"Why Is There So Much Fraud in Academia?" Freakonomics interviews Max Bazerman and others

Below is the latest Freakonomics podcast (and transcript), on fraud in academia.  Those most in the headlines weren't available to be interviewed, but their coauthor (and my longtime HBS colleague) Max Bazerman gives his perspective.

Also interviewed are the Data Colada authors/data sleuths Leif Nelson,  Uri Simonsohn, and Joe Simmons (with some clues about the name of their blog), and Brian Nosek, who founded the prizewinning Center for Open Science (https://www.cos.io/ 

Here it is:

Why Is There So Much Fraud in Academia?  Some of the biggest names in behavioral science stand accused of faking their results. Freakonomics EPISODE 572.

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And here are two paragraphs from Max's HBS web page (linked above), suggesting more to come:

"I have been connected to one of the most salient episodes of data fabrication in the history of social science – involving the signing first effect alluded to above. I am working on understanding all known social science frauds in this millennium. Social science also struggles with a broader problem, namely the fact that many studies fail to replicate due to faulty research practices that have become common in social science. Most replication failures can be traced back to the original researchers twisting their data to conform to their predictions, rather than from outright fraud. Trying to produce “significant” results, they may run a study multiple times, in a variety of ways, then selectively report the tests that worked and fail to report those that didn’t. The result is the publication of conclusions that do not hold up as accurate. Both problems – outright data fabrication and this reporting bias that shapes results – need to be tackled, so all of us in academia can publish results that are replicable and can help create value in society.

         "The last dozen years have witnessed multiple efforts to reform social science research to make it more credible, reproducible, and trusted. I am writing a book on reforming social science, which will provide an account of recent data fabrications, and highlight strategies to move forward to create more credible and impactful scientific research."

Followup on the latest Freakonomics kidney exchange chain

Earlier this month I blogged about a kidney exchange chain at Virginia Mason Hospital, in Seattle, initiated by a non-directed donor who had heard an interview about kidney exchange on Freakonomics.  Subsequently, my colleague Elena Cryst, whose dad is a transplant nephrologist at that hospital, sent her the email below about a short talk he'd prepared, which they have given me permission to reproduce with minor edits. (They also note that "the participants OK’d sharing this so no HIPA violations.")

Dr. Cryst writes:

"I’m a transplant nephrologist, and  I’m  sharing this story on the insistence of these four patients who want to get their story out and encourage others to participate in organ donation and increase the options for kidney transplants in our country”

This is a photo of 4 people – I hope you can see them as you read this.

Three out of four of these folks in the picture just so happened to have appointments in my Monday AM clinic.  I’ve been taking care of kidney transplant patients for thirty years, but by the end of clinic, I was astounded by seeing how much this meant for each one of them and the different reasons why.  As this morning went on I heard this story from three of the four points of view.  It very much took me by surprise how much had changed for all four.…  It was just another day in the office, but this story is striking and they all wanted to share it with everyone in hopes more people can receive transplants.

THE PHOTO: 

THE STORIES:  First with hat on backwards is DC my patient.  A naturally shy and private person.   Happiest I’ve seen him in three years but has had many disappointments.   It has been an emotional roller coaster, as three years ago he thought he was passing a kidney stone- only to learn he had an advanced kidney disorder and soon would either need to get a transplant  or start on dialysis.  There had been lots of struggles to get to the point of transplant…. one by one, donors came forward but were disqualified due to minor health issues.  Finally one did  get through testing and qualify to donate, only to find out she was not a match.  He was devastated again.  After working with our program, we were poised for a paired donor exchange but with time running out…we needed a non-directed donor to step forward.  If someone could donate for DC, his donor would give a kidney for the next person on our waiting list and he would not have to start the process of dialysis. 

Next to DC’s left is Steve, healthy tugboat pilot who commutes to his home inland and on the way listens to lots of podcasts.  Freakonomics Radio had one about Al Roth, a Nobel prize winning economist at Stanford who researches how to create markets for things that don’t have a price.  He was the economist who worked to redesign the resident matching program to accommodate couples in the 1990’s and was fascinated by the challenge of how to allocate kidneys from live donors.  This is another problem of how to make a market for something that could not be exchanged for cash.  He and colleagues designed the system and did the math.  And won the Nobel prize!  Steve caught on to a few facts in the story – like the huge number of potential living donors in this country, and the benefit that could be afforded to those waiting for a kidney from a deceased donor.  The fact that the number of such paired donor exchange transplants has grown from only 2  in 2000 to 1000 in 2018, and said sign me up.  His generosity and courage started this chain of events.  Al Roth’s work is changing the way we are doing kidney transplants at my hospital and bringing in more and more living donors together with recipients they don’t know. The process was hugely important to Steve and it was icing on the cake that he was able to meet DC after it was done.  They all mutually agreed to make the process open rather than confidential which was their personal choice.

Next is Debbie from Ukqiagvik Alaska (formally Barrow)  – the literal ‘end of the earth’ the northern most point in the USA above the arctic circle in Alaska.   Debbie is an Alaska native who toughed it out with barely enough renal function for many  years but time was running out for her as well.  She was at the very top of the waiting list and she was waiting for a deceased donor kidney at our far away transplant center. The logistics of urgent travel to a faraway city fast enough to get a kidney transplant from a deceased donor -- while the clock was ticking -- made it much more better for her to have a living donor transplant that could be scheduled.  As you can tell Debbie has been delighted with her new kidney.  She is a long way from home for a few months, but enjoying the challenges of being in the city, even trying foods not part of her diet - like cucumbers (“not my favorite” she says) - not often available above the arctic circle!  She is here with family for a few months recovering and adapting to having normal kidney function again.

Next is Wendy – Journalist, community organizer and friend of DC.  She did gently insist that he let her get tested to donate.  He was apprehensive and certainly did not want to ask her.  But, as usual, Wendy prevailed.   In exchange her kidney went to Debbie who now feels better than she has in years.  Wendy is being ‘adopted’ by the women in Ukqiagvik and in clinic that morning, she was wearing the traditional hoodie blouse with big pockets that Debbie’s sisters back home had specially made for Wendy.  She is thinking about how to make the trip up north to see her new family of friends.  It was Wendy who also gently admonished me for not doing a better job of telling our story to others.  She strongly felt that we need to point out that her life and Steve’s are forever changed for the better - -  as well as the obvious benefit for DC and Debby. 

Although this is the kind of work we do every day, we would like to do many more living donor transplants for people and take more people off the waiting lists and out of the dialysis units.  There are a lot of moving parts and a lot of people who contribute, but we can scale it up.  The more scheduled procedures we do, opposed to deceased donor surgeries which are by necessity emergency surgeries, the greater our impact  can be. Each living kidney transplant also frees the deceased donor kidney to go to someone else - in effect doubling the benefit.  Thanks to Al Roth, there is now a new market for getting our willing donors together with recipients they do not know.  We always respect privacy and our default is to keep this process of ‘entering the market’ safe and anonymous.  But, as in this case, the participants can decide to share their experience, meet each other and . . . as Wendy said, “get the word out.”   In fact this photo captured the moment after surgery where this group organized a first meeting on their own and went off for lunch.  As a kidney transplant physician, I know we have the systems in place to grow this work.  Facilitating living kidney donation benefits not only more recipients, but it positively  changes lives of these donors.  It really positively affects lives of everyone involved. . .even the doctors like me…and I bet even the economists! 

Cyrus Cryst MD FASN

The complex economics of dialysis and insurance, in Freakonomics

 Freakonomics peeks under the rocks to see what crawls out:

Is Dialysis a Test Case of Medicare for All? (Ep. 457)  by Stephen J. Dubner

"But as he dug into their business, he discovered what looked like a suspicious relationship between the two dialysis chains and a charity called the American Kidney Fund, whose mission is to provide financial support to needy patients.

CHANOS: So, the American Kidney Fund will help various patients pay for private policies. 

Private insurance policies, that is, instead of Medicare.

CHANOS: The patient is strongly urged because of quality of care, convenience, whatever the case might be, that they will be treated better as a commercial-policy patient rather than a government-policy patient and that the American Kidney Fund could help them pay those premiums.

On its surface, that does not sound like a terrible thing for a kidney charity to do. But Chanos looked at it from the perspective of the dialysis industry.

CHANOS: If the dialysis companies could push people that would normally be eligible for Medicare into commercial policies, private policies, they could charge those companies often two to four times what the going Medicare reimbursement rate was.

And Chanos believed that pushing people onto commercial insurance is exactly what the American Kidney Fund was doing. It’s helpful here to follow the money.

CHANOS: It will come as probably no shock that the two largest donors to the American Kidney Fund are the two largest dialysis companies, Fresenius and DaVita. 

In 2018, DaVita and Fresenius reportedly donated a combined $247 million to the American Kidney Fund — or about 80 percent of the charity’s revenues.

CHANOS: So, they are basically putting money into the charity. The charity is turning around and using that money to help pay premiums to enroll patients in commercial insurance. And then, the commercial insurers are charged a huge premium to what the dialysis companies are charging the government. 

It’s estimated that for every dollar that DaVita or Fresenius send to the American Kidney Fund, they receive $3.50 in return from private-insurance payments.

CHANOS: And that’s the problem. 

One especially interesting part of this arrangement is who’s losing money: the insurance companies! It’s not often you hear about insurance companies on the losing end — and maybe you don’t have much sympathy.

CHANOS: “Well, it’s the private sector, right? So, why should we care if the insurers make less profits?” Well, the fact of the matter is it’s raising premiums for everybody in the exchanges.

That is, the insurance exchanges, the marketplaces created by the Affordable Care Act, also known as Obamacare.

CHANOS: And the head of California Blue Cross Blue Shield was on the record saying that the dialysis in California was driving up private policy rates dramatically"

National Kidney Donor Advocate Conference, on YouTube

 Here's an announcement I received from Ned Brooks, the founder of  NKDO, National Kidney Donation Organization (formerly Donor to Donor).  If I understand correctly, the different talks and interviews will be available at the link after first streaming in conference style, starting at 9am Pacific time. It includes a video of Ned interviewing me.

I'll update this post as necessary. 

"This Wednesday, October 21^st, NKDO, National Kidney Donation Organization (formerly Donor to Donor) will release the virtual National Kidney Donor Advocate Conference. This event is designed to give volunteer living donor advocates the information they need to be more effective advocates for living donation. Transplant industry experts across the country will be presenting to you and delivering invaluable advice about their area of expertise.

The conference will stream on our YouTube channel beginning at 12:00 noon Eastern this Wednesday. The conference will be in segments and accessed through the “playlist”, either streaming as one event or accessed at different points in the conference. The link is  https://www.youtube.com/channel/UCsoS-yavRQCVl7bwcjT2iCA , which will go live at noon Eastern on Wednesday.

- Have you ever wondered about the transplant surgeons who do the surgery? What they are thinking and what they would like you to know? Dr. Joshua Mezrich, transplant surgeon at UWMadison and author of “When Death Becomes Life: Notes from a Transplant Surgeon” talks about his experience with organ donors and recipients.

- Are you a living donor or a transplant recipient, or expecting to be one? Do you remember the experience of being evaluated at the transplant center and listening to all the information, and maybe feeling a little overwhelmed? Living Donor Coordinator Marian Charlton and Patient Coordinator Janet Hiller are two of the most respected voices in transplant, and they will tell you what they want you to know to better understand the process. Anyone who goes through this experience or has a loved one in transplant will want to see these segments.

- Living kidney donors deserve all protections available, from reimbursement for out-of-pocket costs and lost wages to medical coverage for medical issues that may arise months or years after donation. Garet Hil, founder and CEO of the National Kidney Registry, talks about the suite of protections available to living donors through Donor Shield.

-  Are you a kidney patient in need of a donor? Harvey Mysel, a two-time kidney recipient and founder and CEO of the Living Kidney Donor Network, talks about how to have your kidney donor find you.

- Professor Alvin Roth won the Nobel Prize in Economics for his work creating the algorithms that contributed to the creation of the “kidney chain”, a development that transformed kidney transplant procedures. Prof. Roth discusseshis work and the business known by the intriguing moniker of “repugnanttransactions.”

- All kidney patients will benefit by watching nephrologist Dr. David Serur talk about kidney disease and what every kidney patient and advocate needs to know to be properly informed about how to deal with renal disease. 

- Non-directed, or altruistic, donors are a rare breed, though we are trying to change that. No one knows the brain of the non-directed donor better than Professor Abigail Marsh, who has been studying non-directed donors for years. If you want to better understand why someone will happily donate a kidney to a stranger, this presentation will help answer that question.  Prof. Marsh is the author of “The Fear Factor: How One Emotion Connects Altruists, Psychopaths, and Everyone In-Between.”

- If you listen to podcasts, you are probably familiar with “Freakonomics” and its creator, Stephen Dubner. It was the Freakonomics interview with Prof. Roth that set Donor to Donor and NKDO into motion, and our interview with Mr. Dubner will interest anyone who understands “the power of the pod”.

- Jim Gleason is a heart transplant recipient and the president of TRIO, Transplant Recipients International Organization. Mr. Gleason is a motivational speaker who asks the question, “Are you a cookie monster?”

Here's the video of my video

Freakonomics on legalizing prostitution

Should Prostitution Be Decriminalized?, a thoughtful post on the subject at Freakonomics.

Celebrating Ramanujan's birthday (with some math quotes)

 Yesterday, 22 December, is celebrated every year as National Mathematics Day in India, in honor of the 1887 birthday of the great Indian mathematician Ramanujan.

Here are some quotes about math in honor of the day, in the Indian periodical RepublicWorld.com

Mathematics Day: Here are some of the most inspirational Happy Mathematics Day quotes on Ramanujan's birthday to honour this special occasion.  By Vageesha Taluja

Not included in that collection of quotes is this one, attributed in Wikipedia to Ramanujan himself: "An equation for me has no meaning unless it expresses a thought of God."

I was pleasantly surprised to see included something much more prosaic that I  was quoted as saying, in a 2010 profile in Forbes magazine called Un-Freakonomics, by Susan Adams: 

"I've always been interested in using mathematics to make the world work better." -Alvin E. Roth

A proliferation of penny auctions

Last year I thought about blogging about Swoopo, the "entertainment shopping" site that is run as an "all pay" auction for consumer goods, in which all bidders must pay to bid, but only the winning bidder receives the object. But soon enough there were excellent posts on the subject by others. I particularly like Ian Ayers at Freakonomics, who explained how Swoopo is similar to the "escalation auction" proposed years ago by Martin Shubik, which has become a staple demonstration in game theory classes, and Tyler Cowen at MR, who observes that Swoopo auctions can make a lot of money for the owners of the site, while most of the bidders lose. He writes "In short, swoopo is about as close to pure, distilled evil in a business plan as I've ever seen. " (emphasis in original). And here's the Wikipedia entry.

Swoopo bidders are a bit of a puzzle of the behavioral economics kind: are they like buyers of lottery tickets, who know that they will likely lose but find entertainment value by purchasing the right to dream (see this paper by Emily Oster)? Or are they making mistakes? And if the latter, will demand for this kind of auction dry up? Or will new suckers keep appearing?

But there are other, market level questions we can ask, and I got the beginning of an answer when I did a google search on "swoopo", or another search on "penny auction" . You'll find two things if you click on those searches: there are now a lot of similar auction sites, and there are also plenty of people who are eager to sell you software to set up your own "penny auction," as these sites have come to be known.

(BidRodeo's icon is a man on a bucking bronco, over the motto "Hold on the longest and win!")

What are the questions to which those observations are the beginnings of answers? I guess one is, "is it easy to earn outsized rents by selling to the gullible?". I presume most of the new sites make very little money. Whether they also attract away swoopo's customers or otherwise reduce swoopo's rents remains to be seen.

A new (job market) paper by Edward Augenblick at Stanford suggests that the already-established penny auctions may not disappear in the blink of an eye: Pay-As-You-Go: Theoretical and Empirical Analysis of a New Auction Format

He finds Swoopo to be quite profitable, and the abstract concludes:
"Finally, I attempt to address the long-term prospects of the market for these auctions. Using high frequency auction supply and user data, I estimate the current and optimal supply of auctions for a given number of users. This analysis suggests that the structure of the auction creates barriers to quickly developing a large userbase, allowing the most-established competitor to continue making large profits in the medium-term. This analysis is supported by auction-level data from five competitors. "

HT Eduardo Azevedo and Muriel Niederle

A Freakonomics listener was inspired to become a non-directed kidney donor by the podcast on kidney exchange

In June, 2015, right around the time my book Who Gets What and Why was published, Steven Dubner and his team at Freakonomics published a podcast called Make Me a Match, in which he interviewed me and others about kidney exchange, among other things. Now, in a new podcast, Dubner interviews a listener named Ned Brooks who was inspired by that interview to become a non-directed kidney donor and start a kidney exchange chain. In fact, not only does Dubner interview the donor, he interviews the woman who received his kidney, and in fact introduces the two of them for the first time. Pretty dramatic stuff.

Here's the link to the podcast, where you can (both) listen to it and read the whole transcript.

Ask Not What Your Podcast Can Do for You, February 25, 2016 by Stephen J. Dubner

Below is the part of the transcript that has to do with kidney donation and transplantation. If you read it through, I predict you'll be moved (at one point Dubner says he's crying, so at least he was moved), and if you get to the end you'll find out about a new organization that Brooks has established to help find new donors for people who need them.

"Let me introduce you now to Ned Brooks.

DUBNER: Ok. Hello, Ned?

NED BROOKS: Stephen, how are you?

DUBNER: Hey! Great, how’re you? Nice to meet you.

BROOKS: Nice to hear you.

DUBNER: Thanks for doing this, the interview, but doing the actual deed.

BROOKS: It was a very easy thing to do.

Ned Brooks is 65 years old.

BROOKS: I live in Norwalk, Connecticut. I’m semi-retired after a couple of careers, on Wall Street and in real estate.

He’s been married for 34 years. Three grown children. One day last year, Brooks was in his car.

BROOKS: And we were listening to your podcast about Alvin Roth, the Nobel Prize winner in economics who created a model to trade indivisible items without the use of money. And I think he was talking about houses at the time, but it seems to work very well for the kidney chain as well.

The episode was called “Make Me a Match.” Al Roth was describing how he and others had created a series of algorithms that helped match people in need of a kidney transplant with potential donors

BROOKS: And I listen to the podcast with growing interest because what came through to me about the power of the kidney chain, as somebody with a business background, is the concept of leverage. That one altruistic donor — and an altruistic donor is someone who gives a kidney without having anybody particular in mind to receive it. And it provides a lot of options for the people who put these things together, to start a kidney chain. And that results in a sequence of transplants that can affect a lot of people.

DUBNER: Now, have you ever considered giving a kidney before then?

BROOKS: No, no I did not.

DUBNER: And what was it about, about the message from Al Roth in that podcast that either, kind of, alerted you? What did you learn, or what changed your mind that made you start to think about that, then?

BROOKS: Well, the concept that we have two kidneys and we only need one.

DUBNER: Now did you know that ahead of time, or not really?

BROOKS: Yes, I did know that much. What I did not know is all the benefits that accrues to one who donates a kidney. The process is lengthy in terms of the amount of testing that you go through to do so. But …

DUBNER: Now, you’re saying that the medical tests were the benefits?

BROOKS: Oh, absolutely.

DUBNER: I just want to clarify here.

BROOKS: Absolutely. Look, you get many thousands dollars of testing for free.

DUBNER: Can I just say something, Ned? I think you and I are fundamentally different people, because if I were going to get several thousands of dollars worth of something free I would want it to be, you know, golf, or something, fishing boat. Not medical testing, but tell me more about your great desire …

BROOKS: Well, you’re not 65, and knowing that all your organs are free of any contaminants is a very reassuring thing, actually.

Let me be clear. It wasn’t really all the free medical testing that made Brooks want to become a kidney donor.

BROOKS: I think this is something I have to do. It required some thought, discussion with my wife that day in the car. I spent one restless night, probably about three hours trying to understand what my own motivations were and if they were the right ones to be doing this. And once I put that to rest, then it was a very easy thing to do.

DUBNER: Did you decide immediately to become a non-directed donor? Meaning that your kidney would be available for anyone who needed it? Or, did you think about trying to help someone in particular?

BROOKS: As great as it would be to help someone in particular, I didn’t know anyone who needed a kidney. And in fact, the leverage comes from being an altruistic donor. You can’t start a kidney chain unless you’re altruistic about it.

DUBNER: Let’s say I need a kidney and my wife is willing to donate or someone else in my family is willing to donate, but they’re not a match. They’re not a physiological match for me. But they would donate a kidney of theirs to someone else who is a match. They then enter the chain, correct?

BROOKS: So, call them “Couple A.” And Couple B is in the same situation as is Couple C, D, down the line.

DUBNER: But then there is this wildcard, X, that’s you. This guy who comes in that doesn’t have anyone that needs one, that just wants to give. Does that make you much more valuable?

BROOKS: That makes me valuable because it allows the algorithm to maximize the length of the chain and kick it off. If you didn’t have the altruistic donor to start, you’d have to have a perfect match. 

DUBNER: Talk about the procedure, working with the hospital, and talk about how the relationship works so that you are not made to feel that you’re being pressured.

BROOKS: Sure. In my case, I had the operation done at New York-Presbyterian. And I chose New York-Presbyterian because they do a lot of these operations. And I think that with any surgery like this you want to go to a place that does a lot of them. And so I was very comfortable with their record. They’ve never lost a donor yet. They provide you with two advocates. And those advocates are there to protect your interest throughout the process. And you go in for testing, you do it through your advocate, you go in for psychological testing, physical testing. They want to make sure you are financially able to this, because, of course, you cannot be compensated for a kidney donation.

DUBNER: To what degree did they push back? In other words, to what degree did they try actively to discourage you or at least make you take a step back and think it through a little bit more?

BROOKS: They didn’t actively discourage me.  The psychiatrist probed quite a bit. But after I seemed to have satisfied her on the answers, that was the end of it.  What they will not do is they will not come after you to keep you coming to hospital for every procedure that needs to be done. In other words, they set the time and the date for your next appointment, and they won’t call you. It’s up to you to make sure that you’re there.

DUBNER: Oh that’s interesting, yeah. And at no point did they catch on to the fact that you were just in it for the free medical testing?

BROOKS: Actually, actually yes. The doctor I spoke with there said, “This is a little-known secret, but the testing is so good that everyone should at least start out to be a kidney donor and find out how their tests go.”

DUBNER:  That is a secret that I’m guessing they really don’t want broadcast. Because I can see an army of senior citizens flooding in for their tests saying, “You know, I think I’m going to hang on to this — to the other kidney.”  And then talk to me about your family’s response.  Was everyone on board?

BROOKS: My wife was supportive. As I said, I have three children. One was very supportive, one was skeptical, and one was opposed. And I guess that’s what you get when you get three children. But the skeptical one, and the one who was opposed, turned around once they felt like they got a lot more facts about it.  It’s a very safe procedure relative to surgery, in general. And once they understood that, then I think their reservations went away.

DUBNER:  I understand you wrote a letter to your family when you had gotten pretty far along in the process. By then you’d undergone some of the testing?

BROOKS: Yes, yes.

DUBNER: Do you happen to have that letter handy?

BROOKS: Actually, I do have it here.

DUBNER:  If you don’t mind giving that a read, that would be great.

BROOKS: Sure. This is a letter that I wrote to my family when I realized that it was what I wanted to do, and I wanted to inform them all at the same time. So, I sent them an email and it goes like this:

All, as you have commented upon, I have had a number of medical tests over the summer. I did not fully answer your questions about those because I wanted to wait until I had cleared all the tests. I’m happy to report that I’m about as healthy as is possible for a 65-year-old male to be.  

Back in the spring, I was listening to a Freakonomics podcast about a man who won the Nobel Prize in economics for constructing a model of a market to trade indivisible objects without the use of money. He was thinking about houses, but it turns out that the model works very well for other things. His work had been used to create an extensive network for the matching of kidney donors and recipients. The more I listened to the podcast, the more fascinated I became as I learned that just one altruistic donor — a person who donates without a targeted recipient — can launch a chain of kidney transplants that can number as high as 43.

I spoke with the National Kidney Foundation and learned more about the process. I registered as a potential donor and began extensive series of tests at New York-Presbyterian, which have now concluded with me be being accepted as a kidney donor.

So why am I doing this? Many of our friends and acquaintances have had their share of health challenges in recent years. It is mightily frustrating to watch the pain and suffering and be unable to give any help. I, on the other hand, am in perfect health. I have no need for my second kidney, and I appreciate that my actions may greatly benefit the lives of not just the recipients of those kidneys but their entire families. Without it being too much of a stretch, my one wholly redundant organ can potentially change and improve the lives of hundreds of people.

There were 5,355 kidney transplants from living donors last year, and there are over 100,000 people on the wait list right now for a kidney.  The operation is several hours. They start about 3 a.m. in order to catch the morning flights around the country, particularly Los Angeles. L.A. does more transplants than any place in the country, and New York-Presbyterian does the most east of the Mississippi. They’ll have me walking that same day, and I should stay two days in the hospital. I’ll be uncomfortable for two weeks, and fully recovered after four weeks. The operation is laparoscopic, with a single incision in the abdomen. I’ve been working hard with my trainer on my abs.

My advocate tells me that because I am blood type O, a universal donor and an altruistic donor, I will light up computer screens across the country when they list me tomorrow. I am happy to report that Mom is fully on board with this. I could go on for a while, but I think you have the picture. If you have interest in hearing the podcast that inspired me, you can find it here and the short Freakonomics blog on the subject here. Let me know if you have any questions.

Love you all, Dad.

The left kidney that Brooks donated wound up launching a three-recipient chain.

BROOKS: I knew nothing about my recipient until the day of the surgery when I was told that it was a 37-year-old female in Denver area and that she was very, very sick and unlikely to find a donor anytime soon. And that this was a real one-in-a-million match.

DUBNER: Did you know anything about the cause of her illness? And would that have mattered to you if you did know?

BROOKS: No, I had no idea.

DUBNER: Look, you’re not getting paid; you might get thanked, you might not get thanked. You’re doing this for your own set of reasons. Was it important to you that that person appreciate those reasons, or appreciate you? Or did it not really work that way for you?

BROOKS: This is where the leverage comes in. They ask that same question in the initial stages in a little bit different way. What they ask is, “If something happens to your recipient, how upset are you going to be?” Quite frankly, my answer was, “This is multiple people who are getting a transplant because of what I’m doing. And if one of them doesn’t work out, I’m terribly sorry, but it’s going to change the lives for all the others.”

DUBNER: So Ned, you learned a little bit about your recipient, and from what I understand, you’ve been in contact — you’ve received a letter from her — is that right? Expressing her thanks?

BROOKS: The way this works is I go through my advocate at the hospital writing a letter to the recipient that goes through the advocate at her hospital to her. Then if she chooses to do so, she comes back to me with whatever she wants to say. And then through the advocates I go back and disclose my identification, then she does that back to me if she wants to. And that’s the way it worked. And we’ve exchanged emails. And I’ve gotten Christmas cards and such from her family, and so forth.

DUBNER: So you haven’t met with her or spoken with her by phone?

BROOKS: I have not met or spoken to her.

DUBNER: OK so, here’s the story. I believe that if technology has served us well that she’s on the other line right now. Danielle from Centennial, Colorado.

BROOKS: Oh my god!  I’ve not spoken to her yet! This would be great.

DUBNER: Danielle, can you hear us? This is Stephen Dubner.

DANIELLE SHAFFER:  Hi, I can hear you guys.

BROOKS: It’s Ned.

SHAFFER:  Hi Ned.

BROOKS: Hi.  

SHAFFER: How are you doing?

BROOKS: I’m doing great.

SHAFFER:  Good, good. This is exciting.

BROOKS: This is very exciting. It’s great to hear your voice. How are you feeling?

SHAFFER:  I’m doing good! I’m feeling real good. Lately it’s been a struggle since the surgery but I’m doing good. A lot better than I was.

BROOKS: Are you on lots of meds?

SHAFFER:  Yeah, unfortunately, I’ll have to be on a ton of meds for probably the rest of my life.  

DUBNER: Hey Danielle, this is Stephen. Can you tell us a bit about what led to your need for the kidney?

SHAFFER: Sure, sure. It all started October 8, 2014. I had received a call from my doctor saying that my blood work had come back — I’d gone to my regular doctor just because I was having a severe headache that wouldn’t go away. And so they did some blood work, they called me the next day and said, “You need to get to the hospital immediately.” They were telling me creatinine was at a 12 and I had no idea what that was. And so, I went to the hospital and was immediately hospitalized for the next 15 days, getting biopsies and MRIs and plasma freezes and dialysis and getting all these tubes put in my neck and chest. It just all happened so fast. To this day, they still don’t have any reason. It happened three weeks after I had my son but they don’t want to associate it to that. So they really have no answers of why this all happened to me.

DUBNER: And what was your, a) I guess, prognosis? Did they think that you would survive? And what was your prognosis for getting a donated kidney?

SHAFFER: Well, when I was hospitalized and they had no answers, and they were functioning a small part, but they said that they were failing. But they had hope — since they really had no idea what was going on with me — that they would kind of kick back in and restart themselves. So we kind of just waited and I started dialysis and everything. And while we were waiting for those next couple months, I actually tried acupuncture for, you know, organ treatment, specifically for that. You know, I was trying everything. And I said, you know what, I’m not going to wait any longer for them to restart. I better get on this transplant list now. So, come January of 2015, I started the process of getting on the transplant list. And starting there.

DUBNER: And what were you told about how long that would likely take you to get you a donated kidney?

SHAFFER: Well, it came back that I had antibodies in my blood from blood transfusions that I had during the hospitalization, and from having children they said I had created all these antibodies. So it made me a very rare match for  — I wasn’t a match to any of my family and so they said because of my rare antibodies I could possibly be on the list five or six years. So that’s the kind of range they gave me back in January of 2015. That, I was looking at five-to-six years being on dialysis.

DUBNER: Wow. How long was it before you heard that there was a donor?

SHAFFER: Well, it was probably come May of 2015 that I started getting word. Me and my father, we decided since I was having such a hard time and nobody in my family matched with me, my father really wanted to donate on my behalf. So we heard about the paired-donor program through the hospital and he wanted to donate his kidney on my behalf. So, it was probably around May of 2015 that we started the chain process. I had several chains lined up throughout the summer of 2015 but it kept falling through due to scheduling with some part of the chain — it kept falling through. So I had many chains lined up throughout the summer, and it was finally in August that we found — I guess Ned was matched to me, and we got the surgery date of September 22, and it kind of just happened really quickly from there.

DUBNER: Way to go, Ned.

BROOKS: Thanks.

DUBNER: What’s it feel like for you, Ned, hearing Danielle talk now? She’s obviously in a much better situation today with your kidney in her than she would be without. So what’s that feel like to hear her on the other end of the line?

BROOKS: It’s emotionally very powerful. It means a lot. A great deal.

SHAFFER: Yeah, it was a real struggle going through dialysis in the last year. I had to do four hours of treatment three days a week. So basically it took 15 hours out of my time every week. And I would go into a dialysis center. And, the first thing you do is you get checked in and they do your blood pressure, your weight, your temperature. They go through all your symptoms that you’re feeling. There’s really no privacy when they’re doing that — I mean, the next patient is five feet from you in their chair, and you’re talking about all of your bodily functions that are not going well for you with all the medications you’re taking and everything and it takes away a little bit of your integrity having to do that so publicly. And then, just to sit there for four hours doing nothing. I can’t get up, I can’t move. My blood is just sitting there, you’re watching your blood go through this machine and it’s really, really depressing. And, it was hard for me. I mean, I cried the first couple times just because I would sit there and I’d look around and I was the youngest, you know obviously, in the whole building. I was 37 years old. And I was the only one driving myself there. It’s just a really hard and depressing time to spend in your day. It was really hard for me to do because I have two small children as well.  

DUBNER: It’s remarkable. You say you were crying then. Now you sound so strong. Ned’s on the other line blubbering there. I’m on the border, holding it together. So…

SHAFFER:  It’s emotional every time I talk about my story too, so.

DUBNER: I’m curious, you said that your dad had entered the donor chain. Did he end up giving a kidney, and if so does he know who the recipient was?

SHAFFER: He ended up giving his kidney. And all we really know is that it went to Connecticut over there where Ned is, and we have not heard from the recipients on that end.

DUBNER: I have a copy of the letter that you wrote to your donor. It’s unclear to me whether you knew exactly who Ned was at this time. It begins, “To my wonderful kidney donor, I don’t even know where to begin.” And I’ve already started to cry. Sorry. I have nothing to do with either of you and I’m crying. OK. So, but then, toward the end, you write, “Just to let you know, your kidney is doing awesome, and I’m already getting my energy back.” Danielle, what’s it like to have this guy Ned’s kidney inside of you? Do you feel whole again? Do you feel different?  

SHAFFER: You know, it was amazing because the very next day after surgery, I felt incredible. I felt 100 percent different. I didn’t feel any of the symptoms that I was having before with the illness and the nausea and the anxiety and everything I was going through. I immediately felt better. My body felt better, and yeah. I was eating and drinking the foods and liquids I was restricted to for so long, and it’s just — I do have the energy again. It’s amazing how much better I feel. And I don’t know if he had any food habits that I’ve picked up, but.

BROOKS: How do you feel about single-malt scotch?

SHAFFER:  You know, I haven’t had the craving for any scotch. It is funny because we joke about that with my dad because he’s a single-malt scotch drinker too, and we say, “Oh, that person’s probably craving it now.”

DUBNER: Well, Danielle, I’m glad you’re doing better and I hope you continue to do even better.

SHAFFER: Yes, thank you so much. And Ned, thank you so much for everything you’ve done for me and my family.

BROOKS: No need to thank me anymore. Thank you for being such a great recipient, and we’ll be in touch.

SHAFFER:  Yes, we will. Thank you.

DUBNER: Danielle, thanks for jumping on the phone with us. Bye bye.

SHAFFER: Alright bye guys.

DUBNER: Bye. Well, Ned, how do you feel now? See what you’ve done now?

BROOKS: Boy, I was shaking in here. This is really something. She’s a great person.

DUBNER: Well, I know you didn’t do it for the thanks, but thanks!

BROOKS: My pleasure.

Ned Brooks, inspired by his own experience — and the huge need for more kidney donations — is starting an organization to help build more altruistic kidney-donor chains. It’s called Donor to Donor."

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