients who do not have their own donor and therefore cannot participate in the kidney exchange program.

It is good news that new forms of living organ donation are now also to be made possible in Germany. The precise organization of these new forms of organ donation is crucial to their success. It can be modelled on the experiences of other countries and at the same time adapted to the specific legal, historical and ethical framework conditions in Germany. The initial investment would be amortized very quickly through the savings in treatment costs for expensive dialysis. 

In view of the draft law, we are optimistic that the wish of many potential donors to help can be fulfilled in the future, thus improving the care situation for kidney patients in Germany.

Ágnes Cseh (University of Bayreuth), Christine Kurschat (University of Cologne), Axel Ockenfels (University of Cologne and Max Planck Institute for Research on Collective Goods in Bonn) and Alvin E. Roth (Stanford University)

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Here's the (rather opaque) graphic the newspaper created (maybe it's a celebration by kidneys):

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Here's a link to what I think was my first op-ed in German on allowing kidney exchange there...

Thursday, March 17, 2016

German organ transplant law should be amended or reinterpreted to allow kidney exchange: my op-ed in Der Tagesspiegel

Simulating kidney exchange policies in Germany

 Here are a set of simulations designed to help Germany establish a national (rather than a fragmented) kidney exchange system.

Itai Ashlagi, Ágnes Cseh, David Manlove, Axel Ockenfels & William Pettersson,  Designing a kidney exchange program in Germany: simulations and recommendations. Central European Journal of Operations Research  (2024). https://doi.org/10.1007/s10100-024-00933-0

"Abstract: We examine some of the opportunities and challenges concerned with establishing a centralized national kidney exchange program in Germany. Despite the many advantages of a national program, without deliberate design and policy intervention, a fragmented kidney exchange program may emerge. We study a number of collaboration strategies, and resulting simulations suggest that transplant centers may find it advantageous not to fully participate, resulting in a net reduction in the number of transplants. These results also suggest that allowing more forms of kidney exchange, such as three-way exchanges and non-directed donations, can significantly increase the number of transplants while making participation in a national program more attractive and thus national coordination and cooperation more robust. We propose a multi-level policy approach that is easy to implement and would promote an efficient German kidney exchange program that benefits recipients, donors and hospitals."

...

The concluding sentence of the paper is:

"Germany should establish a robust, well-functioning national KEP that can be easily and straightforwardly integrated into an international KEP."

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Background:

Thursday, July 18, 2024

Kidney exchange in Germany: draft of a proposed law

Market design at Iowa State: course invites remote access

 Bertan Turhan writes to tell me about the market design course he is offering this semester, to which he invites remote participation (for access you can email him at bertan@iastate.edu ).

He writes:

"I wanted to inform you about a second-year PhD course I am teaching this semester with great guest lecturers. It is in person and taken by both Econ, OR, and CS students at ISU, but I also live broadcast it so that others can benefit. ... The course is mainly based on the Online and Matching-Based Market Design (Echenique, Immorlica, and Vazirani). "

Here is the syllabus and other readings.

Stanford celebrates Susan Athey

 This  from Stanford Report:

What motivates Susan Athey. The economist weighs in on incremental innovation, data-driven impact, and how economics is evolving to include a healthy dose of engineering. 

"Today, Athey, the Economics of Technology Professor at Stanford GSB, is using her expertise to promote the public good. In 2019, she founded the Golub Capital Social Impact Lab, which uses digital technology and social science research to improve the effectiveness of social sector organizations.

...

"For more than a decade, Athey’s professional passions have been linked to their potential for impact. She chose to return to Stanford — after six years teaching at Harvard — because of the opportunity for cross-disciplinary collaboration. And she has helped make such collaboration possible. In 2019, she was a founding associate director of the Stanford University Human-Centered Artificial Intelligence Institute. She is also a leader of the Business and Beneficial Technology pillar within Stanford GSB’s newly launched Business, Government, & Society Initiative, which brings together academics, practitioners, and policymakers to address issues such as technology, free markets, and sustainability.

"Athey’s Golub Capital Social Impact Lab epitomizes interdisciplinary work, putting students from computer science, engineering, education, and economics backgrounds to work helping partner organizations leverage digital tools and expertise that are generally only available to — or affordable for — large technology companies.

“I like building things that demonstrate how a class of problems can be solved,” Athey says. “If there is a problem worth solving, and I can solve it myself in a particular case, I know there are other people like me who are going to encounter the same problem. Part of the motivation and theory of change of the lab is that we will solve particular problems for particular social-impact organizations but also create the research that will guide others in solving similar problems.”

...

"Athey says some parts of economics are evolving to include a healthy dose of engineering. In the Microsoft Research interview, she described stereotypical economics research as evaluating existing programs and often finding that “stuff doesn’t work.”

“There’s a lot of negativity,” she says. With help from data and machine learning techniques, “my prediction is that economists are going to become more [like] engineers. Instead of complaining that nothing works, we’re going to start building things that do work to achieve economic outcomes…. We’re going to realize that nothing works if it’s one size fits all, but that a lot of things work if they are actually personalized and appropriately delivered.”

Social Choice & Fair Division: Theory & Applications, at the University of Tehran this weekend

 Mehdi Feizi (مهدی فیضی) writes to alert me to the upcoming conference, at the University of Tehran, on Social Choice & Fair Division: Theory & Applications

"The Tehran Economic Policy-Making Think-Tank (TEPT) at the University of Tehran and the Ferdowsi Center for Market Design (FCMD) at the Ferdowsi University of Mashhad invite applications for the 2024 Summer School on Social Choice and Fair Division (SCFD): Theory and Applications. The School will take place at the University of Tehran on September 6th and 7th and at the Ferdowsi University of Mashhad on September 8th. The SCFD2024 Summer School is aimed at advanced graduate students, post-docs, and junior faculty members. All courses are taught in English.

Topics and Speakers

The SCFD2024 Summer School will address the most important recent developments in social choice and fair division. It will be practice-orientated with a solid theoretical grounding, combining international policy relevance with a state-of-the-art high-level scientific program. At SCFD2024 Summer School, we have a collection of leading experts in their fields who strongly engage with policy-making institutions.

Keynote Speakers

Haris Aziz (University of New South Wales, Australia)

Fuhito Kojima (University of Tokyo, Japan)

François Maniquet (Université catholique de Louvain, Belgium)

Marcus Pivato (Université Paris 1 Panthéon-Sorbonne, France)

Arunava Sen (Indian Statistical Institute, India)

 

Lecturers

Inácio Bó (University of Macau, China)

Satya Chakravarty (Indira Gandhi Institute of Development Research, India)

Sinan Ertemel (Istanbul Technical University, Turkey)

Flip Klijn (Institute for Economic Analysis, Spain)

Alexander Nesterov (HSE University, Russia)

Kemal Yildiz (Bilkent University, Turkey)

Incentives matter for getting participation in clinical trials by low income households

 Here's a study that casts some light (via a randomized experiment) on the importance of incentives to get representative participation in clinical trials.

Nonrepresentativeness in Population Health Research: Evidence from a COVID-19 Antibody Study By Deniz Dutz, Michael Greenstone, Ali Hortaçsu, Santiago Lacouture, Magne Mogstad, Azeem M. Shaikh, Alexander Torgovitsky, and Winnie van Dijk, AER: Insights 2024, 6(3): 313–323, https://doi.org/10.1257/aeri.20230195

Abstract: "We analyze representativeness in a COVID-19 serological study with randomized participation incentives. We find large participation gaps by race and income when incentives are lower. High incentives increase participation rates for all groups but increase them more among underrepresented groups. High incentives restore representativeness on race and income and also on health variables likely to be correlated with seropositivity, such as the uninsured rate, hospitalization rates, and an aggregate COVID-19 risk index."

"We analyze representativeness in a unique COVID-19 serological study. Unlike most studies, the Representative Community Survey Project (RECOVER)COVID-19 serological study experimentally varied financial incentives for participation. The study was conducted on households in Chicago (the target population). Randomly sampled households were sent a package that contained a self-administered blood sample collection kit and were asked to return the sample by mail to be tested for the presence of COVID-19 antibodies (“seropositivity”). Households in the sample were randomly assigned one of three levels of financial compensation for participating in the study: $0, $100, or $500.

"We find that households in neighborhoods with high shares of minority and poor households are grossly underrepresented at lower incentive levels. High incentives increase participation rates for all groups but increase them more among underrepresented groups. A $500 incentive restores representativeness in terms of neighborhood-level race and poverty status. Representativeness is also restored in health variables likely to be correlated with seropositivity, such as the uninsured rate, hospitalization rates, and an aggregate COVID-19 risk index. Since incentives were randomly assigned and only revealed after the household was contacted, the noncontact rates at $0 and $100 should be the same as at $500, implying that differential hesitancy to participate is responsible for much of the nonrepresentativeness that we find at lower incentives.

"We are not aware of studies that randomize financial incentives in population health studies. It is well appreciated that racial minorities and lower-income households participate in health research at lower rates.1  The impact of incentives on survey participation rates conditional on demographic characteristics has been studied in the survey methodology literature (see Groves et al. 2009; Singer and Ye 2013, and references therein). The incentives used in this literature are typically an order of magnitude smaller than the incentives in the RECOVER study."

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Some earlier related posts:

Monday, February 22, 2021

Ethical Payment in Human Infection Challenge Studies in the American Journal of Bioethics

Monday, March 1, 2021

Compensating challenge vaccine trial participants: further discussion in the American Journal of Bioethics

Thursday, October 29, 2020

Paying participants in challenge trials of Covid-19 vaccines, by Ambuehl, Ockenfels, and Roth

"we note that increasing hourly pay by a risk-compensation percentage as proposed in the target article provides compensation proportional to risk only if the risk increases proportionally with the number of hours worked. (Some risky tasks take little time; imagine challenge trials to test bulletproof vests.) "

Sunday, November 1, 2020

What do we know about the effects of payments to participants in challenge trials for vaccines, and other public spirited activities?

It's illegal to sell cicada infused liquor in Illinois

 Alcohol and insects don't mix in Illinois.  

The Chicago Sun Times has the story:

Suburban brewery fined for selling cicada-infused Malört shot. Noon Whistle Brewing garnered headlines for selling the creative drink during the rare overlap of two cicada broods. But it turns out the shot wasn’t just disgusting — it was also illegal.  By  David Struett 

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It's a good think the Illinois Liquor Control Commission wasn't running the IRB that approved Sandro Ambuehl's experiment that involved eating insects.

Sunday, March 10, 2024

Does high pay equal "undue inducement"? An experiment by Sandro Ambuehl

Oregon ends decriminalization of drugs, continues to experiment

 Here's the story in the Washington Post

Hard drugs illegal again in Oregon as first-in-nation experiment ends

"Sunday marks the end of an experiment that drug-reform advocates called a pioneering and progressive measure to better help people. Oregon legislators reassessed Measure 110 this year and decided to again make it a misdemeanor to possess a minor amount of drugs — essentially anything besides marijuana. Selling and manufacturing illicit drugs was and is still illegal in Oregon.

...

"On Feb. 29, the Oregon House of Representatives voted 51-7 to recriminalize drugs, with bipartisan support. The Oregon Senate did the same by a vote of 21-8 the next day. Gov. Tina Kotek (D) signed recriminalization into law April 1.

"Data shows how the [decriminalization] law was used in practice. The Oregonian reported that circuit court data collected by the Oregon Judicial Department from when the law went into effect Feb. 1, 2021, to Aug. 26, 2024, showed that the state’s circuit courts imposed just under $900,000 in fines under the measure but collected only $78,000 of those fines.

"The conviction rate for the 7,227 people cited was 89 percent, with most of those because people didn’t show up to court, the Oregonian reported. Data showed that 85 people completed the substance abuse screening in lieu of a conviction.

"The most commonly cited drug was methamphetamine, accounting for 54 percent of citations. Fentanyl and other Schedule II drugs, the Oregonian reported, ranked second at 31 percent."

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And here's the Guardian's coverage:

Oregon: drug possession to be a crime again as decriminalization law expires. First-in-nation trial comes to an end, as new law gives those caught with hard drugs option of charges or treatment

"The new recriminalization law, HB4002, will give those caught with illicit drugs – including fentanyl, heroin and meth – the choice to either be charged with possession or treatment, which includes completing a behavioral health program and participating in a “deflection program” to avoid fines.

"Personal-use possession would be a misdemeanor punishable by up to six months in jail. It aims to make it easier for police to crack down on drug use in public and introduced harsher penalties for selling drugs near places such as parks.

"The recriminalization law encourages, but does not mandate, counties to create treatment alternatives to divert people from the criminal justice system and toward addiction and mental health services."

The first four patients who received transplants of organs from genetically modified pigs

 NBC reports on the four patients who have so far received organ transplants from genetically modified pigs.

Their loved ones died after receiving pig organ transplants. The families have no regrets. Four people have received hearts or kidneys from pigs. Some of their relatives recount a roller coaster of hope and uncertainty. By Aria Bendix

"David Bennett Sr., had severe congestive heart failure and wasn’t a candidate for a human transplant. He knew he would likely die soon. There was nothing more to do — other than take a chance on a novel, cutting-edge surgery. Bennett Sr. and his son agreed it was worth the risk.  

"The achievement made headlines around the world after the transplant surgery in January 2022.

...

"But two months later, Bennett Sr.’s body rejected the heart and he died at age 57. In a paper, his doctors at the University of Maryland Medical Center explained that his body had likely produced too many antibodies that fought off the new organ.

...

Three other patients have followed in Bennett Sr.’s footsteps and received pig organs, most recently a pig kidney transplant in April. Together, they represent the pioneer patients of the burgeoning field of xenotransplantation. For their families, three of which spoke to NBC News about the experience, the journey came with a roller coaster of emotions, from uncertainty to blind hope — and, ultimately, admiration for their loved one’s decision. 

...

"None of the patients survived more than three months. To the public, that might seem like failure. But to the families, the transplants accomplished their goals: to buy their loved ones more time and advance research that could potentially save lives one day."

Compensating plasma donors, or buying plasma from the U.S.? Europe clutches its pearls (The Economist)

 The Economist summarizes the plasma situation well.

The plasma trade is becoming ever-more hypocritical. Reliance on America grows, as other countries clutch their pearls

"Last year American blood-product exports accounted for 1.8% of the country’s total goods exports, up from just 0.5% a decade ago—and were worth $37bn. That makes blood the country’s ninth-largest goods export, ahead of coal and gold. All told, America now supplies 70% or so of the plasma used to make medicine.

...

"America’s booming blood trade is not an unmitigated success story, however, since it reflects problems elsewhere. The trade is mostly driven by two factors. The first is greater demand for plasma products: doctors have found ever more uses for the medicines, especially intravenous immunoglobulin. According to Marketing Research Bureau, a data firm, the market for immunoglobulin has grown by 5-7% a year for the past quarter of a century.

"The second reason is restrictions on plasma collection in other countries, owing to a combination of misplaced worries about safety and concerns about the morality of rewarding people for their bodily fluids. It is, for instance, illegal to pay for plasma donation in Britain, although the National Health Service does offer gifts and acknowledgments when donors reach certain milestones. In June the European Parliament approved new regulations that allow compensation to be offered for donations, but ban it from being mentioned in advertising and cap payments to an amount proportionate to the value of time spent donating. 

...

"Such qualms do not stop countries from importing American blood. Britain and Canada are almost entirely dependent on the country’s plasma; Europe brings in lots, too. China, a great rival of America in other areas of trade, is also more than happy to take advantage of America’s supply. Some 43% of Chinese imports of blood products now come from its geopolitical rival, up from just 14% a decade ago, according to figures from the UN. Chinese policymakers ban imports of plasma—a legacy of an attempt to prevent the spread of HIV in the 1980s—with the exception of a single protein, known as albumin. That alone is driving the trade.

"Some countries are even more flagrant in their double standards. France lobbied against the European Union’s recent regulatory changes, arguing that they risked making the human body a commodity, as is “already a reality in the United States”. At the same time, the French government is the sole shareholder in a company that owns six plasma centres in America, which pay donors, with the fluid collected available for use in France."

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Here are all my posts about plasma.

Automated bidding in auctions

 Part of the future of market design (as artificial intelligence evolves from large language models to something more like general AI) will involve not only the design of marketplace rules, but also design of the marketplace participants.  So a good way to get some sense of that future is to look at parts of it that have already arrived.  And there are lots of algorithms already at work participating in high frequency markets.  Here's a paper surveying automated bidding on ad auctions, by a big group of authors at Google.

Auto-bidding and Auctions in Online Advertising: A Survey by Gagan Aggarwal, Ashwinkumar Badanidiyuru, Santiago R. Balseiro, Kshipra Bhawalkar, Yuan Deng, Zhe Feng, Gagan Goel, Christopher Liaw, Haihao Lu, Mohammad Mahdian, Jieming Mao, Aranyak Mehta, Vahab Mirrokni, Renato Paes Leme, Andres Perlroth, Georgios Piliouras, Jon Schneider, Ariel Schvartzman, Balasubramanian Sivan, Kelly Spendlove, Yifeng Teng, Di Wang, Hanrui Zhang, Mingfei Zhao, Wennan Zhu, and Song Zuo

Abstract: In this survey, we summarize recent developments in research fueled by the growing adoption of automated bidding strategies in online advertising. We explore the challenges and opportunities that have arisen as markets embrace this autobidding and cover a range of topics in this area, including bidding algorithms, equilibrium analysis and efficiency of common auction formats, and optimal auction design

Optimism and pessimism on psychedelic drugs as medicine

 "Psychedelics" may prove to be a broad church, with psilocybin and LSD quite different from MDMA, etc., but here are two articles that express very different views about the progress towards making them part of standard medical practice.

Here's some optimism in Columbia Magazine:

The Magic and Mystery of Psychedelic Therapies.  As new trials show that psilocybin and LSD may help treat depression and anxiety, mental-health providers get ready for a revolution.  By Paul Hond |

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And here's some pessimism, in the NYT:

How Psychedelic Research Got High on Its Own Supply, By Caty Enders

"The drug company Lykos Therapeutics had spent much of this year expecting to vault to meteoric heights. It had sent an application to the Food and Drug Administration seeking approval to use MDMA to treat post-traumatic stress disorder. Lykos expected F.D.A. approval; it was banking on it.

"And then on Aug. 9, the F.D.A.’s decision came through: rejection. It was the capstone to months of increasingly loud concerns being voiced over the quality of Lykos’s clinical trials. And in the wake of the F.D.A. decision, the journal Psychopharmacology retracted three papers related to research on MDMA, citing “unethical conduct,” an apparent reference to allegations of sexual abuse on the part of an unlicensed therapist at one of the trial sites. Several of the authors of the retracted papers were affiliated with Lykos.

"It is a shocking decrescendo for a drug that had been promoted for years as best positioned to lead a psychedelic mental health revolution. The F.D.A.’s rejection signals greater uncertainty for the future of psychedelic medicine."

WHO Says Countries Should Be Self-Sufficient In (Unremunerated) Organs And Blood, by Krawiec and Roth

 Requiring national self sufficiency in blood and plasma supplies is particularly hard on low and middle income countries, as is limiting the possibility of participating in active kidney exchange programs.

WHO Says Countries Should Be Self-Sufficient In (Unremunerated) Organs And Blood by Kimberly D. Krawiec and Alvin E. Roth : August 24, 2024,   Available at SSRN: https://ssrn.com/abstract=4935827

Abstract: This chapter critiques the twin World Health Organization (WHO) principles of self-sufficiency and nonremuneration in organs and blood, urging a more sensible approach to the scarce resources of blood products and transplantable organs. WHO and other experts have failed to acknowledge the tension between self-sufficiency and nonremuneration in blood products--no country that fails to pay plasma donors is self-sufficient. Furthermore, international cooperation and cross-border transplantation provide numerous benefits, especially in smaller countries and those without well-developed domestic exchange programs. The combination of these twin principles denies to health care many of the benefits that trade has brought to so many other human endeavors and the effects are particularly damaging to low and middle income countries. Substances of human origin are special, but not so special that we prohibit plasma or organ donation. We should be open to exploring and experimenting with ways to bring to health care some of the benefits that trade has brought to so many other human endeavors, such as the production and distribution of food and lifesaving vaccines and other medicines.

Here's the concluding paragraph:

"We close by noting that the combination of the nonremuneration principle and the self-sufficiency principle deny to health care many of the benefits that trade has brought to so many other human endeavors. Substances of human origin are special, but not so special that we prohibit plasma or organ donation. So we should be open to exploring and experimenting with ways to bring to health care some of the benefits that trade has brought to so many other human endeavors, such as the production and distribution of food and lifesaving vaccines and other medicines."

Why Mpox Vaccines Aren’t Flowing to Africans in Desperate Need.

 The NYT has the story: read it and weep...

Why Mpox Vaccines Aren’t Flowing to Africans in Desperate Need. Drugmakers have supplies ready to ship that are necessary to stop a potential pandemic. But W.H.O. regulations have slowed access. By Stephanie Nolen

"There are no vaccines for mpox available in the Democratic Republic of Congo, the epicenter of a global health emergency declared last week, even though the country first asked for the shots two years ago and the manufacturers say they have supplies.

...

"So where are the shots? They are trapped in a byzantine drug regulatory process at the World Health Organization.

...

"Three years after the last worldwide mpox outbreak, the W.H.O. still has neither officially approved the vaccines — although the United States and Europe have — nor has it issued an emergency use license that would speed access.

"One of these two approvals is necessary for UNICEF and Gavi, the organization that helps facilitate immunizations in developing nations, to buy and distribute mpox vaccines in low-income countries like Congo.

"While high-income nations rely on their own drug regulators, such as the Food and Drug Administration in the United States, many low- and middle-income countries depend on the W.H.O. to judge what vaccines and treatments are safe and effective, a process called prequalification.

"But the organization is painfully risk-averse, concerned with a need to protect its trustworthiness and ill-prepared to act swiftly in emergencies, said Blair Hanewall, a global health consultant who managed the W.H.O. approvals portfolio as a deputy director of the Bill & Melinda Gates Foundation, a key funder, for more than a decade."

Are Swedish gangs becoming the hitmen of Scandanavia?

 We're accustomed to drug violence among gangs even in wealthy countries, but here's a story from The Times (of London) suggesting that the drug and biker gangs in Sweden are going in for contract killing as well.

How Swedish gangs are exporting young contract killers across Scandinavia. Crime bosses are behind a wave of youths being hired for attacks in Denmark and Norway, with fears the trend could spread further

"Sweden is accused of exporting its gang violence problem to its Nordic neighbours after at least 25 young Swedes on suspected contract-killing or bombing missions were arrested in Denmark over the past four months.

...

"Part of the problem, according to Markus Kaakinen, a criminologist at the University of Helsinki, is that Sweden’s notoriously trigger-happy drug gangs are outgrowing their home market. As a result they are not only setting up distribution outposts in countries such as Norway and Finland but are also moving in on “transit” states that serve as conduits for the international drug trade, such as Denmark and Spain, where they compete with the local criminal networks.

...

"Yet that is not the main thing that bothers experts. What really worries them is a previously unknown phenomenon: Swedish youths are being anonymously hired through social media for acts of violence in Denmark, as though they were Deliveroo drivers.

“This is something very new: the recruiting of very young, completely unknown adolescents,” Kaakinen said. “There’s increasing demand for violence and these gangs have noticed that it’s less risky for them to use these channels.”

...

"he Swedish authorities are already having a hard enough time getting a grip on their country’s conventional gang wars, where kingpins with nicknames such as the “Kurdish Fox”, “The Strawberry” and “The Greek” pursue their vendettas through teenage amateur assassins hired on a semi-freelance basis.

...

"Danish ministers feel their state has dealt relatively well with its own problems along similar lines. There are estimated to be about 1,500 active gang members in a population of 5.9 million, while Sweden has roughly 14,000 in a population of 10.5 million."

Travel for medical aid in dying

 CBS has the story:

Why Americans are traveling to Vermont and Oregon to die

""Dying with medical assistance wasn't an option when Milano learned in early 2023 that her disease was incurable. At that point, she would have had to travel to Switzerland — or live in the District of Columbia or one of the 10 states where medical aid in dying was legal.

"But Vermont lifted its residency requirement in May 2023, followed by Oregon two months later. (Montana effectively allows aid in dying through a 2009 court decision, but that ruling doesn't spell out rules around residency. And though New York and California recently considered legislation that would allow out-of-staters to secure aid in dying, neither provision passed.)

...

"At least 26 people have traveled to Vermont to die, representing nearly 25% of the reported assisted deaths in the state from May 2023 through this June, according to the Vermont Department of Health. In Oregon, 23 out-of-state residents died using medical assistance in 2023, just over 6% of the state total, according to the Oregon Health Authority."

Tattoos

 Tattoos used to signal something different than they do today.

The NYT has the story.

The Price of Getting Inked. Whether it’s the expense of getting tattooed or the cost to have one removed, Americans are paying for their ink. By Julia Rothman and Shaina Feinberg

"Once considered countercultural — something for sailors and misfits — tattoos are now culturally ubiquitous: Nearly one-third of American adults have at least one, according to a survey by Pew Research.

...

"The global tattoo market, which currently brings in about $2.2 billion, is expected to grow to more than $4 billion by 2032, according to Fortune Business Insights, a market research firm. There are over 20,000 tattoo parlors in the United States."

Blood donation by family members in India: LGBT donors still banned

 In India, where the shortage of blood supplies is addressed by having family members donate, the ban on donation by LGBT people is a serious constraint.

The BBC has the story:

LGBT Indians demand end to 'discriminatory' ban on blood donation  by Umang Poddar

"In 2018, India's top court legalised gay sex in a landmark ruling - but the country still doesn't allow transgender people and gay and bisexual men to donate blood.

"People from the LGBT community say the decades-old ban is "discriminatory" and have gone to court to challenge it.

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"Activists argue that apart from it being discriminatory, the ban is also irrational because of the high demand for blood transfusions in the country.

"A study published by the Public Library of Science in 2022 estimated that India faced an annual deficit of around one million units of blood."

HT: Vincent Jappah

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Earlier:

Tuesday, November 28, 2023

"Professional blood donors" in India (where paying blood donors is illegal)

Surrogacy under continued attack in Italy

The language of repugnance is strong in these latest developments.

The NYT has the story:

Has Power Moderated Italy’s Leader? Not to Same-Sex Parents.  Prime Minister Giorgia Meloni has mostly shown a pragmatic streak abroad. But at home, her government is plunging many gay families into panic. 

"Surrogacy is already illegal if conducted in Italy. But the government of Prime Minister Giorgia Meloni wants to expand the prohibition. It has promoted a bill that would also punish Italians who make use of surrogacy even in places abroad where it is legal, like in parts of the United States. Those Italians who do could face up to two years in prison and be fined the equivalent of about a million dollars.

"Italy’s lower chamber of Parliament approved the bill last summer, and the Senate’s justice committee greenlighted it last month. The Senate is expected to vote on it as soon as the fall.

...

"No one can convince me that it is an act of freedom to rent one’s womb,”  [Prime Minister Meloni] said in the spring at an event in Rome. “No one can convince me that it is an act of love to consider children as an over-the-counter product in a supermarket.”

“Uterus renting is a shameful, inhuman practice,” she said. “It will become a universal crime.”

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Earlier

Wednesday, April 5, 2023

Surrogacy under siege in Italy