Market Design in El Mercurio--Chile's oldest newspaper

Last Tuesday, in Chile I was interviewed by Eduardo Olivares, the editor for Economics and Business of El Mercurio,  which published the interview yesterday. We talked for an hour about market design generally, about how markets work when they're working well or working badly, and we spoke about school choice (where Chile is a leader) and transplantation (where it is not). The interview is behind a paywall, but below are some extracts (retranslated back into English via Google Translate).

On markets generally:

—Many people ask that “markets be free,” as has recently happened in Argentina. Should they be free?

“That's a complicated question. Markets should be free to function well, but they need conditions that allow them to function well. Having a free market does not necessarily mean a market without rules. A wheel can spin freely because it has a well-greased axle and bearings. A wheel by itself cannot turn very well, and the same goes for the market.”

—Who puts the oil in the wheel gears?

“That's the job of market design. Part of what makes markets work well are good market rules. The government has a role in regulating markets, concerning property rights and things like that. But on another level, entrepreneurs do things. Here in Santiago I [can]... call an Uber using the same app and rules I use in California. Uber is a marketplace for passengers and drivers. The rules can be made by both private organizations and the government.”

On prices:

—Do prices matter?

"A lot. “Prices are important to help allocate scarce resources, but also to make them less scarce.”

...

—When do they not matter?

“Let me start with when they matter a lot: in commodity markets. If you want to buy commodities, price is really the only thing that's happening. But when 'El Mercurio' wants to hire journalists, it doesn't limit itself to offering a salary: it wants it to be a good job, with special reporters. Price is important, but in other markets other things are also important. When you get a new job, the first question your friends ask you is not what the salary is, but who you work for.”

On school choice:

“Most markets are not commodity markets... In some markets we don't like prices to work at all. One of the places where Chile is a leader in market design is school choice: how people are assigned to schools and Chile has done a lot of work on this, although mainly for public schools.”

—What do you know about this system in Chile?

“Not long ago, before there was centralized and widespread school choice in Chile, there were the usual problems with decentralized school choice; That is, parents had to get up early to get in line, and they had a difficult process to register their children.”

—The new system has been criticized. Some claim it caused more people to choose the private system over the public school system. Isn't it similar to what is happening in New York, for example?

“There is something to that. In New York and Boston we also have a system that we call charter schools: free access schools, but organized by private entities, even if they are municipal schools. And they also have different standards. School choice is important, but it does not solve the problems of poverty or income inequality. Now, one of the reasons we have school choice in the United States and perhaps also in Chile is because we think that, otherwise, there is a danger that the poor will be condemned to send their children to poor schools. .

—Has there been any successful case in which parents can honestly rank the order of preference for the school they want their children to go to?

“In Chile, procedures are used that [make it] what game  theorists call a dominant strategy to express true preferences. The [remaining] problem is not in creating systems that make it safe to express preferences, but in distributing the information so that people can form preferences sensibly. In the United States, the hardest families to reach are those who don't speak English at home, so it's sometimes difficult to communicate with them. And different families have different feelings about what kind of schools their children should attend.”

“The benefits of school choice come from the fact that some schools may be high quality for some children but not for others, so we would like children to attend the schools that are best quality for them.”

On kidneys:

—You are famous for the proposal that allowed the “kidney exchange.” Years after the first experience, what do you see now in this type of market?

“Kidney exchange is working quite well in the US, but it works especially well for patients who are not too difficult to match. Even in the US, a fairly large country, we have patients who are so difficult to match that we have trouble finding a kidney for them.”

—And in other countries?

“Smaller countries, with 20 million inhabitants, like Chile, would benefit if we could make national borders not so important. When we look at transplants per million inhabitants, Chile is in the middle of the world. But since it is a small country, when the total number of transplants performed is analyzed, Chile has very few. Kidneys are obtained from both deceased and living donors. In Chile, as in much of the world, the majority of transplants come from deceased donors. Kidney exchange would allow more transplants to come from living donors ... “Twenty million is not enough, so it would be very good to see in South America an exchange of kidneys that can cross between countries, which is not so easy to do.”

Equality of exchange and the role of perceptions

“One of the things that worries people when talking about transplants is that [they think it might be] a medical process that exploits the poor. Of course, the thing about kidney exchange is that each pair of people gives one kidney and receives one kidney. It is very egalitarian. I think kidney exchange is a good place to combat this notion that transplantation is like trafficking,” he notes.

—Notions, perceptions are very important. Many people think of “exchange” as the exchange of securities in the stock market.

“That's right, but not every exchange involves money. One of the discussions about money in the world that is taking place in the European Union at the moment is about payment to blood plasma donors. In the EU, only Germany, Austria, the Czech Republic and Hungary pay blood plasma donors. And those are the only EU countries that have as much blood plasma as they need. The others have to import everything, and they do it from the United States. The United States is the Saudi Arabia of blood plasma (…) The World Health Organization says that plasma must be obtained in each country, and from unpaid donors. You have to be self-sufficient... an economist finds that a little funny. Blood is a matter of life and death. “When there is a pandemic, we do not tell countries that they must be self-sufficient [in vaccines].”

—When we talk about these exchanges of blood plasma and kidneys, school choice systems, we are talking about the same idea: coincident or paired markets. But the concept of the market has been so questioned, especially by some political groups, for so long...

"It's true. Now,  kidney exchange is special because money doesn't change hands. Money changes hands to get medical care, you have to pay doctors, nurses and hospitals. But we are not talking about buying kidneys from donors, but rather that, at the patient level, each pair receives a kidney and donates a kidney. It is radically egalitarian. Many people who think about markets may not think of it as a market, but I think that's a mistake. Many markets are not just about money… we would worry much less about markets if income and wealth inequality did not exist. “What worries us about markets is that some people are poor and some people are rich, and markets seem like a way to give the rich an advantage.”

“There is no doubt that being rich is better than being poor. The real question is what do we do to alleviate poverty. Making it invisible is not the same as alleviating it. One of the reasons I think many countries don't allow blood and plasma donors to be paid is because they don't like the way that looks. It reminds them that some people would like to get some money and would donate blood for it.”

Apparently, according to the caption, I'm "affable and smiling" (although not in this picture:)

I was in Chile to participate in what turned out to be a wonderful workshop on market design at the University of Chile, organized by Itai Ashlagi, José Correa, and Juan Escobar.

Some related recent posts:

Saturday, December 23, 2023

Market design: some press accounts in Chile

Wednesday, December 20, 2023

Public lecture today at the Casa Central de la Universidad de Chile:“Quién obtiene qué y por qué: La nueva economía del diseño de mercados”

Sunday, December 17, 2023

Market Design Workshop 18 - 20 December 2023 Santiago, Chile

Saturday, November 4, 2023

The EU proposes strengthening bans on compensating donors of Substances of Human Origin (SoHOs)--op-ed in VoxEU by Ockenfels and Roth

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Update (Dec. 27): Here's an account of my closing public talk from the U. Chile's Center for Mathematical Modeling, one of the hosts of the market design workshop.

Alvin Roth: “Markets are human artifacts, they are tools that we build ourselves to help us”.

And here's a picture at the close, including some of those mentioned above: At my far left in the picture is José Correa,  who in addition to his other roles is Vice Rector for Information Technologies. Next to him is Alejandra Mizala, prorrector (provost) of the university.  Next to her (immediately to my left) is Rector of the University of Chile, Rosa Devés, and immediately to my right is market designer and director of the MIPP Millennium Institute, Juan Escobar. Next to him is Héctor Ramírez, director of the Center for Mathematical Modeling. And next to him (at my far right) is professor Rafael Epstein who (along with Correa, Escobar, and his daughter Natalie Epstein) has been involved with school choice in Chile, among other things.

The EU proposes strengthening bans on compensating donors of Substances of Human Origin (SoHOs)--op-ed in VoxEU by Ockenfels and Roth

 The EU has proposed a strengthening of European prohibitions against compensating donors of "substances of human origin" (SoHOs).  Here's an op-ed in VoxEU considering how that might effect their supply.

Consequences of unpaid blood plasma donations, by Axel Ockenfels and  Alvin Roth / 4 Nov 2023

"The European Commission is considering new ways to regulate the ‘substances of human origin’ – including blood, plasma, and cells – used in medical procedures from transfusions and transplants to assisted reproduction. This column argues that such legislation jeopardises the interests of both donors and recipients. While sympathetic to the intentions behind the proposals – which aim to ensure that donations are voluntary and to protect financially disadvantaged donors – the authors believe such rules overlook the effects on donors, on the supply of such substances, and on the health of those who need them.

"Largely unnoticed by the general public, the European Commission and the European Parliament’s Health Committee have been drafting new rules to regulate the use of ‘substances of human origin’ (SoHO), such as blood, plasma, and cells (Iraola 2023, European Parliament 2023). These substances are used in life-saving medical procedures ranging from transfusions and transplants to assisted reproduction. Central to this legislative initiative is the proposal to ban financial incentives for donors and to limit compensation to covering the actual costs incurred during the donation process. The goal is to ensure that donations are voluntary and altruistic. The initiative aims to protect the financially disadvantaged from undue pressure and prevent potential misrepresentation of medical histories due to financial incentives. While the intention is noble, the proposal warrants critical analysis as it may overlook the detrimental effects on donors themselves, on the overall supply of SoHOs, and consequently on the health, wellbeing, and even the lives of those who need them. We illustrate this in the context of blood plasma donation.

"Over half a century ago, Richard Titmuss (1971) conjectured that financial incentives to donate blood could compromise the safety and overall supply. This made sense in the 1970s, when tests for pathogens in the blood supply were not yet developed. But Titmuss’ conjecture permeated policy guidelines worldwide, despite mounting evidence to the contrary. Although more evidence is needed, a review published by Science (Lacetera et al. 2013; see also Macis and Lacetera 2008, Bowles 2016), which looked at the evidence available more than 40 years after Titmuss’ conjecture, concluded that the statistically sound, field-based evidence from large, representative samples is largely inconsistent with his predictions.

"Getting the facts right is important because, at least where blood plasma is concerned, the volunteer system has failed to meet demand (Slonim et al. 2014). There is a severe and growing global shortage of blood plasma. While many countries are unwilling to pay donors at home, they are willing to pay for blood plasma obtained from donors abroad. The US, which allows payment to plasma donors, is responsible for 70% of the world’s plasma supply and is also a major supplier to the EU, which must import about 40% of its total plasma needs. Together with other countries that allow some form of payment for plasma donations – including EU member states Germany, Austria, Hungary, and the Czech Republic – they account for nearly 90% of the total supply (Jaworski 2020, 2023). Based on what we know from controlled studies and from experiences with previous policy changes, a ban on paid donation in the EU will reduce the amount of plasma supplied from EU members, prompting further attempts to circumvent the regulation by importing even more plasma from countries where payment is legal. At the same time, a ban will contribute to the global shortage of plasma, further driving up the price and making it increasingly unaffordable for low-income countries (Asamoah-Akuoko et al. 2023). In the 1970s, it may have been reasonable to worry that encouraging paid donation would lead to a flow of blood plasma from poor nations to rich ones. That is not what we are in fact seeing. Instead, plasma supplies from the US and Europe save lives around the world.

"In other areas, society generally recognises the need for fair compensation for services provided, especially when they involve discomfort or risk. After all, it is no fun having someone stick a needle in your arm to extract blood. This consensus cuts across a range of services and professions – including nursing, firefighting, and mining – occupations, most people would agree, that should be well rewarded for the risk involved and value to society. To rely solely on altruism in such areas would be exploitative and would eventually lead to a collapse in provision. Indeed, to protect individuals from exploitation, labour laws around the world have introduced minimum compensation requirements rather than caps on earnings. In addition, payment bans on donors, even if they’re intended to protect against undue inducements, raise concerns about price-fixing to the benefit of non-donors in the blood plasma market. In a related case, limits on payment to egg donors have been successfully challenged in US courts. 1

"In addition, policy decisions affecting vital supplies such as blood plasma should be based on a broad discourse that includes diverse perspectives and motivations. Ethical judgements often differ, both among experts and between professionals and the general public, so communication is essential (e.g. Roth and Wang 2020, Ambuehl and Ockenfels 2017). Payment for blood plasma donations is an example. We (the authors of this article) are from the US and Germany, countries that currently allow payment for blood plasma donations while most other countries prohibit payment. On the other hand, prostitution is legal in Germany but surrogacy is not, while the opposite is true in most of the US. And while Germany currently prohibits kidney exchange on ethical grounds, other countries – including the US, the UK, and the Netherlands – operate some of the largest kidney exchanges in the world and promote kidney exchange on ethical grounds.

"The general public does not always share the sentiments that health professionals find important (e.g. Lacetera et al. 2016). This tendency is probably not due to professionals being less cognitively biased. In all areas where the question has been studied, experts such as financial advisers, CEOs, elected politicians, economists, philosophers, and doctors are just as susceptible to cognitive bias as ordinary citizens (e.g. Ambuehl et al. 2021, 2023). Recognising the similarities and differences between professional and popular judgements, and how ethical judgements are affected by geography, time, and context, allows for a more constructive and effective search for the best policy options.

"In our view, the dangers of undersupply of critical medical substances, of inequitable compensation (particularly for financially disadvantaged donors), and of circumvention of regulation by sourcing these substances from other countries (where the EU has no influence on the rules for monitoring compensation to protect donors from harm) are at least as significant as those arising from overpayment. Carefully designed transactional mechanisms may also help to respect ethical boundaries while ensuring adequate supply. Advances in medical and communication technologies, such as viral detection tests, can effectively monitor blood quality and ensure the safety and integrity of the entire donation process – including the deferral of high-risk donors and those for whom donating is a risk to their health – without prohibiting payment to donors. Even if it is ultimately decided that payments should be banned, there are innovations in the rules governing blood donation that have been proposed, implemented, and tested that would improve the balance between blood supply and demand within the constraints of volunteerism; non-price signals, for instance, can work within current social and ethical constraints.

"As the EU deliberates on this legislation, it is imperative to adopt a balanced, empirically sound, and research-backed approach that considers multiple effects and promotes policies to safeguard the interests of both donors and recipients.

References

Asamoah-Akuoko, L et al. (2023), “The status of blood supply in sub-Saharan Africa: barriers and health impact”, The Lancet 402(10398): 274–76.

Ambuehl, S and A Ockenfels (2017), “The ethics of incentivizing the uninformed: A vignette study”, American Economic Review Papers & Proceedings 107(5), 91–95.

Ambuehl, S, A Ockenfels and A E Roth (2020), “Payment in challenge studies from an economics perspective”, Journal of Medical Ethics 46(12): 831–32.

Ambuehl, S, S Blesse, P Doerrenberg, C Feldhaus and A Ockenfels (2023), “Politicians’ social welfare criteria: An experiment with German legislators”, University of Cologne, working paper.

Ambuehl, S, D Bernheim and A Ockenfels (2021), “What motivates paternalism? An experimental study”, American Economic Review 111(3): 787–830.

Bowles S (2016), “Moral sentiments and material interests: When economic incentives crowd in social preferences”, VoxEU.org, 26 May.

European Parliament (2023), “Donations and treatments: new safety rules for substances of human origin”, press release, 12 September.

Iraola, M (2023), “EU Parliament approves text on donation of substances of human origin”, Euractiv, 12 September.

Jaworski, P (2020), “Bloody well pay them. The case for Voluntary Remunerated Plasma Collections”, Niskanen Center.

Jaworski, P (2023), “The E.U. Doesn’t Want People To Sell Their Plasma, and It Doesn’t Care How Many Patients That Hurts”, Reason, 20 September.

Lacetera, N, M Macis and R Slonim (2013), “Economic rewards to motivate blood donation”, Science 340(6135): 927–28.

Lacetera, N, M Macis and J Elias (2016), “Understanding moral repugnance: The case of the US market for kidney transplantation”, VoxEU.org, 15 October.

Macis M and N Lacetera (2008), “Incentives for altruism? The case of blood donations”, VoxEU.org, 4 November.

Roth, A E (2007), “Repugnance as a constraint on markets”, Journal of Economic Perspectives 21(3): 37–58.

Roth A E and S W Wang (2020), “Popular repugnance contrasts with legal bans on controversial markets”, Proc Natl Acad Sci USA 117(33): 19792–8.

Slonim R, C Wang and E Garbarino (2014), “The Market for Blood”, Journal of Economic Perspectives 28(2): 177–96.

Titmuss, R M (1971), The Gift Relationship, London: Allen and Unwin.

Footnotes: 1. Kamakahi v. American Society for Reproductive Medicine, US District Court Northern District of California, Case 3:11-cv-01781-JCS, 2016.

Organ donation day in Germany

 Yesterday was organ donation day in Germany. Here's a post from the German Health Economics Association (DGGÖ): Day of Organ Donation on June 3, 2023

"In Germany, there are about 8,500 people waiting for an organ donation (www.Bundesärztekammer.de). On the Day of Organ Donation, the German Society for Health Economics (dggö) wants to emphasize the urgency of increasing organ donation rates to improve the lives of these individuals. This applies equally to deceased organ donation and living donation. An international comparison also shows that there is room for improvement in Germany: Both in terms of living and deceased donations per million population, Germany lags behind in the EU (see Figure 1).

...

"On Wednesday, May 31, 2023, Nobel laureate in economics and professor at Stanford University, Alvin Roth, spoke to a broad audience in the 6th virtual dggö Talk (see https://www.dggoe.de/aktuelles for details) about the possibilities of kidney exchange between compatible but previously unknown pairs and the implementation of cross-over donations and exchange chains in the US.

"Unlike in the US, in Germany, living donation outside of close family is only possible if a close relationship between the donor and recipient has been officially confirmed. Alvin Roth noted in the case of cross-over kidney donations, that it was very complicated for German hospitals to build up and prove a close relationship between two pairs of donors in front of a commission. This should be simplified, especially considering the overall strong support for kidney exchange among the German population. As Figure 2 from a survey conducted by Roth and Wang (2020) illustrates, 79% even agree to kidney exchange across borders and outside of family and friends, although such an exchange is currently not legally possible in Germany.

*********

Earlier: 

Tuesday, May 30, 2023

Kidney exchange, around the world and in Germany? German Health Economics Association (DGGÖ) webinar 

Kidney exchange, around the world and in Germany? German Health Economics Association (DGGÖ) webinar tomorrow

Tomorrow  I'll be giving a talk in Germany (8am California time, 17:00 in Germany), hosted by the German Health Economics Association (DGGÖ).  (Bob Slonim will be giving a talk in this series in the summer.)

My title will be Kidney Exchange to increase transplantation: around the world, and in Germany?

(One big issue is that kidney exchange isn't yet supported in Germany.) 

There is a webinar address at the above link for those who might like to listen.

Paired kidney donation performed in Germany--a guest post by Ágnes Cseh

 Below is a post written by Ágnes Cseh, about a kidney exchange conducted legally in Germany, in October, after being identified outside of the medical establishment. (The links she supplies are all worth looking into, and Google translate works well enough.)

"The legal basis for a living organ donation in Germany is a relationship or close personal connection between donor and recipient. This well-meant rule implicitly forbids paired kidney donation, because even though recipient and donor are closely related in each of the two pairs participating in a paired donation, the physical graft a patient receives technically comes from the relative of the other recipient.

A cumbersome, but legal way around the regulation is to establish a close personal connection between all four persons involved in a paired donation. Then, an ethical committee might approve of the two transplants separately. This constellation even inspired filmmakers to shoot a fictional movie about such a venture -- the genre is supposed to be comedy. In reality, paired transplants have been performed very sporadically in the past years in Germany.

A new initiative offers a centralized platform for paired kidney donations. It is run by Susanne Reitmaier, an activist fighting for the complete legalization of paired donations and Ágnes Cseh, a researcher specialized in matching theory. They maintain a database of the voluntarily submitted medical data of incompatible recipient-donor pairs. If a possible match among these pairs is found, then the two pairs are put into contact with each other so that they can establish the personal connection required by the law.

The first match in this program was identified in July 2020. After a long journey (see the detailed report in English here and in German here), the transplants were finally performed in October 2021 in Berlin. The ethical committee first rejected their claim, but then approved of the two transplants as one paired donation, not as two separate donations. This might be a milestone in the practice and potentially lead to more standardized procedures in the future.

As time goes by and word gets around, more and more incompatible pairs enter their data into the database. A handful of already identified pairs for paired donations are currently in different stages of the medical and legal process. The first step taken by Charité Berlin encouraged other hospitals to show interest in conducting paired transplants.

Despite of this recent progress, an efficient kidney exchange program would clearly require a law change in Germany. It would be sufficient to modify the current regulation marginally, by stating that the close personal connection is meant for the pairs entering the pool together and not for the matched pairs."

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

Here's a link to (and translation of) an op-ed I published in a German newspaper in 2016 urging that the law be amended to allow regular kidney exchange:

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

And here are all my posts on kidney exchange in Germany.

A step towards kidney exchange in Germany

 Here's an announcement of the German Medical Association's endorsement of kidney exchange, in the Deutsches Ärzteblatt.

Ärztetag spricht sich für Cross-over-Lebend­spende aus Mittwoch, 3. November 2021

Google translate: Doctors' day advocates cross-over living donation

"Berlin - The 125th German Medical Association (DÄT) has spoken out in favor of expanding the number of living organ donors. From the point of view of the medical parliament, a cross-over living donation - as it is already allowed in other countries - should also be made possible in Germany in the future.

"New legal regulations are required for this. Specifically, paragraph 8, approach 1 of the Transplantation Act (TPG) would have to be expanded, a donor-recipient pair can agree with a suitable second pair that two living organ donations are carried out crosswise (i.e. donor A / recipient B and vice versa).

"Living organ donation must be reorganized and rethought based on the current state of science," said Günther Matheis, President of the Rhineland-Palatinate Medical Association ( LÄKRLP ), at yesterday's debate.

T"he TPG currently limits the donor-recipient group for living organ donation to first- or second-degree relatives, spouses, fiancés or other persons who are obviously particularly close to the donor. The DÄT believes that a similar fate can bind people who have not been known to one another just as closely as people who are close to one another.

"In view of over 9,000 patients on the waiting lists who are urgently waiting for a life-sustaining transplant and the still far too low number of available donor organs, possible changes to the regulations on living organ donation have long been discussed in Germany."

HT: Axel Ockenfels

Earlier posts: https://marketdesigner.blogspot.com/search?q=Germany+AND+kidney&max-results=20&by-date=true

It's time to allow kidney exchange in Germany: Axel Ockenfels in the Handelsblatt

 As I noted last month, there's a conclave on kidney transplantation at the end of June in Germany. Axel Ockenfels keeps the focus on kidney exchange, in the Handelsblatt:

Die Regeln für Organspenden in Deutschland sollten reformiert werden

Google Translate: "The rules for organ donation in Germany should be reformed.

In the Federal Republic of Germany only close relatives can be considered as living organ donors. This is unnecessarily restrictive, thinks Axel Ockenfels and promotes cross-donations."

...

"In Germany, the necessary reforms for cross-donation can be accomplished within the current value framework, which presupposes the voluntary and altruistic nature of organ donation. Organ trafficking can be reliably excluded through institutional arrangements.

In a new survey, cross-donation receives great approval, both in Germany, where it is still prohibited, and in countries where it is permitted. There is much to be said for reform."

***********

Here's a link to a (the?) survey of attitudes in Germany and elsewhere:

Thursday, July 30, 2020

Surrogacy and global kidney exchange receive popular support even where banned, in PNAS by Roth and Wang

A glimmer of hope for German kidney transplants: a discussion of kidney exchange

 Axel Ockenfels (who, along with Dorothea Kubler has been at the forefront of advocating for kidney exchange in Germany) forwards me this announcement (translated from German):

"the German Federal Ministry of Health is organizing a digital symposium on Tuesday, June 29, 2021, from 09:30 to approx. 15:30 on the topic of "Expanding the donor pool for living organ donation - a perspective for Germany?", to which we cordially invite you. Please feel free to forward the invitation to interested parties from your industry.

"An organ transplant is often the only way to save the lives of seriously ill people or to restore their quality of life. In view of long waiting times for a post-mortem organ donation, the question of living donation sometimes arises. Living organ donation has been permitted in Germany since 1997 within narrow limits and under special conditions. The donor and recipient must be "manifestly close in a special personal bond." However, living donation may be excluded in such cases for medical reasons. In order to increase the chances of organ transplantation for patients who are affected by this, some countries have established so-called kidney exchange programs.

"The symposium will take a look at various possibilities for extending organ donation: What are the opportunities and risks associated with cross over donation, pooled donation and so-called non-directed living donation? What procedures are necessary to protect donors? These and other questions will be discussed from a medical, legal and ethical perspective with an interdisciplinary audience. 

"We would be delighted if you could contribute your expertise to the discussion and if we could welcome you at the event on

"Tuesday, June 29, 2021, 09:30 - approx. 15:30 hrs.

...

"welcome to the event. The invitation is explicitly transferable. 

"If you would like to attend the event, please register by June 28, 2021 at the following link: Event Management Tool link.

Yours sincerely

"Joachim Becker

"Head of the Department of Medical and Professional Law, Prevention

Translated with www.DeepL.com/Translator (free version)"

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

This seems like a potentially very positive first step, despite (or maybe because) of the fact that it seems to be signed by the Ministry of Health's department of prevention... (Leiter der Abteilung Medizin- und Berufsrecht, Prävention)

A previous post observed that kidney exchange receives popular support in Germany:

Thursday, July 30, 2020

Surrogacy and global kidney exchange receive popular support even where banned, in PNAS by Roth and Wang

(It turns out that I have a lot of previous posts related to kidney exchange in Germany...)

Surrogacy and global kidney exchange receive popular support even where banned, in PNAS by Roth and Wang

Popular repugnance contrasts with legal bans on controversial markets
Alvin E. Roth and  Stephanie W. Wang
PNAS first published July 29, 2020 https://doi.org/10.1073/pnas.2005828117

reviewed by Nicola Lacetera and Mario Macis

Abstract: We study popular attitudes in Germany, Spain, the Philippines, and the United States toward three controversial markets—prostitution, surrogacy, and global kidney exchange (GKE). Of those markets, only prostitution is banned in the United States and the Philippines, and only prostitution is allowed in Germany and Spain. Unlike prostitution, majorities support legalization of surrogacy and GKE in all four countries. So, there is not a simple relation between public support for markets, or bans, and their legal and regulatory status. Because both markets and bans on markets require social support to work well, this sheds light on the prospects for effective regulation of controversial markets.

"Our main result is that (unlike prostitution) the laws banning surrogacy and GKE do not seem to reflect popular demand. Neither do these bans reflect that opponents of legalization feel more strongly than supporters.

...

"All three transactions are the subject of current debate in at least one of the countries we surveyed.¶¶ Based on the results of our surveys, we do not see entrenched popular resistance to either surrogacy or GKE (or simple kidney exchange) where it is presently illegal, and thus, we anticipate that efforts to lift or circumvent current restrictions are likely to be increasingly successful, while efforts to legalize or decriminalize prostitution where it is presently illegal may face greater opposition from the general public.

"Understanding these issues is important, not just for the hundreds of Spanish couples stranded outside of Spain while they look for a way to bring their surrogate children home and not just for the people in need of kidney exchange but for whom it is out of reach in Germany or in the Philippines. These issues are also of importance to social scientists in general and economists in particular. When markets enjoy social support, when they are banned, and when, in turn, bans are socially supported are questions that touch upon many transactions, particularly as social and economic interactions are increasingly globalized.

"Our findings suggest that the answer to these questions may not be found in general public sentiment in countries that ban markets or legalize them. Rather, we may have to look to the functioning of particular interested groups, perhaps with professional or even religious interests, that are able to influence legislation in the absence of strong views (or even interest) among the general public about the markets in question."

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

Here's the published citation:

Roth, Alvin E. and Stephanie W. Wang, “Popular Repugnance Contrasts with Legal Bans on Controversial Markets,” Proceedings of the National Academy of Sciences (PNAS),  August 18, 2020 117 (33) 19792-19798; https://doi.org/10.1073/pnas.2005828117 

Germany sticks with opt-in donation for deceased donor organs for transplants

Axel Ockenfels points me to this story, in English, in Deutsche Welle:

German parliament: Explicit consent still necessary from organ donors
Germany's parliament has rejected a health ministry proposal for a new organ donation system. With low donor numbers, the health minister wanted a presumed-consent system, with the onus on people to refuse to donate.
Date 16.01.2020  Author Mark Hallam, Astrid Prange

"Germany's organ donation rules will remain largely unchanged after an emotional debate in the Bundestag on Thursday morning. The country will stick with a system of informed consent, whereby only people who voluntarily register as organ donors are eligible. Most, but not all, EU members have moved to an opt-out system that presumes a willingness to donate.

Presumed vs. informed consent

"Health Minister Jens Spahn, a Christian Democrat, had led the push to reform the system along with a Social Democrat, Karl Lauterbach. They had proposed a system of presumed consent, albeit also adding the chance for relatives to object to organ donations after the person's death. The motion failed by 292 votes to 397.

"A rival proposal, put forward by a group led by Green party lawmaker Annalene Baerbock, passed by 432 votes to 200, with 37 abstentions, in the decisive final vote. It advocated keeping the existing system of informed consent. However, in a bid to shorten Germany's transplant waiting lists, people will be asked when renewing their national identity cards if they'd like to donate organs. "

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Recent, somewhat related post:

Monday, November 11, 2019

Debate on kidney exchange in Germany

Kidney exchange, in French, in Forbes

Here's a short interview in French about kidney exchange, in Forbes France:

Alvin Roth, Lauréat Du Prix Nobel D’Economie Veut Revolutionner Les Dons De Reins
Philippe Branche   10 janvier 2020

Here's one bit:

Are you currently working with politicians, legislators or medical administrators to resolve this problem ? 

Alvin Roth: I am, but not with great success. I recently spoke to decision makers in several countries: India, China, Germany, Canada and of course the United States. In October, renowned bioethicist Peter Singer expressed strong support for the Global Kidney Exchange Program, so that recently the idea of ​​expanding kidney exchange to include international exchanges has gained momentum. I also recently debated with a member of the Bundestag, the German parliament. In Germany, kidney transplantation from a living donor is legal, but a patient can only receive a kidney from an immediate family member, and therefore the literal interpretation of the law makes it impossible to exchange kidneys. German law provides that monetary exchanges of parts of the human body are illegal and, apparently, it is to avoid any possibility of payment for a kidney that the limitation to family members is applied. A minimal amendment to German law could allow immediate family members to make an indirect donation, via the kidney exchange system, which would preserve the confidence that the donor was not paid to make an exchange. By designing this market in this way, we are trying to expand the database and reduce the waiting time for sick people.

Kidney exchange explained in 1 minute (video), and a BBC story

Here's a link to a 1 minute BBC video that was recorded when I was in Berlin recently, discussing how changes in the German transplant law (which presently allows only immediate family members to donate a kidney to someone) could be minimally modified to allow kidney exchange also.

 (a short ad comes on first--my part is only 48 seconds:-)


Here's an accompanying story that somewhat confusingly (it seems to me)  mashes together discussions of kidney exchange, global kidney exchange, and compensation for donors.

How an economist helped thousands get a new kidney By Ian Rose, BBC News
Berlin
...
"Roth, working with Tayfun Sönmez and Utku Unver, has revolutionised kidney donation around the world by using an economic theory to make kidneys more available.
...

"German exchange change?
"We meet in Berlin as Nobel laureates and other luminaries gather to discuss the future of healthcare. Alvin Roth is there in part because Germany is one of the only major industrialised countries where kidney exchange is not lawful.

"I think that the bureaucratic rules and regulations for kidneys as for every market have to be revisited from time to time in the in the light of new developments, and should be modernized and adapted to current capabilities," he says.

"When contacted about the issue the German Health Ministry tells me that they are planning to organise a public debate on the issue but have no schedule for that yet.

"Prof Roth says he understands the concerns behind the German ban. "They're worried about organ trafficking.

"They're worried that if I showed up and wanted to give you a kidney, it would mean that you had paid me and it may be I was a poor and desperate person. But on the other hand, if your brother shows up and wants to give you a kidney, they're not worried about that."
********
update:
The BBC publishes in many languages, and so you can read the story in Chinese, Indonesian, Turkish, Spanish, Portuguese, and here's a site that has translated it to Hungarian.

KIDNEY EXCHANGE AND THE ETHICS OF GIVING by Philippe van Basshuysen

 Philippe van Basshuysen considers various forms of kidney exchange, including non-directed (altruistic) donor chains, but not global kidney exchange (GKE), which he defers for future consideration. His work is motivated by the effective ban on kidney exchange in Germany, and, he writes, in " Bulgaria, Estonia, Finland and Hungary, among others." He also notes that non-directed donors are excluded in " Belgium, France, Greece, Poland and Switzerland..."

KIDNEY EXCHANGE AND THE ETHICS OF GIVING
Philippe van Basshuysen,  December 2019
Forthcoming in Journal of Ethics and Social Philosophy

"The arguments given here are not wedded to a specific moral theory. They will appeal to effective altruists, but because of their weak, conditional premises, many people who are not committed effective altruists will welcome them as well. They are also consistent with conservative views on donor protection and allocative justice concerning patients on waiting lists. I hope that these arguments will lead to a clarification of the debates about the ethics underlying KE programmes, particularly in countries that have hitherto banned these programmes."

Debate on kidney exchange in Germany

On Friday in Berlin I found myself in a debate with the chairman of the Research Committee of the Bundestag, the German Parliament, about legalizing kidney exchange in Germany. I proposed that a minimal amendment of the law, which now only allows close relatives to donate, would be to also allow them to be the intended donors of their close relatives in kidney exchange.  However it doesn't seem as if this is going to happen anytime soon (it looks like only the Free Democratic Party in inclined to support it...)

The medical newspaper ärztezeitung has the story
Transplantation
Lebendspende breiter aufstellen
Beim Thema Organspende rücken die Lebendspenden zunehmend in den Fokus. Ein Nobelpreisträger befeuert die aufkommende Debatte.
[Widen living donation
With regard to organ donation, living donations are increasingly coming into focus. A Nobel Prize winner fuels the emerging debate.]

"Nobel laureate Professor Alvin Roth submitted on Friday morning a proposal on how the living donation of kidneys in Germany could be broadened. Instead of considering only first and second degree relatives, spouses, registered partners and close friends as potential donors in the transplantation law, the pair organ exchange of living donors should also be possible, he said at the Nobel Prize Dialogue of the Leopoldina in Berlin. The aim of this model is to increase the chances of being able to mediate compatible organs to dialysis-dependent patients.

"The chairman of the Research Committee of the Bundestag, Ernst Dieter Rossmann (SPD) advised in his reply to not overburden the population in Germany. First, the contradiction solution must be introduced and its effect on the donor numbers to be waited, he warned.

"At the end of October, the Greens warned against commercialization and organ trade if the so-called cross-donation was introduced. At the FDP, the considerations have fallen on fertile ground."

Controversial markets, at Humboldt University

This evening I'll be speaking at Humboldt University:

BSE Lecture on "Controversial markets" by Nobel Laureate Alvin E. Roth

Wann: 07.11.2019 von 14:30 bis 15:45 

Wo: Humboldt-Universität zu Berlin, Dorotheenstraße 24, 10117 Berlin, Fritz-Reuter-Saal, 3rd floor

Abstract:Markets need social support to work well. So do bans on markets, since without sufficient social support, bans can be ineffective and can sometimes lead to active black markets.  I’ll describe some examples of how these tensions have played out differently in different places, for example,  for markets for surrogacy, prostitution, and drugs. A particular example will be the almost (but not quite) universal ban on monetary markets for kidneys, and how this has influenced the treatment of kidney disease and the organization of kidney transplantation around the world, including the development of kidney exchange, which is growing worldwide, but is effectively banned in Germany by current German transplant law.

"If you want to attend the lecture, please register by giving the subject "Registration BSE Lecture Alvin Roth" as well as your name and your institution via email to veranstaltungen@hu-berlin.de.

"After the lecture, at 16:00, up to 25 students (Master's and PhD) as well as Postdocs will have the opportunity to attend a round-table discussion with Alvin Roth in which he will address your questions. This round-table discussion will be held at room 2070a at HU's main building (Unter den Linden 6, 10117 Berlin)."
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Tonight I'll also speak at an event organized by the Einstein Institute, concerning how changes in the current German transplant law could make kidney exchange practical in Germany.

Kidney exchange in Germany? It will need an amendment to the Transplantation Act

Axel Ockenfels points out that the Frankfurter Allgemeine Sonntagszeitung has a recent piece on "Tauschen wir die Nieren?" ("Do we exchange kidneys?"). I can't find it online, but here's a picture:

Google translate renders the opening paragraphs as follows:

"Patients wait a long time for donor organs. That can be changed - with a proposal that has received the Nobel Prize.
Organ donation is literally a matter of life and death. Anyone who receives the urgently needed organ in good time lives on. In Germany, however, many are waiting for the necessary transplantation - often for years. At the same time, the number of organ donations is falling. So how can the number of donated organs be increased so that affected people can live? That's a tricky question, because too many answers tend to limit the voluntary nature of the donation. On Wednesday, the topic is on the agenda of German politics, when the Health Committee of the Bundestag deals with the amendment of the Transplantation Act.
The economists Dorothea Kübler and Axel Ockenfels advise the politicians to take a look at living donations. Kidneys or parts of the liver can also be donated by living people - and this is much less common in Germany than in other countries. The proposal goes in the direction of the FDP parliamentary group around the chairman Christian Lindner, who are pushing for more living donations. In a motion for the health committee on Wednesday, the FDP is proposing to allow the cross-donation of two couples and an anonymous live donation to an organ pool. "

Some movement towards kidney exchange in Germany

Axel Ockenfels writes:

"On 9 November 2018, members of the parliament of the German liberal party FDP submitted a petition ("Chancen von altruistischen Organlebendspenden nutzen – Spenden erleichtern") to ask the German government to draft a law that makes kidney exchange, non-directed altruistic kidney donations into a pool and, under certain circumstances, directed kidney donations to strangers possible in Germany": 
Chancen von altruistischen Organlebendspenden nutzen – Spenden erleichtern
"Make use of the opportunities of altruistic organ donation - make donations easier"

It calls for specific amendments to remove the current legal restrictions on kidney exchange.

German market design economists have been at the forefront of efforts to change the transplant law in this and other respects.

Here's an earlier post on the subject, whose links contain links to still earlier ones--maybe this series will converge soon in a way that reverses the decline in transplantation in Germany:

Tuesday, July 3, 2018

Obstacles to kidney exchange in Germany

Obstacles to kidney exchange in Germany

An op-ed in yesterday's Handelsblatt Global (in English) proposes that kidney exchange should be allowed in Germany:
Germany should allow donating organs to strangers
by Fabian Kurz and Fred Roeder, July 2, 2018

An earlier brief discussion/blog post (in German) with some interesting links describes some of the current obstacles to kidney exchange in Germany:

Nieren-Tausch kann Leben retten (Kidney exchange can save lives)
von Alexander Fink & Fabian Kurz, 20. Juni 2018

Here's the German Transplant Act.

Here's a ruling of the German Federal Social Court, confirming the effective ban on kidney exchange.

Here's a 2005 news story about two patient-donor pairs who were allowed to engage in a kidney exchange after arguing that they had established a sufficient relationship with each other, to fit the requirement of the law that transplants can only be received from close relations, i.e. immediate family, or a "special personal bond" .
Nieren-Tausch soll Leben retten (Kidney exchange is supposed to save lives)
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Some earlier discussions and links:

Thursday, March 17, 2016

Transplants in Germany, further discussion of changing the transplant law, in Der Tagesspiegel

Sunday, January 21, 2018

The number of organ donors in Germany has fallen to its lowest level in 20 years.

Wednesday, February 21, 2018

Organ donation in Germany

Organ donation in Germany is declining, from an already low rate.

Kidney exchange in Europe: 3rd Workshop of the European Network for Collaboration in Kidney Exchange Programmes (ENCKEP)

 The international participation in this conference is a sign of the growing reach of kidney exchange:

3rd Workshop of the European Network for Collaboration in Kidney Exchange Programmes (ENCKEP)

Program:
Thursday, September 28, 2017
9h15 Registration
09h40 Welcome and Introduction

10h10 Ruthanne Leishman (UNOS)

10h55 Lisa Burnapp and Rachel Johnson (desensitisation)

11h15 Coffee break

11h45 Joke Roodnat (Dutch KEP)

12h15 Tommy Andersson (Swedish KEP and STEP update)

13h00 Lunch (at workshop venue)

14h30 Round-table: Barriers to Establishing KEPs
Facilitator: Lisa Burnapp (UK)
Participants: Eyjólfur Ásgeirsson (Iceland)
Haris Gavranovic (Bosnia and Herzegovina)
Balázs Nemes (Hungary)
Axel Rahmel (Germany)
Mikko Salonen (Finland)


16h00 Coffee break

16h30 David Manlove (UK KEP)

17h00 Bart Smeulders (Belgian KEP)

17h20 María Valentín and Francesc Castro" (Spanish KEP)

18h00 Close

Friday, September 29, 2017

09h30 Christian Jacquelinet (French KEP)

10h00 Xenia Klimentova (Portuguese KEP)

10h30 Pavel Chromy / Jiri Fronek (Czech/Austrian KEP)

11h00 Rafal Kieszek (Polish KEP)

11:30 Coffee break

12h00 Discussion: Next handbook, Skype Joris, Global Kidney Exchange, Financial Aspects of KEPs, ...

Kidney exchange in Switzerland in 1999, and some early repugnant reaction

Kidney exchange is well established and growing in Europe today, but the first exchange was greeted in some quarters as a repugnant transaction.

The first kidney exchange in Europe was actually an international exchange, involving a German couple and a Swiss couple. It was conducted in Basel on May 23rd 1999, and reported in

G. Thiel, P. Vogelbach, L. Guerke, T. Gasser, K. Lehmann, T. Voegele, A. Kiss, and G. Kirste  ”Crossover renal transplantation: hurdles to be cleared!”, Transplant Proc , 2001

They report that
"The Swiss Health Insurance paid the hospital bill without hesitation. The German insurance, however, refused to pay, despite the fact that the cost (including donor nephrectomy) was lower in Basel than cadaveric transplantation alone would have been in Germany and despite huge savings for the German insurance by being released from further payments for dialysis treatment. The insurance agency argued that crossover transplantation is not allowed in Germany, and that they would not pay for an illegal procedure. …Crossover transplantation is legal in Switzerland”

Following the publication of the paper, press coverage reflected a good deal of repugnance for kidney exchange and criticized the German surgeon Prof Dr. Gunter Kirste (with whom I have discussed these matters prior to my recent talk in Geneva). Muriel Niederle pointed me to this story from Der Spiegel 12.02.2001: “[Opening the] Door to Commerce”

Here's another, from the Suddeutsche Zeitung, also in 2001, kindly supplied by Dr. Kirste, which compares kidney exchange to organ trafficking: "Organs of a Travelling Salesman"