Sunday, February 28, 2010

The market for cooked food (and thoughts of D'Artagnan at Maastricht)

The market for pleasure boats ranges from canoes to yachts, and air transport ranges from economy class to big private jets, but the market for cooked food must rival them in its range. Here's an account of an enterprise yacht/jumbo jet meal: The D’Artagnan Anniversary Party.

"To mark the 25th anniversary of her company, D’Artagnan, Ariane Daguin, a native of the Gascon region in the southwest of France, flew in over two hundred of her countrymen for a week-long celebration in New York. ... What’s more, throughout the week Ms. Daugin installed a handful of Michelin-starred Gascon chefs in some of the most venerated kitchens in the city. The collaborations between the visiting chefs and their hosts culminated last Sunday in what D’Artagnan billed as, “The 32 Star Dinner: A Progressive Dining Experience.” Thirty-two is the total number of Michelin and New York Times stars achieved by the group of chefs responsible for the meal, which, true to the epicurean spirit of the evening, was served not in one restaurant, but in four: cocktails, hors d’oeuvres, and the first two courses at Daniel, the next at Jean-Georges, two more at Per Se, and dessert at Le Bernardin. The buses that chauffeured us from stop to stop were filled with Gascon Armagnac."

(The headline of the article had led me to think it might be about the historical D'Artagnan, whose experience of Maastricht, in 1673, was more unfortunate than mine in 2009:)

Living Liver and Kidney Donation

The American Journal of Transplantation has assembled a "virtual issue" of articles they have published on various aspects of live donation, including kidney exchange. It seems to be ungated.

Living Liver and Kidney Donation

Guest Editor: Dr. Jonathan Bromberg
"This virtual issue of the American Journal of Transplantation is focused on living donation. For practical purposes, the articles are restricted to only liver and kidney donation. It would not be an overstatement to say that donation has probably been the number one issue to dominate the field for the last decade, as organ quality and availability determine all activities in transplantation. The breadth of importance and ramifications of donation are reflected in the wide variety of articles and topics that cover this area of interest. Novel sources of donors, such as altruistic, anonymous, and non-directed donation among others are covered in the first section. While considered even unusual a few years ago, many of these sources are now firmly partly of the mainstream of living donation. Exchanges, swaps, chains, and dominos are included in the second section, reflecting the evolution of the field as ever more complex donor and recipient algorithms are implemented, and their attendant ramifications on quality, cost, and outcomes. The third section covers organ utilization and outcomes, with an emphasis on matching the optimal donor with the correct recipient, and comparing deceased to living donor organs. The fourth section covers regulatory issues at the national and local levels, and their influence on donation and outcomes. The fifth section comprises issues relating to the donor and donor safety. The work-up process, safeguards, operative techniques, short term outcomes, and very long term outcomes are major issues the have dominated recent trends. The sixth and last section covers educational issues as they related to donor and family knowledge and attitudes toward donation, and that affects donation rates. These reports should provide the reader with a comprehensive view of issues in living liver and kidney donation, and the diverse paths taken that have moved the field forward."

Novel Donor Sources:
Twenty-Two Nondirected Kidney Donors: An Update on a Single Center's ExperienceC. L. Jacobs, D. Roman, C. Garvey, J. Kahn, A. J. Matas
Altruistic Living Donors: Evaluation for Nondirected Kidney or Liver DonationM.D. Jendrisak, B. Hong, S. Shenoy, J. Lowell, N. Desai, W. Chapman, A. Vijayan, R.D. Wetzel, M. Smith, J. Wagner, S. Brennan, D. Brockmeier, D. Kappel
Living Anonymous Liver Donation: Case Report and Ethical JustificationL. Wright, K. Ross, S. Abbey, G. Levy, D. Grant
Successful Expansion of the Living Donor Pool by Alternative Living Donation ProgramsJ. I. Roodnat, J. A. Kal-van Gestel, W. Zuidema, M. A. A. van Noord, J. van de Wetering, J. N. M. IJzermans, W. Weimar
Elective Surgical Patients as Living Organ Donors: A Clinical and Ethical InnovationG. Testa, P. Angelos, M. Crowley-Matoka, M. Siegler
Kidney Donor Exchanges, Chains, and Dominos:
A Comparison of Populations Served by Kidney Paired Donation and List Paired DonationS. E. Gentry, D. L. Segev, R. A. Montgomery
The Dutch National Living Donor Kidney Exchange ProgramM. de Klerk, K. M. Keizer, F. H. J. Claas, M. Witvliet, B. J. J. M. Haase-Kromwijk, W. Weimar
Characterization of Waiting Times in a Simulation of Kidney Paired DonationD. L. Segev, S. E. Gentry, J. K. Melancon, R. A. Montgomery
Attitudes of Minority Patients with End-Stage Renal Disease Regarding ABO-Incompatible List-Paired ExchangesP. D. Ackerman, J. R. Thistlethwaite Jr, L. F. Ross
Incompatible Kidney Donor Candidates' Willingness to Participate in Donor-Exchange and Non-directed DonationA. D. Waterman, E. A. Schenk, A. C. Barrett, B. M. Waterman, J. R. Rodrigue, E. S. Woodle, S. Shenoy, M. Jendrisak, M. Schnitzler
Utilizing List Exchange and Nondirected Donation through 'Chain' Paired Kidney DonationsA. E. Roth, T. Sönmez, M. U. Ünver, F. L. Delmonico, S. L. Saidman
Expanding Kidney Paired Donation Through Participation by Compatible PairsS. E. Gentry, D. L. Segev, M. Simmerling, R. A. Montgomery
Successful Three-Way Kidney Paired Donation with Cross-Country Live Donor Allograft TransportR. A. Montgomery, S. Katznelson, W. I. Bry, A. A. Zachary, J. Houp, J. M. Hiller, S. Shridharani, D. John, A. L. Singer, D. L. Segev
The Roles of Dominos and Nonsimultaneous Chains in Kidney Paired DonationS. E. Gentry, R. A. Montgomery, B. J. Swihart, D. L. Segev
Asynchronous, Out-of-Sequence, Transcontinental Chain Kidney Transplantation: A Novel ConceptF. K. Butt, H. A. Gritsch, P. Schulam, G. M. Danovitch, A. Wilkinson, J. Del Pizzo, S. Kapur, D. Serur, S. Katznelson, S. Busque, M. L. Melcher, S. McGuire, M. Charlton, G. Hil, J. L. Veale
Clinical Outcomes of Multicenter Domino Kidney Paired DonationY. J. Lee, S. U. Lee, S. Y. Chung, B. H. Cho, J. Y. Kwak, C. M. Kang, J. T. Park, D. J. Han, D. J. Kim
Organ Utilization and Outcomes:
Living-Donor Liver Transplantation for HepatoblastomaM. Kasahara, M. Ueda, H. Haga, H. Hiramatsu, M. Kobayashi, S. Adachi, S. Sakamoto, F. Oike, H. Egawa, Y. Takada, K. Tanaka
Living Donor Liver Transplantation for Biliary Atresia: A Single-Center Experience with First 100 CasesC.-L. Chen, A. Concejero, C.-C. Wang, S.-H. Wang, C.-C. Lin, Y.-W. Liu, C.-C. Yong, C.-H. Yang, T.-S. Lin, Y.-C. Chiang, B. Jawan, T.-L. Huang, Y.-F. Cheng, H.-L. Eng
Association Between Waiting Times for Kidney Transplantation and Rates of Live DonationD. L. Segev, S. E. Gentry, R. A. Montgomery
Regional and Racial Disparities in the Use of Live Non-Directed Kidney DonorsD. L. Segev, R. A. Montgomery
Recipient Morbidity After Living and Deceased Donor Liver Tranasplantation: Findings from the A2ALL Retrospective Cohort StudyC. E. Freise, B. W. Gillespie, A. J. Koffron, A. S. F. Lok, T. L. Pruett, J. C. Emond, J. H. Fair, R. A. Fisher, K. M. Olthoff, J. F. Trotter, R. M. Ghobrial, J. E. Everhart
Incidence and Severity of Acute Cellular Rejection in Recipients Undergoing Adult Living Donor or Deceased Donor Liver TransplantationA. Shaked, R. M. Ghobrial, R. M. Merion, T. H. Shearon, J. C. Emond, J. H. Fair, R. A. Fisher, L. M. Kulik, T. L. Pruett, N. A. Terrault
Resource Utilization of Living Donor Versus Deceased Donor Liver Transplantation Is Similar at an Experienced Transplant CenterJ. C. Lai, E. M. Pichardo, J. C. Emond, R. S. Brown Jr.
Organ Donation and Utilization in the United States: 1998–2007J. E. Tuttle-Newhall, S. M. Krishnan, M. F. Levy, V. McBride, J. P. Orlowski, R. S. Sung
Unique Early Gene Expression Patterns in Human Adult-to-Adult Living Donor Liver Grafts Compared to Deceased Donor GraftsJ. de Jonge, S. Kurian, A. Shaked, K. R. Reddy, W. Hancock, D. R. Salomon, K. M. Olthoff
Regulatory:
Incentive Models to Increase Living Kidney Donation: Encouraging Without CoercingA. K. Israni, S. D. Halpern, S. Zink, S. A. Sidhwani, A. Caplan
Limiting Financial Disincentives in Live Organ Donation: A Rational Solution to the Kidney ShortageR. S. Gaston, G. M. Danovitch, R. A. Epstein, J. P. Kahn, A. J. Matas, M. A. Schnitzler
Public Attitudes Toward Incentives for Organ Donation: A National Study of Different Racial/Ethnic and Income GroupsL. E. Boulware, M. U. Troll, N. Y. Wang, N. R. Powe
The Association of State and National Legislation with Living Kidney Donation Rates in the United States: A National StudyL. E. Boulware, M. U. Troll, L. C. Plantinga, N. R. Powe
The Evolution and Direction of OPTN Oversight of Live Organ Donation and Transplantation in the United StatesR. S. Brown, Jr, R. Higgins, T. L Pruett
Stimulus for Organ Donation: A Survey of the American Society of Transplant Surgeons MembershipJ. R. Rodrigue, K. Crist, J. P. Roberts, R. B. Freeman Jr., R. M. Merion, A. I. Reed
Donor Procedures, Outcomes and Safety:
Obesity in Living Kidney Donors: Clinical Characteristics and Outcomes in the Era of Laparoscopic Donor NephrectomyJ. K. Heimbach, S. J. Taler, M. Prieto, F. G. Cosio, S. C. Textor, Y. C. Kudva, G. K. Chow, M. B. Ishitani, T. S. Larson, M. D. Stegall
Laparoscopic Procurement of Kidneys with Multiple Renal Arteries is Associated with Increased Ureteral Complications in the RecipientJ. T. Carter, C. E. Freise, R. A. McTaggart, H. D. Mahanty, S.M. Kang, S. H. Chan, S. Feng, J. P. Roberts, A. M. Posselt
Pre-donation Assessment of Kidneys by Magnetic Resonance Angiography and Venography: Accuracy and Impact on OutcomesS. A. Ames, M. Krol, K. Nettar, J. P. Goldman, T. M. Quinn, D. M. Herron, A. Pomp, J. S. Bromberg
Long-Term Consequences of Live Kidney Donation Follow-Up in 93% of Living Kidney Donors in a Single Transplant CenterJ. Gossmann, A. Wilhelm, H.G. Kachel, J. Jordan, U. Sann, H. Geiger, W. Kramer, E.H. Scheuermann
More on Parental Living Liver Donation for Children with Fulminant Hepatic Failure: Addressing Concerns About Competing Interests, Coercion, Consent and Balancing ActsA. Spital
Predictive Capacity of Pre-Donation GFR and Renal Reserve Capacity for Donor Renal Function After Living Kidney DonationM. Rook, H. S. Hofker, W. J. van Son, J. J. Homan van der Heide, R. J. Ploeg, G. J. Navis
Laparoscopic-Assisted Right Lobe Donor HepatectomyA.J. Koffron, R. Kung, T. Baker, J. Fryer, L. Clark, M. Abecassis
Cold Ischemia Time and Allograft Outcomes in Live Donor Renal Transplantation: Is Live Donor Organ Transport Feasible?C. E. Simpkins, R. A. Montgomery, A. M. Hawxby, J. E. Locke, S. E. Gentry, D. S. Warren, D. L. Segev
Evaluating Living Kidney Donors: Relationship Types, Psychosocial Criteria, and Consent Processes at US Transplant ProgramsJ. R. Rodrigue, M. Pavlakis, G. M. Danovitch, S. R. Johnson, S. J. Karp, K. Khwaja, D. W. Hanto, D. A. Mandelbrot
The Medical Evaluation of Living Kidney Donors: A Survey of US Transplant CentersD. A. Mandelbrot, M. Pavlakis, G. M. Danovitch, S. R. Johnson, S. J. Karp, K. Khwaja, D. W. Hanto, J. R. Rodrigue
Rescue of a Living Donor with Liver TransplantationB. Ringe, G. Xiao, D. A. Sass, J. Karam, S. Shang, T. P. Maroney, A. E. Trebelev, S. Levison, A. C. Fuchs, R. Petrucci, A. Ko, M. Gonzalez, J. C. Reynolds, W. C. Meyers
Nephrectomy Elicits Impact of Age and BMI on Renal Hemodynamics: Lower Postdonation Reserve Capacity in Older or Overweight Kidney DonorsM. Rook, R. J. Bosma, W. J. van Son, H. S. Hofker, J. J. Homan van der Heide, P. M. ter Wee, R. J. Ploeg, G. J. Navis
Pregnancy and Birth After Kidney Donation: The Norwegian ExperienceA. V. Reisæter, J. Røislien, T. Henriksen, L. M. Irgens, A. Hartmann
Pregnancy Outcomes After Kidney DonationH. N. Ibrahim, S. K. Akkina, E. Leister, K. Gillingham, G. Cordner, H. Guo, R. Bailey, T. Rogers, A. J. Matas
Education:
Preferences, Knowledge, Communication and Patient-Physician Discussion of Living Kidney Transplantation in African American FamiliesL. E. Boulware, L. A. Meoni, N. E. Fink, R. S. Parekh, W. H. L. Kao, M. J. Klag, N. R. Powe
Organ Donation Decision: Comparison of Donor and Nondonor FamiliesJ. R. Rodrigue, D. L. Cornell, R. J. Howard
Increasing Live Donor Kidney Transplantation: A Randomized Controlled Trial of a Home-Based Educational InterventionJ. R. Rodrigue, D. L. Cornell, J. K. Lin, B. Kaplan, R. J. Howard
Emigration from the British Isles to Southeastern Spain: A Study of Attitudes Toward Organ DonationA. Ríos, P. Cascales, L. Martínez, J. Sánchez, N. Jarvis, P. Parrilla, P. Ramírez
Virtual Issue compiled online 2 Feb 2010

Saturday, February 27, 2010

Herb Scarf explains mathematical economics

Herb Scarf (who certainly knows) explains what is mathematical economics to a Humanities audience. His powerpoint slides for that talk are here, along with videos of some other talks (that I wasn't able to download, however).

His examples include matching of medical residents, school choice, and kidney exchange.

Friday, February 26, 2010

The Future of Same Sex Marriage

The University of San Francisco Law Review's Spring Symposium, held today, is on The Future of Same-Sex Marriage.

I like the sound of the first panel discussion, called
Crunching the Numbers: Examining empirical data regarding the material consequences of denying or recognizing same-sex marriage.

Stability may be hard to achieve in decentralized matching

So says a paper by Muriel Niederle and Leeat Yariv: Decentralized Matching with Aligned Preferences

Abstract. We study a simple model of a decentralized market game in which firms make directed offers to workers. We focus on markets in which agents have aligned preferences. When agents have complete information or when there are no frictions in
the economy, there exists an equilibrium that yields the stable match. In the presence of market frictions and preference uncertainty, harsher assumptions on the richness of the economy have to be made in order for decentralized markets to generate stable outcomes in equilibrium.

Thursday, February 25, 2010

Compatible pairs in kidney exchange

The question of whether compatible patient-donor pairs should be invited to take part in kidney exchange is gaining some exposure with recent articles and news items in the medical literature. The issue is that if kidney exchange is restricted to patients who are incompatible with their live donors, we will be seeing many fewer blood type O donors than are in the general population, so exchanges will be more difficult to find, and there will be fewer transplants than if there weren't such a shortage. (Since O donors don't have a blood type incompatibility with any recipient, most of them will be compatible with their intended recipients; O donors are only incompatible if there is some other, immunological incompatibility.)

Here's a story from the most recent, Feb 2010 Nephrology Times: Dramatic Increase in Transplant Rates Projected if Compatible Pairs Are Included in Kidney Swaps

It follows up on a recent article by Lloyd Ratner, of Columbia University/New York–Presbyterian Hospital, reporting such a three-way exchange (Transplantation, 2010;89:15-22). The story also interviews some of the other pioneering surgeons involved in kidney exchange, including Frank Delmonico, Bob Montgomery and Steve Woodle.

Inviting compatible pairs to participate in exchanges seems like a very good idea indeed. (An early discussion, with simulations to provide quantitative estimates of the effect of including compatible pairs (which is quite large), was reported in Table 1 of:
Roth, Alvin E., Tayfun Sonmez, and M. Utku Unver, "A Kidney Exchange Clearinghouse in New England" American Economic Review, Papers and Proceedings, 95,2, May, 2005, 376-380. )

Wednesday, February 24, 2010

Market design at Yahoo!

Here's a project description from Yahoo! Research: Microeconomics and Market Design
By Michael Schwarz and David Reiley


What are the effects of complexity in mechanism design? Participating in an auction mechanism (or any market institution) requires time and effort on the side of the buyers. That in turn may lead some buyers to bid very conservatively, or not to participate at all, in order to economize on effort. We lack a theory for quantifying the complexity of a mechanism.


Auction theory and matching theory offer models and algorithms for allocating goods or matching market participants. However, the majority of markets do not use structured mechanisms (such as auctions and matching algorithms). Why are some markets (such the medical residency match) using centralized matching procedure while other markets (such as the purchases of automobiles with various options packages) do not? Answering this question may help to design structured market mechanisms for the markets where chaotic negotiations rule the day.

Understanding when and how reputations emerge, and how to improve the designs of structured reputation systems. Reputations of individuals and businesses play an important role in economic and personal life. With some exceptions, most notably in electronic commerce, the mechanisms for accumulating reputation are informal rather than structured.

How should a firm set posted prices for a menu of products? Although economics offers a theoretical framework for how to set prices, most theory assumes omniscience about demand. To build a practical pricing engine, one needs a system that generates exogenous price variation and then uses it to calculate appropriate prices going forward. Yahoo! offers thousands, even millions, of different advertising products, so estimating a demand system suffers from the curse of dimensionality as well as practical constraints (perceived fairness, etc.) in generating price variation. We are looking for better theory and econometrics for the problem of building a pricing engine.

Tuesday, February 23, 2010

Choosing schools (in NYC and SF)

I've written elswhere about the school choice process for public schools in San Francisco and for high schools in New York City. But, regardless of whether the process is a good one or not, the problem facing parents who have to decide how much they like each school can be a tough one, especially if there are a lot of schools.

Two articles help you feel the pain:

New Plan on School Selection, but Still Discontent discusses San Francisco, and
It’s a nightmare to apply for high schools in city discusses New York.

Some more background information here.

HT: Parag Pathak

Determining death for deceased organ donation

Darshak Sanghavi, writing a while ago in the NY Times Sunday Magazine, discusses When Does Death Start?

"Organ transplantation must abide by the so-called dead-donor rule: a person has to be declared dead before any vital organs can be removed. Yet organs have to be alive if there is any hope of successful transfer to a recipient. Medical professionals have handled this paradoxical situation — finding a dead body with live organs — by fashioning a category of people with beating hearts who are said to be brain-dead, usually after a traumatic head injury, and who are considered just as dead as if they had rigor mortis.
To diagnose brain death, doctors typically go through a checklist of about a dozen items, including assessing reflexes like blinking, coughing and breathing, which are all controlled by the brainstem. The criteria are extremely strict, and only a tiny fraction of severely brain-injured people meet them."

Before brain death, the traditional definition of death involved irreversible cessation of heart beat, and you can also donate after cardiac death (DCD), but things have to move fast, since once circulation stops the organs begin to die. "D.C.D. requires doctors to confront the shadowy question of exactly when somebody dies after the heart stops."

In the U.S., we seem to be converging on a 5-minute rule.

Monday, February 22, 2010

Kim Krawiec on selling virginity

Kim Krawiec has a post commenting on recent news stories and linking to a new paper: Like A Virgin? We Sell That Here!

"A few days ago, an anonymous 19-year-old New Zealand student offered her virginity to the highest bidder on the Web site http://www.ineed.co.nz/ under the name "Unigirl," saying she would use the money to pay for her tuition. According to Unigirl, more than 30,000 people have viewed her ad and over 1,200 made bids before she accepted a $32,000 offer. Story from NPR. (HT: Tonja Jacobi)
Though the story is creating a ruckus, including international press, the attention pales in comparison to that bestowed on the very similar story of “Natalie Dylan,” a pseudonym adopted by a 22-year old UC San Diego graduate who auctioned her virginity on the website of the Moonlight Bunny Ranch, a Carson City brothel, in January of 2009 in order to foot the bill for graduate research in women’s studies. In contrast to Unigirl’s paltry returns, Dylan reportedly received over 10,000 bids, the highest of which was $3.8 million, receiving both condemnation and praise in the auction process. Critics have argued that she is degrading herself and women generally, risks exporting Nevada’s poor morals to the rest of the country, and is selling something (virginity) for profit that should be cherished and freely given.
In an article I posted to SSRN over the weekend, A Woman’s Worth, I consider the reactions to Dylan’s virginity auction plan and the possible motivations underlying those reactions. What drives the attention and controversy generated by the Dylan auction? What are the perceived harms associated with Dylan’s actions, and in what ways are they greater than the harms associated with similar common activities? "

And here's the abstract to her paper on SSRN:

A Woman's Worth
Kimberly D. Krawiec Duke University - School of LawFebruary 6, 2010 North Carolina Law Review, Forthcoming

Abstract: This Article examines three traditionally “taboo trades”: (1) the sale of sex, (2) compensated egg donation, and (3) commercial surrogacy. The article purposely invokes examples in which the compensated provision of goods or services (primarily or exclusively by women) is legal, but in which commodification is only partially achieved or is constrained in some way. I argue that incomplete commodification disadvantages female providers in these instances, by constraining their agency, earning power, and status. Moreover, anticommodification and coercion rhetoric is sometimes invoked in these settings by interest groups who, at best, have little interest in female empowerment and, at worst, have economic or political interests at odds with it.

Keywords: Sex Work, Virginity, Prostitution, Oocyte Donation, Sperm Markets, Surrogacy, Medical Marijuana

See also her related post Chicago Students Have All the Fun

Beer legally for sale in another Mississippi county

Another repugnant transaction bites the dust: A Voting Result That Faulkner Could Drink To


"NEW ALBANY, Miss. — There was a vote here last month. It was hard-fought, with dueling newspaper advertisements and yard signs, tableside debates in restaurants, a prayer rally and a fusillade of last-minute phone calls.
But only one side could win, and the victory was a historic one: in a couple of months, a person will be able to buy a beer legally here in William Faulkner's birthplace for the first time in more than 50 years.
Liquor and wine, of course, are still illegal, because the vote concerned only the sale of beer and wine coolers. But there is no shortage of bad news for teetotalers.
At a post-election meeting of the Board of Aldermen, people opposed to alcohol urged, among other things, that beer not be sold on Sundays, or in single bottles, or even refrigerated. They recommended that cases of beer be available only warm, as they are in the city of Oxford 30 miles down the road, requiring a degree of premeditation on the part of the discriminating beer buyer.
The aldermen ruled against them on all counts."
...
"Mississippi, the first state to ratify Prohibition, has a peculiar history when it comes to temperance. Liquor was banned here long after federal Prohibition was repealed in 1933, under an arrangement that pleased everyone: the Baptists, the bootleggers and the state, which, curiously enough, levied taxes on illegal alcohol. "

Sunday, February 21, 2010

A National kidney exchange takes another tentative step forward

UNOS issued the following press release on Friday: Participants Named for National Pilot Project for Kidney Paired Donation

"Four organizations representing more than 80 kidney transplant programs nationwide have been selected to enroll patients and potential living donors in a national pilot project to facilitate kidney paired donation (KPD) transplants. Kidney paired donation involves the coordinated matching of living donors with medically compatible recipients in cases where the original intended recipient is not compatible with his or her potential donor.

The national Organ Procurement and Transplantation Network (OPTN), operated under federal contract by United Network for Organ Sharing (UNOS), will coordinate the project. Its goals include assessing whether more compatible matches are made possible through a large pool of donors and candidates, as well as studying the feasibility of implementing a national program.

The following organizations, each affiliated with a number of additional transplant programs, will participate in the initial phase of the pilot:

Alliance for Paired Donation, Maumee, Ohio
Johns Hopkins Hospital, Baltimore, Md.
New England Program for Kidney Exchange, Newton, Mass.
UCLA Medical Center/California Pacific Medical Center, Los Angeles and San Francisco, Calif.

"Each group was chosen for its experience with kidney paired donation and its willingness to broaden the availability of this procedure to a much wider group of people needing transplants," said James Wynn, M.D., president of the OPTN and UNOS and chair of the OPTN/UNOS Board of Directors. "Kidney paired donation offers the possibility of hundreds more transplants per year, perhaps over a thousand per year as the transplant community gains more experience. In turn this may enhance opportunities for more candidates to get deceased donor transplants."

Participants replied to an OPTN request for proposal and were selected by a group drawn from the OPTN/UNOS Kidney Transplantation Committee, the Kidney Paired Donation Work Group and OPTN/UNOS leadership. No member of the selection group was directly affiliated with any of the applicants. In addition, all information identifying the specific applicants was blinded to allow the group to focus on objective criteria in each application.

"In addition to the thousands of hours of volunteer expertise donated by kidney professionals and the living donation community," said Dr. Wynn, "this program depends on the gracious support of project partners, charitable gifts and in-kind donations. The software to be used in the matching process has been donated by various institutions, and we continue to be guided by the people and programs with the greatest expertise in kidney paired donation."

The Organ Procurement and Transplantation Network (OPTN) is operated under contract with the U.S. Department of Health and Human Services, Health Resources and Services Administration, Division of Transplantation by the United Network for Organ Sharing (UNOS). The OPTN brings together medical professionals, transplant recipients and donor families to develop organ transplantation policy."

A number of tough challenges remain, among them how to organize the national exchange to attract full participation from hospitals and exchange networks, so as to have a thick pool of donors and patients (and not just those who hospitals find hardest to match).

Saturday, February 20, 2010

Sipping lattes while bearing arms

A NY Times editorial suggests that coffee drinking while carrying is repugnant. (Background: it's legal to carry unconcealed weapons in California, and in a number of other states, under some restrictions.)

"Two sizable chains, Peet’s Coffee & Tea and California Pizza Kitchen, have banned patrons carrying guns, and a struggle is under way at the prized Starbucks coffee shops.
Should customers be free to sip Skinny Cinnamon Dolce Lattes at their laptop screens while brandishing a gleaming Ruger .357? So far, Starbucks executives say yes, claiming they are quite safety-minded within a policy that “supports the federal, state and local laws in the communities in which we do business.”
Fortunately, Californians are treating the showdown at Starbucks as far from settled. Thousands are signing petitions from the Brady Campaign to Prevent Gun Violence, wisely begging the chain not to jangle its trademark caffeine serenity by tolerating firearms. Starbucks should listen."

Books about markets for body parts (for and against)

Below are a mix of books, some scholarly some popular, mostly harvested by clicking on the Amazon links "people who bought this book also bought," from one book to the next. The descriptions are from Amazon:

Body Shopping: Converting Body Parts to Profit by Donna Dickenson
Product Description
According to law, you don't actually own your own body, and you might be shocked by the cunning ways everyone from researchers and entrepreneurs to doctors, insurers, and governments are using that fact to their advantage. Thanks to developments in biotechnology and medicine, cells, tissues, and organs are now viewed as both a valuable source of information and as the raw material for new commercial products.This 'currency of the future' might be fueling the new biotechnology industry, but the former owners of that flesh and bone aren't entitled to one fraction of the proceeds. In "Body Shopping", award-winning writer Donna Dickenson makes a case against the newfound rights of businesses to harvest body parts and gain exclusive profit from the resulting products and processes. To illustrate her case, she presents a series of compelling stories of individuals injured or abused by the increasingly rapacious biotechnology industry. Some cases have become public scandals, such as the illicit selling of the late broadcaster Alastair Cooke's bones by a body parts ring involving surgeons and undertakers.Others are hardly known at all, including the way in which for-profit umbilical cord blood banks target pregnant women with offers of a 'service' that professional obstetrics bodies view as dangerous, the leukemia patient who tried and failed to claim property rights in a $3 billion cell line created from his tissue, and the real risks facing women who provide eggs for the global market in baby-making. "Body Shopping" offers a fresh, international, and completely up-to-date take on the evolving legal position, the historical long view, and the latest biomedical research - an approach that goes beyond a mere recital of horror stories to suggest a range of new strategies to bring the biotechnology industry to heel. The result is a gripping, powerful book that is essential reading for everyone from parents to philosophers, and from scientists to lawmakers - everyone who believes that no human should ever be reduced to the sum of their body parts.


Black Markets: The Supply and Demand of Body Parts by Michele Goodwin, 2006
From Publishers Weekly
Law professor and bioethicist Goodwin sheds much needed light in this disturbing examination of yet another failure of the American health care system: an organ donation process that leads to the sale of human organs. Despite some highly technical sections, the author artfully uses case law and tragic stories of people caught in the machinery of an organ marketplace that favors the well connected. Even readers well versed in current events are likely to be shocked by the prevalence of "presumed consent" legislation in 28 states that shifts the choice to donate away from potential donors —corneas, for instance, are routinely harvested by local coroners unless a specific prior refusal has been communicated (and sometimes even despite such a directive). The author does a good job of linking this country's history of medical scandals that victimized African-Americans to that community's misgivings about serving as either donors or seekers of a spot on the coveted transplant waiting lists. Her controversial recommendations, which include lifting the taboo on selling cadaveric organs to address the organ deficit, should spark much discussion. (Mar.)


Tissue Economies: Blood, Organs, and Cell Lines in Late Capitalism (Science and Cultural Theory) ~ Catherine Waldby (Author), Robert Mitchell (Author)
Product Description
As new medical technologies are developed, more and more human tissues—such as skin, bones, heart valves, embryos, and stem cell lines—are stored and distributed for therapeutic and research purposes. The accelerating circulation of human tissue fragments raises profound social and ethical concerns related to who donates or sells bodily tissue, who receives it, and who profits—or does not—from the transaction. Catherine Waldby and Robert Mitchell survey the rapidly expanding economies of exchange in human tissue, explaining the complex questions raised and suggesting likely developments. Comparing contemporary tissue economies in the United Kingdom and United States, they explore and complicate the distinction that has dominated practice and policy for several decades: the distinction between tissue as a gift to be exchanged in a transaction separate from the commercial market and tissue as a commodity to be traded for profit.
Waldby and Mitchell pull together a prodigious amount of research—involving policy reports and scientific papers, operating manuals, legal decisions, interviews, journalism, and Congressional testimony—to offer a series of case studies based on particular forms of tissue exchange. They examine the effect of threats of contamination—from HIV and other pathogens—on blood banks’ understandings of the gift/commodity relationship; the growth of autologous economies, in which individuals bank their tissues for their own use; the creation of the United Kingdom’s Stem Cell bank, which facilitates the donation of embryos for stem cell development; and the legal and financial repercussions of designating some tissues “hospital waste.” They also consider the impact of different models of biotechnology patents on tissue economies and the relationship between experimental therapies to regenerate damaged or degenerated tissues and calls for a legal, for-profit market in organs. Ultimately, Waldby and Mitchell conclude that scientific technologies, the globalization of tissue exchange, and recent anthropological, sociological, and legal thinking have blurred any strict line separating donations from the incursion of market values into tissue economies.


Body Brokers: Inside America's Underground Trade in Human Remains (Paperback)~ Annie Cheney 2006
From Booklist
*Starred Review* Here's one with the potential to keep folks up nights, wondering whether the urn on the mantel contains 100-percent Uncle Fred or a blend. Before journalist Cheney began an assignment for My Generation magazine, she had never suspected there might be diverse career opportunities for cadavers, that whatever one wants to be when one grows up, options continue to exist postmortem. But consider the ever-popular organ donor program. And then there's the option of donating one's body to a medical school for the betterment of mankind through science. Once that latter choice is made, Cheney learned, alternatives multiply, and a corpse can follow one of several roads. On a lower thoroughfare, big bucks are waiting for the cold-blooded entrepreneur ready to carve human bodies up like chickens and parcel them out to the highest bidder for such uses as military bomb test dummies, lifelike operative subjects for medical seminars, and resource troves for the machine-tooling of bones into orthopedic apparatus. Even if one never willingly donates one's body, there are enough unscrupulous morticians and morgue workers who will surreptitiously carve out an ulna or a femur and replace it with a PVC pipe, then sell the goods on the not-so-open open market. This is a chilling expose of the grisly industry of body trading. Donna ChavezCopyright © American Library Association. All rights reserved --This text refers to the Hardcover edition.


Kidney for Sale by Owner: Human Organs, Transplantation, and the Market )~ Mark J Cherry, 2005
Product Description
Over the past decade in the United States, nearly 6,000 people a year have died waiting for organ transplants. In 2003 alone, only 20,000 out of the 83,000 waiting for transplants received them - in anyone's eyes, a tragedy. Many of these deaths could have been prevented, and many more lives saved, were it not for the almost universal moral hand wringing over the concept of selling human organs. Bioethicist Mark Cherry explores the why of these well-intentioned misperceptions and legislation and boldly deconstructs the roadblocks that are standing in the way of restoring health to thousands of people. If most Americans accept the notion that the market is the most efficient means to distribute resources, why should body parts be excluded? Kidney for Sale by Owner contends that the market is indeed a legitimate - and humane - way to procure and distribute human organs. Cherry stakes the claim that it may be even more just, and more compatible with many Western religious and philosophical traditions, than the current charity-based system now in place. He carefully examines arguments against a market for body parts, including assertions based on the moral views of John Locke, Immanuel Kant, and Thomas Aquinas, and shows these claims to be steeped in myth, oversimplification, and contorted logic. Rather than focusing on purported human exploitation and the irrational "moral repugnance" of selling organs, Cherry argues that we should focus on saving lives. Following on the thinking of the philosopher Robert Nozick, he demonstrates that, with regard to body parts, the important core humanitarian values of equality, liberty, altruism, social solidarity, human dignity, and, ultimately, improved health care are more successfully supported by a regulated market rather than by well meant but misguided, prohibitions.


The Ethics of Organ Transplants: The Current Debate (Contemporary Issues (Buffalo, N.Y.).) (Paperback 1999)~ Arthur L. Caplan (Author, Editor), Daniel H. Coelho (Editor)
From Library Journal
Renowned bioethicist Caplan (Ctr. for Bioethics, Univ. of Pennsylvania) and medical writer Coelho have selected 35 articles that are representative of the ethical issues surrounding organ transplantation. Scarcity of organs and the high costs involved in these procedures force difficult legal, philosophical, scientific, and economic choices. What are the sources of organs used in transplantation? How can we make the procurement system more efficient? Should we pay for organs? Should someone who has already received one transplant be allowed a second? Should alcoholics be given liver transplants? Are transplants really worth the tremendous costs? These are just a few of the questions discussed here. In many cases, the editors have selected companion articles that illustrate contrasting viewpoints on a particular issue. Although some articles are slightly dated, the issues are still relevant. This well-balanced, reasonably priced compilation is recommended for all libraries.ATina Neville, Univ. of South Florida at St. Petersburg Lib.Copyright 1999 Reed Business Information, Inc.


The U.S. Organ Procurement System: A Prescription for Reform (AEI Evaluative Studies.) (Hardcover) by David L. Kaserman and A. H. Barnett
Product Description
Experts make a compelling and persuasive case for markets in human organs.

Kieran Healy, Last Best Gift. Altruism and the Market for Human Blood and Organs. Chicago University Press, 2006


The Baby Business: How Money, Science, and Politics Drive the Commerce of Conception (Hardcover)~ Debora L. Spar
From Publishers Weekly
Among the troubling aspects of new reproductive technologies is the takeover of reproduction by the marketplace. This probing study accepts the free market process while casting a discerning and skeptical eye at its pitfalls. Harvard business prof Spar (The Cooperative Edge: The Internal Politics of International Cartels) explores many aspects of the high-tech commodification of procreation: the fabulous revenues commercial fertility clinics earn from couples' desperate desire for children and the ensuing conflicts between medical ethics and the profit motive; the premiums paid for sperm and eggs from genetically desirable donors; the possible exploitation of poor, nonwhite and Third World surrogate mothers paid to gestate the spawn of wealthy Westerners; the fine line between modern adoption practices and outright baby selling; and the new entrepreneurial paradigm of maternity, in which the official "mother" simply finances the assemblage of sperm, purchased egg and hired womb and lays contractual claim to the finished infant. Spar considers most of these developments inevitable and not undesirable (they provide kids to parents who want them), but calls for government regulation to curb excesses and protect the interests of all involved. Her sanguinity will not satisfy all critics, but she offers a lucid, nuanced guide to this brave new world. (Feb. 14) Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

Friday, February 19, 2010

College admissions in England

In England, universities faced with unexpectedly many applicants are raising the grades required for admission, which is apparently regarded as somewhat suspect:

A-level entry requirement shock for university applicants


"LEADING universities have been accused of unjustly raising A-level entry requirements at the last minute because of a surge in applicants and severe government cuts. "

Thursday, February 18, 2010

SF School Board Meeting, Feb 17: new choice system


At the latest public meeting of the San Francisco Board of Education (last night, Wednesday, Feb. 17), the commissioners and the public were engaged in a detailed discussion of the algorithms and priorities being proposed for the new school choice system.

Muriel Niederle explains and answers questions about the new Assignment with Transfers school choice plans being proposed (with variations for elementary school, middle school, and high schools). She comes on just after minute 36 of this video of the 3 hour meeting, and her presentation, interspersed with questions and answers, continues for a little over an hour (to minute 1:39), although she's back answering questions at the end again. Also presenting the general plan and answering questions is Orla O'Keefe, the SFUSD official leading the effort to design the new school choice system.

There's something very encouraging about seeing the public policy discussion focusing on choice systems that are non-wasteful (Pareto efficient, for you economists), strategically simple for parents (so that truthful preference revelation is a dominant strategy), and flexible (so that the school board can tweak the system in years to come without harming the first two properties). The 'political' issues are the priorities that different children have at different schools.

Another attractive aspect of the proposal (discussed by Ms. O'Keefe following Muriel's presentation) is that data would be collected each year for continual monitoring of how the choice and assignment system is working.

The discussion touches on a number of interesting questions. (Even if the algorithm makes truthful preference revelation the best strategy, there are still issues of checking e.g. addresses in any system in which priorities at schools depend on home address...). But it looks like SF is well launched on adopting a sensible, workable, well thought out and flexible framework.

Why isn't the queue longer for deceased donor kidneys?

There are approximately 80,000 people signed up on the waiting list for deceased donor kidneys in the U.S., and this list has been getting longer. We only manage to do about 11,000 deceased donor transplants a year. (There are another approx. 6000 live donor transplants per year).

Kidney exchange and other innovations in transplantation are attempts to make the list shorter.
But a different kind of public health question is, why isn't the list longer? According to the latest Kidney and Urologic Diseases Statistics for the United States, there are presently just over half a million people suffering from End Stage Renal Disease, of whom just over 350,000 are undergoing dialysis. Why aren't all these folks on the deceased donor transplant list?

Some of them may not be in a position to benefit from a transplant, e.g. they may have other critical illnesses, or may not be healthy enough to undergo major surgery. But some of them may just not be getting adequate information about transplantation. Here's a story about that from the St. Louis Post Dispatch: Program touts kidney transplants over dialysis.

"Several years ago, Amy Waterman, assistant professor of medicine and a social psychologist at Washington University, realized that most people with kidney failure go on dialysis and stay on it until they die.

She studied more than 1,000 renal patients and living donors and found that they're often so overwhelmed with information about dialysis, including necessary lifestyle changes, that they're given little or no information on kidney transplants in the crucial months after being diagnosed"
..."But time is of the essence because patients spend an average of four years on transplant waiting lists, yet only about a third of all dialysis patients live more than five years after diagnosis, Waterman says. In comparison, 70 percent to 80 percent of those who get kidney transplants live more than five years."

On a related matter, Dorry Segev of Johns Hopkins is quoted in a press release about a forthcoming article in the AJT suggesting that too few elderly patients are put on the waiting list for extended criteria deceased donor kidneys: Seniors Stymied in Wait for Kidney Transplants

Wednesday, February 17, 2010

Cat stew

Italian Food TV Host Under Fire For "Succulent" Cat Stew Recommendation (VIDEO)

"Leading Italian food expert, writer and TV host Beppe Bigazzi has been suspended indefinitely from his TV program for curiously recommending a cat stew to viewers, and explaining a rough method of preparation. Bigazzi's spectacle occurred on a recent episode of his midday show, La Prova del Cuoco ("The proof of the cook"), which appears on Italy's main public broadcasting channel, RAI.
Said Bigazzi, as his co-host (and cat-owner) Elisa Isoardi nervously looked on, "I've eaten it myself and it's a lot better than many other animals. Better than chicken, rabbit or pigeon... I've eaten its delicious white meat many times."
Leading animal rights groups in Italy are predictably enraged. The Italian Animal Protection Agency has called for his firing, explaining, "anyone who goes on television to promote the taste of cat meat is guilty of instigating viewers to commit an act of cruelty to animals, a crime punishable by up to 18 months in prison."
Italy's Deputy Health Minister, Francesca Martini, decried Bigazzi's rant as well, saying it was "absolutely unheard of for a public service broadcaster to tell people how delicious cats are to eat" and "offensive to the growing number of people who care about the way we treat animals." She also noted that "cats are pets protected by law [against] cruelty, maltreatment and abandonment."
Bigazzi, previously the author of "Cooking with Common Sense," has since explained that he was joking, although he indeed has enjoyed feasting on cat. "Mind you, I wasn't joking all that much. In the 1930s and 1940s, when I was a boy, people certainly did eat cat in the countryside around Arezzo," he explained. "

HT: Bettina Klaus

Matrimony and dating sites with attitude

The NY Times reports on the market for online dating and marriage sites that have ideas about who should be matched with whom: Better Loving Through Chemistry.

"Now, a handful of dating Web sites are competing to impose some science, or at least some structure, on the quest for love by using different kinds of tests to winnow the selection process. In short, each of these sites is aiming to be the Netflix of love.
Instead of using a proprietary algorithm to recommend movies you might enjoy, based on your past choices, however, these dating sites offer you a list of romantic candidates whose selection is based on proprietary analyses of personality characteristics or biological markers.

Consider ScientificMatch.com, founded about two years ago, which aims to create romantic chemistry via genetic testing. The site, which matches people based on certain genetic markers for the immune system, takes its cue from studies showing that women are more attracted to the smell of men who have very different immune systems from their own. The site charges $1,995.95 for a lifetime membership — the lofty fee includes a cheek swabbing kit, DNA processing, a criminal and bankruptcy background check, as well as verification of age and marital status, the site says.
Then there’s Chemistry.com, started in 2006 by the dating giant Match.com. Helen Fisher, the biological anthropologist who developed Chemistry.com’s questionnaire, says the site is designed to predict compatibility based on traits of temperament like adventurousness, decisiveness or empathy. And it charges a premium for its services: about $50 for a one-month membership, compared with about $35 for Match.com.
But both ScientificMatch.com and Chemistry.com are refinements of an idea originally developed by eHarmony.com. "

..."Online dating is a $976 million annual industry in the United States, according to estimates from Marketdata Enterprises, a research firm. So, to stand out among hundreds of mass-market, open-community sites that attract everyone from people trolling for quick hookups to those headed for holy matrimony, a few services offer more elaborate mate-finding methods.
They build brand identity when they “target people who are looking for relationships rather than just dating,” says John LaRosa, the research director at Marketdata Enterprises. That means matchmaking sites with fewer users can charge more per subscriber than larger sites that list online personals.
Match.com, with an estimated 1.2 million paid subscribers, had revenue of about $365 million in 2008, Mr. LaRosa estimates. EHarmony, meanwhile, with about 656,000 paid members, had estimated revenue of $216 million that year, he says. "

Tuesday, February 16, 2010

Girls and the Little League

An obituary of Judge Sylvia Pressler reminds us of some recent history: NJ Judge Who Opened Little League to Girls Dies

"While serving as a hearing examiner with New Jersey's Division on Civil Rights, Pressler ruled that a 12-year-old northern New Jersey girl should have been allowed to play on a Little League team.
''The institution of Little League is as American as the hot dog and apple pie,'' Pressler wrote in a sharply worded opinion. ''There is no reason why that part of Americana should be withheld from girls.''
The ruling was decried by Little League as ''conceived in vindictive and prejudicial fashion of the worst kind,'' but it was upheld on appeal, and New Jersey became the first state to bar sex discrimination in Little League.
By the following year, Little League amended its charter to allow girls and also created a softball division."
...
"The Little League case reached Pressler in 1973. Maria Pepe, a 12-year-old Hoboken resident, had played three games for her Little League team the year before but stopped when Little League's national office threatened to revoke the league's charter. The National Organization for Women filed a lawsuit on her behalf.
Pressler said his wife didn't consider the Little League case one of her more difficult decisions, despite its ramifications and the publicity surrounding it.
''It was an important case because of its timing,'' he said. ''But it was perfectly obvious to her that they were completely cockeyed in barring girls if they were physically able.'' "