Double-M/FlickrFor those who need a transplant, the wait for an organ in America is growing longer: As Nobel economist Gary Becker lays in out in a recent op-ed for The Wall Street Journal, 95,000 Americans were on the waiting list for new kidneys in 2012, but only 16,500 kidney transplants occurred that year. Today, there are over 78,000 candidates waiting for an organ transplant.
"The exchange of kidneys represents what economists call a repugnant market: It could be made more efficient if people were allowed to pay for them, but there are ethical concerns about introducing money into the equation. As demand far outstrips supply—the average wait for a kidney has climbed to 4.5 years—there’s an increasing call for establishing a regulated organ market.
"A new NBER paper explores whether information—such as the depressing numbers above—affects people's attitudes toward an organ market. The researchers were interested to look at how morals about markets play out, and to measure how people respond to new information about a charged issue.
"First, they surveyed a control group on their attitudes about a regulated organ market—52 percent expressed a positive opinion. Next, a treatment group was required to read about the dire situation in the kidney transplant system in America. They were then asked to respond to various statements, including one about supporting a regulated organ market for live donors and families of deceased organ donors. Support for "regulated monetary payments for organ donors" for that group was 72 percent, significantly higher than the control group.
"Overall, they found that liberals and moderates were more sensitive to new information than conservatives. Perhaps unsurprisingly, those self-reporting lower income than the national median and those with a religious affiliation were both less in favor of payments for organs. And while the hope is that an official marketplace for organ would reduce organ theft, another huge concern is that allowing such transactions would expose cash-strapped individuals to exploitation.
"Solutions in recent years to the kidney shortage problem have included a matching system devised by Al Roth, who won a Nobel in economics for market design. In Roth's system, those who wanted to give a kidney to a loved one but couldn't because their blood types don't match, could be paired with another couple with the same problem. This program, the New England Program for Kidney Exchange, increased the number of matches. Another method is being pioneered in Israel to increase supply: You move up in the transplant waiting list if you've signed a donor card, or if a family member has donated an organ before.
"In both cases: No money changes hands, not as many problems. But as the organ-shortage problem persists, money seems to not only be the easy and extremely hard-to-swallow option—but also a last resort."
In his State of the Union address, President Obama presented a series of initiatives aimed at the middle class and the growing income inequality in the United States.
One thing on the minds of many working-class Americans is greater federal regulation of payday loans, the small, short-term high-interest loans that are currently under state jurisdiction. Critics of payday loans say they lead to a cycle of ballooning debt for consumers, who can rarely afford to pay them back and must take out more loans to stay afloat. But payday lenders say that strict rules would eliminate the industry and with it, the only viable lending option for people with bad credit.
Technological innovations will draw customers who use payday loans to cheaper products, like credit cards and installment loans, that better meet their needs.
New rules must keep predatory lenders from pushing consumers into increased risk of losing bank accounts, their foothold into the mainstream financial system.
David F. Manlove and Gregg O’Malley. 2015. Paired and Altruistic Kidney Donation in the UK: Algorithms and Experimentation. J. Exp. Algorithmics19, Article 2.6 (January 2015), 1.11 pages. DOI=10.1145/2670129 http://doi.acm.org/10.1145/2670129 "We study the computational problem of identifying optimal sets of kidney exchanges in the UK. We show how to expand an integer programming-based formulation due to Roth et al. [2007] in order to model the criteria that constitute the UK definition of optimality. The software arising from this work has been used by the National Health Service Blood and Transplant to find optimal sets of kidney exchanges for their National Living Donor Kidney Sharing Schemes since July 2008. We report on the characteristics of the solutions that have been obtained in matching runs of the scheme since this time. We then present empirical results arising from experiments on the real datasets that stem from these matching runs, with the aim of establishing the extent to which the particular optimality criteria that are present in the UK influence the structure of the solutions that are ultimately computed. A key observation is that allowing four-way exchanges would be likely to lead to a moderate number of additional transplants."
The Journal of Bone and Joint surgery has a new article on the experience of the fellowship matches in orthopedic surgery, many of which started after a study of the (then unraveled) match process in the 2008 article, Harner, Christopher D., Anil S. Ranawat, Muriel Niederle, Alvin E. Roth, Peter J. Stern, Shepard R. Hurwitz, William Levine, G. Paul DeRosa, Serena S. Hu, "Current State of Fellowship Hiring: Is a universal match necessary? Is it possible?," Journal of Bone and Joint Surgery, 90, 2008,1375-1384. The new report, by Lisa K. Cannada, MD, Scott J. Luhmann, MD, Serena S. Hu, MD, and Robert H. Quinn, MD is The Fellowship Match Process: The History and a Report of the Current Experience, 2015-01-01Z, Volume 97, Issue 1, Pages e3(1)-e3(7), The Journal of Bone and Joint Surgery. It's gated, so here are some relevant paragraphs:
"Beginning in 2007, there was substantial movement from the American Academy of Orthopaedic Surgeons (AAOS) and the American Orthopaedic Association (AOA) to promote a coordinated match process for orthopaedic fellowships. It is estimated that at least 90% of all orthopaedic surgery residents participate in a year of fellowship training 1. The results of a survey at the 2007 AOA Symposium on Fellowships found that 79% of attendees believed that the current process was unacceptable and 87% believed that the process was unfair to residents 2. The situation of those disciplines that were not in an organized match process was compared with problems often seen in a decentralized labor market 2. A survey of residents indicated that 80% of residents were in favor of an organized match for fellowship and wanted a later date in their fourth postgraduate year for the decisions 2. ... "There have been previous attempts at a formalized match process for fellowship positions. However, the process for most subspecialties unraveled over time. The failure of the match process in the past was due to a variety of reasons: fewer applicants than positions, interviews in the third postgraduate year, early offering of positions, and the lack of a regulated process with a central agency for applications with deadlines
The Orthopaedic Hand Surgery Fellowship Match is administered by the National Resident Matching Program (NRMP) and has been so since 1990.The American Shoulder and Elbow Surgeons (ASES) made arrangements to administer their own match, which they have done since 2005.The Sports Match was run through the NRMP until 2005. Sports rejoined the formal match process in 2008, using the San Francisco Match (SF Match).The Adult Reconstruction Match joined SF Match in 2009, and the match is now run with the same applications and timeline as the Tumor Match. There has been no formal match in place for tumor fellowships in the past.The Pediatric Orthopaedic Society of North America (POSNA) had a previous match that had failed, in part, because of noncompliance by the fellowship programs and directors. POSNA ran another match from 2008 to 2009 and joined SF Match in 2010.The Spine Match involves cooperation among multiple societies: the North American Spine Society, the Cervical Spine Research Society, and the Scoliosis Research Society. They joined SF Match in 2009.The American Orthopaedic Foot & Ankle Society was the pioneer in the new match process, initially beginning in 2006 through the NRMP. Subsequently, the American Orthopaedic Foot & Ankle Society joined SF Match in 2007.The Orthopaedic Trauma Association (OTA) had a match program in the 1990s that dissolved. The OTA reinstated the match in 2007, which was initially administered through the OTA. In 2008, the OTA formalized the match process through SF Match."
Another important aspect is the time away from work and the financial burden of interviewing. As mentioned, residents have an average of ten interviews. This number seems to be consistent between the subspecialties and to be representative of the number of interviews for the fellowship match process. The subspecialty societies have different approaches to the process. The OTA previously offered interviewing at its annual meeting in the fall. However, many programs still require on-site interviews. Currently, the OTA annual meetings offer information sessions from the programs. In this way, the applicants can meet and can interact with faculty and can decide if the program would be suitable for them. The meeting affords the applicants the ability to talk to the fellowship program faculty and current and past fellows before spending several hundred dollars on an interview. Sports fellowships attempt to offer regional interviews so that the applicant can attend several interviews in a short time period, saving time and the added expense of additional flights.POSNA permits interviews at the International Pediatric Orthopaedic Symposium. The society encourages applicants to attend formal interviews at the fellowship location, but it is not a requirement.The Board of Specialty Societies Match Committee has offered interview space to each subspecialty society during the AAOS Annual Meeting. One perceived limitation of regional or national meeting interviews is the inability of the applicant to see the program site firsthand.The cost of the interviewing process associated with the match process has been raised as a concern by applicants from almost every subspecialty society. The costs cited by applicants in the post-match survey response from the applicants ranged from $600 for the interview process to more than $5000.".."A previous reason cited for the failure of the previous matches was the lack of process regulation. To ensure the integrity of a match process, guidelines need to exist. The biggest concerns lie in the area of communication between applicants and programs after the interview. The precedent for the current strict rules could possibly be traced back to the failure of the previous matches in the 1990s and early 2000s. There was no universal match process at that time. The ASES rules state: “No communication between the applicant and program director/staff after the interview.” Likewise, the spine and sports subspecialties have similar strict rules of no communication. The sanctions that each society has in place are available on their web sites. The subspecialty society for the respective match imposes any sanction necessary. Most sanctions to the program involve restriction from participation in the match for a specific time period to fellowship faculty not being allowed to serve on subspecialty boards of directors and/or committees or to the program being banned from making podium presentations or receiving research grants. There have been no major sanctions reported by any subspecialty society.In conclusion, with the advent of a fellowship match and the increased number of applicants, the fellowship application process is not so different from the residency application process.
"Policies inspired to nudge (translated into Italian as 'gentle push') and to the political philosophy of libertarian paternalism have gained increasing attention over the years, representing a tool available to the policy makers to design and implement interventions is increasingly aimed at the citizen, to simplify and, ultimately, the conditions in which the latter makes his choices. What is a great tool, among many of the box, however, is likely to turn into a mantra, sometimes losing sight of the complexity of reality, if you neglect the main teaching of the nudge same: the experimental method used to test every intervention measure and evaluate their effectiveness. The risk of giving the principle of auctoritas, a bit 'as in the "Name of the Rose" by Umberto Eco, is strong: it is just to update, from century to century, the person called upon to play the role of Aristotle.
...
"The first issue was first addressed in a working paper of the Nobel Prize Alvin Roth and Judd Kessler, published last August on NBER. The results are wavering confidence accorded to the theory of the nudge. The active choice, in fact, it even seems to decrease enrollment rates, not increase them! The research of the two authors is based on two experiments. The first is a natural experiment - the case where the conditions of an experimental set are created without the intervention of an investigator. From July 2011, the state of California has, in fact, introduced the active choice through the modules of the Department of Motor Vehicles. The Californian city is now asked: "Would you like to sign up to become an organ donor?", With the dual option of answer: "Yes, add my name to the donor registry" and "I do not want to sign up now." Comparing the data before and after the introduction of active choice and using the rate of registration of the other 26 states as a control, it is seen as from July 2011 recordings in California have declined. Through this change of context of choice, it is estimated to have been lost almost 3% of potential subscribers compared to not change the rules.
Obviously, one can not impute to the introduction of the single active choice the fall of recordings. To isolate the causal effect, the two authors have thus created a particular experiment. In Computer Lab for Experimental Research of Harvard University, 368 subjects had the opportunity to login to register for organ donors and to change its status as a donor. The design of the experiment - conducted in the laboratory, but with consequences on the real life of the subjects - has allowed the manipulation of two variables. The first was the way in which each subject was asked if he intended to become a donor, asking to check one available ("I want to register in the register of donors"), or one of two boxes ("I want to register in the register of donors" or "I do not want to sign up to the register of donors"), reproducing the method of active choice. The condition of the single box is meant to simulate the principle of consent. In the event that the box had not been crossed, the subject would not have been entered in the register. The second variable consisted of the information provided about organ donation. In this case, for some subjects appeared on the web page the words "It is estimated that a donor can save or enhance the lives of as many as 50 people donating organs and tissues." Others appeared the same sentence, with the addition of a list of the organs can be donated, such as corneas, heart, kidneys, liver, lungs and others. The intersection of these two variables, therefore, has enabled the creation of four treatment groups.
The subjects who showed a higher rate of registration were those included in the treatment containing the explicit consent and the list of the organs can be donated (40% chance of recording at the end of the study), doing better, respectively, of the combination of "active choice list + "," explicit consent not list + "," + active choice not list ". In general, the subjects were more likely to enroll when the request was framed in the form of explicit consent, rather than active choice between two options. The difference between the two types of treatment is also in the order of magnitude of the difference observed in the experiment natural rate registration in California.
The ability to know what were the subjects already enrolled in registers before the experiment has uncovered two encouraging results. Provide a list of the organs can be donated to those who initially were not donors has increased the probability of recording. The 34.9% of non-donors with list joined, against 22.6% of those without the list. The most obvious result, however, was another. Provide individuals the opportunity to change their status of donor increases the number of registered donors. The subjects are in fact as many as 22 times more likely to enroll in the registry rather than unsubscribe. For this reason, the title of the article quotes the motto of Winston Churchill: "Do not accept a 'No' for an answer." Remember after a little time to the citizens the opportunity to enroll in the registers may prompt them to change the decision not to enroll taken in the past.
If this first experiment seems to question from an experimental point of view the effectiveness of the previously assumed active choice, such problems are overlooked by the behavioral sciences in addressing the complexity of the issue of the donations?
First, the regulations vary from country to country, making it impossible attempts to enclose in categories precise recording systems. A study conducted in 2012 by Amanda Rosenblum and colleagues shows how each donor registry has its own peculiar characteristics of membership, including the method of recording, the minimum age for enrollment, the role of family members and the ability to change the choice. How is it possible to identify the causal contribution of each of these characteristics?
Here emerges a second problem. Labels such as those of "explicit consent", "explicit dissent", "presumed consent", "silence", "active choice" (which in English is expressed by formulas as "mandated choice", "prompted choice" and "active choice ") are often missing in representing important nuances present in the regulatory systems. In literature, this leads inevitably difficulties on the use of terms, which affect the very possibility of successfully replicate entire experimental sets. An example is provided by the working paper analyzed, as the "explicit consent" used in the study may seem like a form of "active choice". This proposal is subject to, within a laboratory, while in many states, in the life of every day, is the subject that has to take steps to register.
A third problem is related to the major role that is played by the decisions of the family of a potential donor. In many countries, in fact, family members can change the choice of the deceased donor, not consenting to organ harvesting. Conversely, may consent to the donation, without the deceased has expressed its consent to life. Alvin Roth and Judd Kessler conducted a survey with 803 subjects, asking if they would have consented to organ harvesting of a relative in the event that the latter had written, or not, to the registers via the express consent or active choice. The results show that a family member is more reluctant to agree the removal of organs if the deceased relative has expressed his desire not to be a donor through the active choice, rather than not giving his explicit consent. As another experiment, therefore, the introduction of active choice would seem to lead to worse results than actual donations to the express, influencing the opinion of family members.
Finally, a fourth problem is the meaning that individuals attach to gesture to donate their organs. We are sure that a citizen confers the same value in the donation through different systems of registration? In this case, active choice and explicit consent could lead to similar outcomes. Shai Davidai and colleagues, in a study of 2012, as noted in a context of choice where there is presumed consent, people placed on a scale of values the gesture of organ donation close to passing in front of someone when you are in tail and to devote part of their time to volunteering. Conversely, in a scenario where worth the explicit consent, assign people to donate organs a value similar to that which is given to gestures like to donate half their wealth to charity or do a hunger strike in support of a cause.
The cited literature, abundant and complex, and not containing unequivocal conclusions about the effectiveness of a particular intervention, does not point to the conclusion that certain institutional immobility is the answer: designing policy interventions that seek to achieve a particular goal is not only desirable, but it is necessary for a society of citizens aware and well informed. That said, it is worth reiterating as there is a science of miracles, whatever form it takes the same miracle that, in turn, becomes fashion in the academic community, generating curiosity (legitimate) and trust (often uncontrolled). Study, analyze, publish a scientific result, no certainties. If not that, in fact, not to have.
The Conference of the
Society for Economic Design 2015will take place at Istanbul Bilgi University on July 1-4, 2015. The
plenary speakers are Eric Maskin (Leo Hurwich Lecture), Stephen Morris (Murat
Sertel Lecture), Charles Plott (SED
Lecture) and Rakesh Vohra (Paul Kleindorfer Lecture)
Organizing the sessions not by methodology but
by topic, the conference aims to implement a platform for theorists and
experimentalists to benefit more from each other. Deadline for submissions is February
15, 2015. Please see the details at http://sed2015.bilgi.edu.tr
To follow the tradition, there will be a doctoral school adjunct to the
conference on June 30-July 1, 2015. This year's school is organized by Bilgi Economics Lab of
Istanbul on experimental economics with special emphasis on the role of
experiments for economic design. The lecturers are Gary Bolton, Jordi Brandts,
Seda Ertac, Ayca Ebru Giritligil and Emin Karagozlu. For details, please seehttp://sed2015.bilgi.edu.tr/site_media/docs/SED2015-Grad-School-Jan-2015.pdf
or the attached.
NBER Working Paper No. 20774 Issued in December 2014 NBER Program(s): ED
This paper examines non-price competition among colleges to attract highly qualified students, exploiting the South Korean setting where the national government sets rules governing applications. We identify some basic facts about the behavior of colleges before and after a 1994 policy change that changed the timing of the national college entrance exam and introduced early admissions, and propose a game-theoretic model that matches those facts. When applications reveal information about students that is of common interest to all colleges, lower-ranked colleges can gain in competition with higher-ranked colleges by limiting the number of possible applications.
"Section 309 of the Indian Penal Code of 1860, a piece of legislation designed by the very Victorian Lord Macaulay, which punished attempts to commit suicide with a fine or up to a year in jail or both. Aiding or instigating suicide — an offense created later — was punishable by up to ten years in jail, including possibly hard labor.
"The rationale for criminalizing attempted suicide is the standard theological argument: Since only God could give you life, only God could take it away. The harsher penalty for abetment arose from something more distinctly Indian.
"India has strict laws against demanding a dowry of brides and their families. But even after marriage, women can be harassed by in-laws asking for money, gold or gifts, and some, driven to despair, kill themselves. Criminal abetment to suicide was often used to take such cases to court.
"But now, at the instigation of the ruling Bharatiya Janata Party, the law stands to be repealed. This follows a 2008 recommendation by the Law Commission, which suggested that attempted suicide should be “regarded more as a manifestation of a diseased condition of mind deserving treatment and care rather than an offense to be visited with punishment.”
"The news comes none too soon, given that India has the world’s highest suicide rate for 15-to-29-year-olds and desperately needs to rethink its approach to mental health. (In many cities, electro-convulsive therapy remains a common treatment for depression and suicidal tendencies; in small villages, the standard cure might be exorcism.) Although the anti-suicide law has rarely been applied, its very existence — and the threat of prison — discouraged people who attempted or considered suicide from seeking help. The authorities would sometimes leverage it for political advantage or to extract money by blackmailing already traumatized families."
"Political leaders must agree a plan to legalise assisted dying as one Briton a fortnight is now travelling abroad to end their lives, an alliance of prominent figures from across public life warns today.
In a letter to The Daily Telegraph, some 80 doctors, writers, actors, clerics and politicians say an “overwhelming majority” of the public now supports a change in the law and that Parliament must allow time to finally resolve the issue.
The signatories, which include Lord Carey, the former Archbishop of Canterbury and Ian McEwan, the author and winner of the Booker Prize, argue that Britain is “closer than ever” to a historic change after progress in the House of Lords on a Bill tabled by Lord Falconer, the former Lord Chancellor."
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"The chain, which began in December 2013, has matched 34 living donors with 34 recipients to create the longest kidney-transplant chain ever recorded in the United States; previously, the longest chain on record involved 30 donors and recipients in 17 hospitals around the country. All 34 recipients in the UAB kidney chain have been transplanted at UAB Hospital or Children’s of Alabama. ... "Sixty-seven of the 68 surgeries in the chain to date have been performed at UAB Hospital. One recipient,15-year-old Ryane Burnsof Union, Mississippi, was transplanted at Children’s of Alabama, making it the only program in the Southeast to offer living-kidney paired donation to recipients younger than 18.
...
"more transplants are planned in January 2015. Denise Prewitt is a bridge donor who is expected to be part of the chain in the New Year. She is donating on behalf of Marjorie Wilhite who received her kidney this past summer."
"A rapidly growing public health startup, ORGANIZE, is seeking to hire a forward-thinking, entrepreneurial individual to serve a two-year appointment of Innovator In Residence (IIR) at the Department of Health and Human Services (HHS). The IIR will play an instrumental role in evaluating ongoing efforts to increase organ donation and transplantation and will work closely with HHS staff, including staff in the Health Resources and Services Administration’s (HRSA) Division of Transplantation and the broader organ donation and transplantation community, to identify gaps between these efforts and opportunities for better coordination. The IIR will work with stakeholders to develop an implementation strategy toward improvements in the organ donation system, including new technology, access to data necessary to evaluate the effectiveness of Organ Procurement Organizations (OPOs), best practices and systemic improvements to increase organ donor conversion rates and empower OPOs to operate most efficiently.
"This will include studying a broad range of potential focus areas, which the IIR will identify in consultation with HHS and the organ donation and transplantation community, including existing models of federal financial reimbursement of OPOs and transplant centers for organ recovery and transplantation, harmonizing the forces acting on OPOs and their various partners (e.g. transplant centers), and creating opportunities for OPOs to operate most flexibly and effectively. The research will be guided by a panel of experts including HHS staff and thought leaders in the OPO industry. The position is located in Washington D.C., although frequent travel is possible.
"The IIR will work onsite at HHS with the HHS Chief Technology Officer and staff from other HHS operating divisions for exposure to a wide range of policy, stakeholder engagement, and technical expertise. The IIR will work with donor hospitals, transplant centers, OPOs, and other relevant stakeholders toward identifying innovative approaches for increasing the number of organ transplants performed annually and streamlining OPO operations. The IIR will bring experience and expertise in data science, policy, social enterprise, and project management. ...
"Application Requirements
Send a one page letter describing your interest in and qualifications for the position, including a CV and three references to iir@organize.org.
This position will remain open until a candidate is selected.
Available to US citizens or eligible naturalized US citizens.
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