Death with dignity in Colombia, and a last minute reversal (Updated)

 The Washington Post has the story (followed by new developments at the very last minute):

She’s 51, a mother and a devout Catholic. She plans to die by euthanasia on Sunday.   By Samantha Schmidt and Diana Durán 

"In November 2018, a doctor gave Martha Sepúlveda her diagnosis: amyotrophic lateral sclerosis, the progressive neurological disease known in the United States as Lou Gehrig’s disease. In the months that followed, the Colombian woman lost control of the muscles in her legs — and she knew it would only get worse.

...

"Sepúlveda started reading about an option that could relieve her fear of what was to come: Euthanasia. Colombia, she learned, is the only country in Latin America — and one of only a few worldwide — that permits patients to end their lives.

"Until this year, the option has been available legally only to those who are expected to live for six months or less. On Sunday, Sepúlveda, who considers herself a devout Catholic, plans to become the first person in Colombia without a terminal prognosis to die by legally authorized euthanasia.

"Colombia’s constitutional court ruled in July that the right to euthanasia — recognized here in 1997 — applies not only to terminal patients, but also to those with “intense physical or mental suffering from bodily injury or serious and incurable disease.”

"The ruling has divided the faithful in this majority-Catholic country. Church officials have described euthanasia as a “serious offense” to the dignity of human life; a member of the national bishops’ conference urged Sepúlveda to “calmly reflect” on her decision and invited all Catholics to pray that God will grant her mercy."

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

Update: some late breaking news:

They cancel euthanasia of the Colombian Martha Sepúlveda, who was going to die this Sunday

"The IPS Incodol (Colombian Institute of Pain) canceled the euthanasia of Martha Sepulveda, which was scheduled for this Sunday at 7 am

"The Interdisciplinary Scientific Committee for the Right to Die with Dignity “unanimously concluded to cancel the procedure.”

"The IPS added that “The request was reviewed and analyzed again in a comprehensive and sufficient manner”, then “it is defined that the termination criterion is not met, as was considered in the first committee ”.

"This 51-year-old woman was to become the first non-terminal patient to access euthanasia this Sunday. Sepúlveda did not know of the mass that was celebrated in his name, nor of the request that the Colombian Episcopal Conference for you to reconsider your decision.

"She was ready to die and had even turned off her cell phone. “Martha has no idea what the priests have said, so it’s really like the world is exploding outside and she has no idea what’s going on. If Martha’s cell phone were available, she would have no life, but we have been very careful that she is in her world, sheltered now and that no one interferes with her peace and tranquility “, said Camila Jaramillo Salazar, her lawyer, before meeting the IPS."

*********

Here's the Washington Post followup on this development:

She had canceled her phone plan and was ready to die. Now a surprise decision has halted her euthanasia bid.  By Samantha Schmidt and Rachel PanBOGOTÁ, Colombia — A 51-year-old woman was set to become the first person in this majority-Catholic country without a terminal prognosis to die by legally authorized euthanasia on Sunday. But a surprise 11th-hour decision by health officials has halted her bid.

"Martha Sepúlveda was awakened by her lawyers Friday night with the news of a letter announcing that her euthanasia procedure scheduled for 7 a.m. Sunday had been canceled, after a medical committee determined that she no longer met the conditions because her health had apparently improved.

"The decision to cancel the procedure came as a complete surprise, according to her lawyers. She had no idea health officials were even meeting to review her case. She had been quietly living out her final hours, and had tuned out media coverage of her case.

...

"“They’re obligating her to live a life that she is not willing to continue to live,” said Lucas Correa Montoya, a lawyer representing Sepúlveda alongside Jaramillo with DescLAB. “What has happened in the past few weeks is an example of the long road ahead for death with dignity in Colombia.”

*******

Update: here's the end of that story:

Colombian woman dies by euthanasia after historic legal fight. By Samantha Schmidt and Diana Durán  January 8, 2022

"A 51-year-old Colombian woman died by euthanasia on Saturday after a historic legal battle to exercise the right in this majority-Catholic country.

"The case of Martha Sepúlveda drew international attention last year when she planned to become the first person in Colombia without a terminal prognosis to die by legally authorized euthanasia. But less than two days before she planned to die in October, a medical committee determined she no longer met the conditions and canceled the procedure. A judge eventually cleared the way for Sepúlveda to move forward.

...

"Colombia was one of the first countries in the world to decriminalize euthanasia; its constitutional court recognized the right in 1997. But for many years, the country extended the right only to patients with a terminal prognosis of six months or less.

...

"Although ALS is a fatal disease with no cure, patients can survive from two to 10 years or more, depending on how their conditions progress. When Sepúlveda first sought out euthanasia, her prognosis did not qualify as “terminal.”

"But in July, the country’s constitutional court ruled that the right applies not only to terminal patients but also to those with “intense physical or mental suffering from bodily injury or serious and incurable disease.” The decision allowed Sepúlveda to schedule her euthanasia for Oct. 10.

"As her story circulated in Colombian news in early October, her decision drew a rebuke from local church leaders. A member of the national bishops’ conference urged Sepúlveda to “calmly reflect” on her decision and invited Catholics to pray that God would grant her mercy.

"Then, in an 11th-hour move, her euthanasia was abruptly canceled. The Colombian Institute of Pain, or Incodol, which had been scheduled to carry out the procedure, said Sepúlveda’s condition had improved between July and October.

...

"After her appeal, a judge from Medellín ruled on Oct. 27 that Sepúlveda was entitled to die by euthanasia.

"The judge confirmed that patients who endure intense physical or mental suffering — with diseases such as Lou Gehrig’s — are legally allowed to access euthanasia even if their prognosis is not terminal, and that Sepúlveda’s health provider was not justified in its denial of her request.

...

"On Friday, a day before Sepúlveda’s death, a different Colombian patient became the first person without a terminal prognosis to die by euthanasia. The patient, a man in Cali named Victor Escobar, suffered from end-stage chronic obstructive pulmonary disease.

“The fight to take control over the end of life continues and will not end until people in Colombia can access an assisted medical death according to their will and without barriers,” Sepúlveda’s lawyers said."

Peter Lorentzen interviews me about market design (podcast)

 Peter Lorentzen interviews me about market design, and my book Who Gets What and Why. (We have an interesting conversation on market design and my career, not closely related to the book...)

"In our interview, we range far beyond the examples from the book to discuss the implications of his work for the design of tech’s market-making “platform” businesses like Airbnb, Amazon, Lyft, or Uber, the challenges he faces when countries or people view some kinds of transactions as “repugnant” or morally unacceptable, and the reasons why San Francisco’s school district (unlike Boston’s or New York’s) chose not to implement the un-gameable school choice plan his team devised for them.

"Host Peter Lorentzen is an Associate Professor in the Department of Economics at the University of San Francisco, where he leads a new digital economy-focused Master's program in Applied Economics."

;

Repugnance watch: Dog (as) food in Korea--opposition from the President, amidst growing pet ownership

 Here's the story from the Guardian:

South Korean president suggests ban on eating dog meat. Moon Jae-in, a dog-lover, says ‘time has come’ for traditional practice to end. 

"The South Korean president, Moon Jae-in, has raised banning the eating of dogs in the country, his office said, a traditional practice that is becoming an international embarrassment.

"The meat has long been a part of South Korean cuisine with about 1 million dogs believed to be eaten annually, but consumption has declined as more people embrace the animals as companions rather than livestock.

"The practice is something of a taboo among younger generations and pressure from animal rights activists has been mounting.

“Hasn’t the time come to prudently consider prohibiting dog meat consumption?” Moon asked the prime minister, Kim Boo-kyum, during a weekly meeting on Monday, according to the presidential spokesperson."

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

And from the Washington Post:

South Korea considers ban on eating dog meat as pet ownership grows in the country  By Grace Moon  and Andrew Jeong

 "South Korea is considering a ban on dog meat consumption, officials said Tuesday, a day after President Moon Jae-in ordered the government to explore such a move.

"The news comes after years of public outcries against the roughly 3,000 dog farms still operating in South Korea. Animal rights activists have accused the farmers of holding dogs in horrid conditions.

"Criticism surrounding the consumption of dog meat has grown as more South Koreans adopt canine pets: About 27 percent of South Korean homes have pets, with the majority of them being dogs — up from 17 percent in 2010 — according to the agriculture ministry. (About half of American households reported having pets in 2018, according to the Census Bureau and Simmons National Consumer Study.)"

Market design in La Republica

 In anticipation of the Econometric Society meeting in Colombia later this month, I was interviewed by La Republica. The interview was in English, and is published in Spanish, but is fairly readable via Google Translate...)

"Migración será uno de los problemas más grandes del market design”: Alvin E. Roth

"Migration will be one of the biggest problems in market design": Alvin E. Roth

by Lilian Mariño Espinosa 

"The Universidad del Rosario, in its 367 years, has sought to be a pillar of knowledge, which is why it tends to generate spaces for dialogue that analyze and provide solutions to changes in society. In the midst of the current situation, in which the covid increased problems such as inequality, the institution will be the organizer of the Annual Meeting of the Latin American and Caribbean Economic Association (Lacea) and the Latin American chapter of the Econometric Society (Lames) , which will take place on October 20, 21 and 22, virtually.

"The event, which will feature policy makers, public and private officials and academics such as Alvin E. Roth, (from Stanford University and Nobel Prize in Economics in 2012), Pinelopi Goldberg (from Yale University and former Chief Economist of the Bank Mundial) and Oriana Bandiera (from the London School of Economics), will discuss and reflect on how Latin America can best cope with these difficulties, without losing sight of other economic challenges.

"As an appetizer for the event, at LR we spoke with Roth, who explained how market design can be an opportunity to solve several of the problems facing the region and the world..."

Indian Society of Organ Transplantation 2021 Annual Meeting, Oct 7-10

 31st Annual Conference of The Indian Society of Organ Transplantation 7th to 10th October 2021 GRAND HYATT LULU BOLGATTY CONVENTION CENTER in Kochi (Cochin)

My talk (via Zoom) tomorrow morning in CA/evening in India will be on 

"Kidney exchange, around the world and in India"

http://www.isot2021.com/images/pop1.jpeg?refresh=210923023039

ABOUT ISOT 2021 KOCHI  Virtual Conference

"It is our pleasure to invite you to the 31st Annual Conference of the Indian Society of Organ Transplantation, ISOT 2020 Kochi a programme organized by team of Transplant Professionals of Kochi to be held at hotel Grand Hyatt, Lulu Bolgatty Convention Centre from 07th to 10th of October 2021. We are fortunate to have renowned experts across the globe as speakers. This conference will also give you an opportunity to interact with the experts in the field. Wide range of topics, venue of International standard, best hospitality in the Gods own country of Keralam will be the highlights.

"Grand Hyatt Kochi is a Luxury 5 star deluxe waterfront hotel overlooking the serene waters of Vembanad lake with a range of dining, wellness and enriching experiences.

"With a large number of advanced tertiary/quaternary care facilities, Kochi has one of the best healthcare facilities in India. It is the prime destination for people seeking advanced healthcare facilities across Kerala. In recent times, it has attracted a large number of patients from all over India, Middle East, African nations as well as from Europe and United States looking for relatively inexpensive but advanced medical care. Kochi is the only city in Kerala that have carried out successful kidney, liver, heart, pancreas and composite tissue transplantation. VPS Lakeshore Hospital, Amrita Institute of Medical Sciences and Research Centre, Medical Trust Hospital, Lisie Hospital, AsterMedicity, Lourde’s Hospital are some of the advanced tertiary/ quaternary healthcare facilities in Kochi.

"Kochi also known as Cochin is the financial and industrial capital and the biggest city of Kerala that offers excellent airline connectivity with direct flights to 22 destinations including all the major cities of the country. It is also known for its salubrious climate particularly during the month of October attracting a large number of tourists from Europe, Americas and rest of Asia as well as domestic tourists. City also flaunts one of the finest natural harbours of the world. Finest beaches, tranquil back waters, luxurious houseboats, multi-cuisine restaurants, and numerous shopping malls are other attractions."

Fuhito Kojima and I will discuss improving social welfare with matching theory in a Nikkei Business webinar this evening

Fuhito Kojima and I will participate in a Nikkei Business Zoom webinar on The Future of Management 2030, in English and Japanese (I think translation will be available).

 "Nikkei Business LIVE will hold a webinar entitled "The Future of Management 2030: Rebuilding Capitalism and Revitalizing Innovation" for three days from October 5th to 7th. 

Our discussion, on "Creating a better society by implementing matching theory" will be at 11AM tomorrow in Japan (which is 7PM this evening in California).

"Creating a better society by implementing matching theory in society"

"Auction theory that was in the limelight at the 2020 Nobel Prize in Economics. It is one of the theories representing the new field of microeconomics, "market design," which seeks to design a market in which traders can satisfy each other, rather than analyzing the existing market as in the past. The pioneer who won the Nobel Prize in Economics for "market design" is "matching theory" by Professor Alvin Roth and others. He talks with Professor Fuhito Kojima of the University of Tokyo Graduate School of Economics, who is a direct pupil and a former colleague at Stanford University, about the future brought about by the social implementation of economic theory." (via Google translate)

More on the UAE-Israel kidney exchange

If you're just tuning in, you can follow the story of the kidney exchange between the UAE and Israel here. The pairs who exchanged kidneys were an Israeli Arab husband and wife, a Jewish Israeli mother and daughter, and a mother and daughter who wish to be identified only as Arab residents of the United Arab Emirates.  (I joined their family at their home for a meal when I was in Abu Dhabi, but won't say more about them.)

It isn't a surprise that the donor in each pair couldn't donate to the intended recipient, because in each pair the recipient was a highly sensitized mother ( i.e. for whom it was hard to find a compatible kidney, because she had many antibodies against human proteins). During childbirth, mothers can develop such antibodies to the father's proteins that the children inherited. So the father and the daughters were incompatible donors, since the mother had antibodies against the paternal proteins (human leukocyte antigens) in their kidneys. Together with the fact that the mothers were quite hard to match, and that Israel and the UAE are both small, each with populations of around ten million, they had to look across national borders.

Cross border kidney exchange requires some diplomacy, particularly when the countries involved are getting together for the first time (and don't necessarily have a long history of cooperation). The key medical diplomats were Dr. Tamar Ashkenazi* the director of Israel Transplant and Dr Ali Abdulkareem Al Obaidli, Chairman of the UAE National Transplant Committee.  (Other key collaborators in the complicated logistics were Itai Ashlagi at Stanford and Atul Agnihotri and Mike Rees of the Alliance for Paired Kidney Donation.)  

So this was the plan:

And here's a picture of the Abu Dhabi kidney packed for shipping (masked in the picture are Sue and Mike Rees, who have a lot of experience with packing and shipping kidneys, another nurse whose name I don't know, and Dr. Muhammad Badar Zaman the UAE transplant surgeon who transplanted the  kidney that was on the way.

The little box taped to the top of the shipping container allows the kidney to be tracked in transit, via an app that gives you a picture of where it is at it travels:

And here's the swap of the two kidneys in shipping containers in the airport in Abu Dhabi (Tamar Ashkenazi and Dr. Ali are in the center, Atul and Mike are at the two ends...). Dr Ashkenazi was on both legs of the flight above--she flew in with the Israeli kidney and flew out with the UAE kidney.

On my last night in Abu Dhabi I had dinner with a lot of the docs. Across from me in the picture below are the two surgeons most actively involved in this exchange on the UAE side, transplant surgeon Dr. Zaman and the nephrectomy surgeon Dr. Hamid Reza Toussi.  Next to me is the nephrologist Dr. Mohamed Yahya Seiari.

Below is that whole dinner party. If you've been following these posts up til now, you've met all of them except the gentleman second from the left, Dr. Gehad ElGhazali, who is the head of the HLA lab, which is responsible for the data that allows the matching algorithm to predict which kidneys are compatible, and is responsible for the final 'crossmatch' tests that verify compatibility. Like all the other docs I encountered, he has a multi-international background. This reflects the UAE's very international population, which is why it seems a natural global hub for kidney exchange.

I only met the Israel participants in the exchange later, by Zoom: Shani Markowitz is the donor from the Jewish pair, and Walaa Azaiza is the recipient from the Israeli Arab pair.

The Israeli transplant surgeons are Dr Tony Karam at Rambam Hospital and Dr. Eitan Mor at Sheba Medical Center.

^^^^^^^^^^^^^^^^^^^

*As it happens, I've twice had the privilege of  being Dr. Ashkenazi's coauthor (concerning deceased organ donation):

1. Stoler, Avraham,  Judd B. Kessler, Tamar Ashkenazi, Alvin E. Roth, Jacob Lavee, “Incentivizing Authorization for Deceased Organ Donation with Organ Allocation Priority: the First Five Years,” American Journal of Transplantation, Volume 16, Issue 9, September 2016,  2639–2645. http://onlinelibrary.wiley.com/doi/10.1111/ajt.13802/full 

2. Stoler, Avraham, Judd B. Kessler, Tamar Ashkenazi, Alvin E. Roth, Jacob Lavee, “Incentivizing Organ Donor Registrations with Organ Allocation Priority,”, Health Economics, April 2016 online http://onlinelibrary.wiley.com/doi/10.1002/hec.3328/full ; doi: 10.1002/hec.3328. In print: Volume: 26   Issue: 4   Pages: 500-510   APR 2017

Technology and Equality in the Digital Era--Luohan Academy

 Last week I participated in a Luhohan Academy discussion called 

Boosting Shared Prosperity: Technology and Equality in the Digital Era

Speakers : David Autor, Erik Berglof, Long Chen, Hanming Fang, Ginger Jin, Alvin Roth, Tom Sargent, Michael Schwarz, Michael Spence, Steve Tadelis, Robert Townsend,

I discussed the presentations by David Autor and Rob Townsend.

Here's the video (on YouTube):

Here's a Symposium summary.

UAE as a natural hub for international/global kidney exchange

 There are excellent hospitals in the United Arab Emirates that can perform kidney transplants, and they are prepared to do kidney exchange, both domestically and internationally.  My post today is about why the UAE would be a natural international center for kidney exchange. 

International hubs for kidney exchange are needed because hard-to-match patient-donor pairs may need to find compatible exchanges outside the borders of their own countries. This is particularly true for citizens of countries with relatively small populations of potential compatible donors, and of countries that don't yet have widespread kidney exchange. But even a big country like the U.S., in which kidney exchange is a standard mode of transplantation, can sometimes be too small to find compatible kidneys for the hardest to match  patients. (The U.S. itself is a natural hub for global kidney exchange, about which I've written elsewhere. But so far, bureaucratic obstacles have prevented us from integrating kidney exchange even with Canada...)

The UAE itself is already quite international, as only about 10% of its approximately 10 million residents are Emirati citizens; the rest, largely foreign workers and their families, are citizens of other countries. The biggest of the Emirates, Abu Dhabi, provides medical care for its residents that includes dialysis and transplantation for kidney failure, which is prevalent there (perhaps due in part to the very hot weather and the perils of frequent dehydration in outdoor work). Most of those patients are on dialysis, although the national health insurance will pay for transplants for those who have willing donors either in the Emirates or in their home country. The UAE is wealthy, and many of the home countries are not, so my understanding is that the UAE is prepared to assume the costs of bringing family members to the UAE and providing the necessary medical care. This is cost effective as well as good for the patient, because in the UAE as elsewhere, transplantation is much cheaper than dialysis, as well as being the best treatment. So taking a UAE resident off dialysis via transplant saves a life and pays for itself.

Of course, sometimes the UAE resident's family member who is willing to donate a kidney isn't compatible with the UAE resident. So kidney exchange makes a lot of sense in this case. But with a resident population of only 10 million, there are severe limits on how much kidney exchange can do for hard-to-match patients. So international, global kidney exchange makes sense, in which patient-donor pairs from other countries could also be transplanted in the UAE through kidney exchange with UAE residents (or, eventually, with other international pairs).

It helps a lot that the UAE is also an air transit hub, with two international airlines. Emirates has a hub in the Emirate of Dubai, and Etihad has a hub in Abu Dhabi. So a big portion of the world's population is within a few hours of direct air travel to the UAE.  (When I went to the UAE this summer in connection with the UAE-Israel kidney exchange, I took a direct flight from San Francisco to Dubai, but that takes sixteen hours...)

My main goal in the UAE was to meet with various mostly government bodies engaged in an effort, in collaboration with the Alliance for Paired Kidney Donation, to make domestic and international kidney exchange a regular part of medical care there. To that end, we met with the Ministries of Health in Dubai and in Abu Dhabi, with the national health insurance, with the Red Crescent (which is able to get involved in care of patients and donors after they return home), and others.

The key player in organizing this collaboration, and in transplantation generally in the UAE is  Dr Ali Abdulkareem Al Obaidli, transplant nephrologist and Chairman of the UAE National Transplant Committee. Two other key figures from the APKD are Mike Rees and Atul Agnihotri. Many of our meetings ended in photos, and I'm with those three in all pictures below. 

I expect to write some more about this. In the meantime, here are related posts.

Thursday, September 30, 2021

Kidney Exchange between Israel and the UAE (in USA Today, yesterday)

Friday, October 1, 2021

Stanford celebrates Itai Ashlagi and the UAE-Israel kidney exchange

And this older one:

Friday, August 7, 2020

Global kidney exchange between Abu Dhabi and Kerala (India)

Here's a slide from a talk I'll be giving shortly at the annual conference of the Indian Society of Transplantation (ISOT) that provides some more information about this UAE-India exchange

Stanford celebrates Itai Ashlagi and the UAE-Israel kidney exchange

Here's a Stanford story celebrating Itai Ashlagi's role in this summer's UAE-Israel kidney exchange. (His matching software is embedded in the software suite of the Alliance for Paired Kidney Exchange (AKPD) which is a partner with a remarkable Abu Dhabi effort to further kidney exchange.)

Stanford engineers develop algorithm to aid kidney transplant exchanges. A historic and complex kidney exchange between Israel and Abu Dhabi put a spotlight on the Stanford algorithm that made it all possible. BY ANDREW MYERS.  AUGUST 12, 2021

"A historic kidney transplant exchange recently took place in the Middle East, but it might never have transpired without an algorithm developed at Stanford by Itai Ashlagi, a Stanford associate professor of management science and engineering, and his graduate student Sukolsak Sakshuwong. In all, three ailing recipients received life-sustaining transplants while three healthy donors gave kidneys.

...

"“One of the nice things in the software we developed is the user interface. We collect all the relevant patient data, but then we let the user play with the various thresholds that determine successful matches to see what works for them,” Ashlagi said as he explained the team’s game-like approach to matching. The software acts as a platform and allows different organizations to easily collaborate and create more possibilities for exchanges. “Just a few days ago, I was looking for matches and found an unexpected exchange between pairs from Israel and other European countries. Hopefully, this will lead to new collaborations.”

“Itai’s software was used on both sides of that historic exchange between Abu Dhabi and Israel,” said Alvin Roth, Nobel Laureate and Ashlagi’s mentor and frequent collaborator, who was in Abu Dhabi in connection with the exchange.

"Roth says Ashlagi exemplifies the concept of scientist-engineer and is now a driving force in contemporary kidney exchange through both his deep understanding of the immunological issues of matching kidneys to patients and his intimate appreciation of the needs of transplant centers.

“He’s turned those practical theoretical insights into widely deployed digital tools with the power to change lives,” Roth added. “Having the chance to collaborate with him has been among the best experiences of my intellectual career.”

Kidney Exchange between Israel and the UAE (in USA Today, yesterday)

 I spent a week in the UAE this summer, in connection with a three-pair kidney exchange between the UAE and Israel.  (The UAE is a natural hub for kidney exchange, something I'll say more about in subsequent posts.) Because there were some sensitivities about how it would be publicized, I've  refrained from blogging about it until now, but yesterday's front page story in USA Today met with just about everyone's approval, and so over the next few days I'll post some observations. Today I'll start with the USA Today story, which is gated, but can also be found ungated on Yahoo, here:

How three Jewish and Arab families swapped kidneys, saved their mothers and made history by Marco della Cava, USA TODAY, Wed, September 29, 2021 AM

"At a time when the world seems rife with division and discord, what happened on July 28 reminds how mutual survival often depends on shared humanity triumphing over historical differences.

"In this case, with the assistance of organ transplant experts in the United States, Israel and the United Arab Emirates, three pairs of kidney donors and recipients in Israel and the UAE saved each other in a series of choreographed, pay-it-forward surgeries known as a cyclic exchange.

...

"Just consider the logistics involved in the UAE-Israel exchange. A UAE daughter who was not a match for her mother volunteered to give her kidney to a stranger. An Israeli Arab woman was a match for that kidney, so her husband agreed to donate his kidney to save an Israeli Jewish mother – whose daughter in turn gave her kidney to the sick mother in UAE.

"“The reason we are excited about this is simply because the bigger the pool, the more likely you are to find matches,” says Dr. Michael Rees, a surgeon and founder of the Alliance for Paired Kidney Donation, a Toledo, Ohio-based nonprofit instrumental in making this politically groundbreaking kidney transplant chain a reality.

...

"Those communications, however, remain politically sensitive. When asked for comment, officials in the UAE focused less on the partnership with Israel and more on a general need for international cooperation.

"We are pleased that our innovative partnership with the Alliance for Paired Kidney Donation has allowed us to help our patients,” says Dr. Ali Al Obaidli, chairman of the UAE National Transplant Committee. He added that a collaborative spirit between countries can be used to “close the gap” for those in need of kidneys.

"The UAE donor daughter and recipient mother asked not to be identified by name or religion. Conversations with those involved in the cyclic exchange say kidneys donated outside the UAE generate negative reactions among some Emirati.

...

"This unique transplant chain began when the 60-something mother in the UAE found out in fall 2020 that she had kidney failure and would soon need to start dialysis or find a new kidney.

"Because her family members were not matches, Rees and his Alliance for Paired Kidney Donation team got to work finding a match, which also involved seeing where her daughter’s donor kidney might go.

"The first step was to plug all the relevant medical details into an algorithm ...

"Also crucial to the process was Roth's Israeli colleague Itai Ashlagi, who had developed software that could instantly mine his native country’s kidney database. While Israel had started to develop transplant relationships with Austria and the Czech Republic, he was excited about this new involvement with the UAE.

“Better to exchange kidneys than bombs,” says Roth, adding that using computers to search the world for medical solutions radically increases the chances of patients getting help. “International boundaries are artificial markers. Kidney disease doesn’t care about that.”

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

Here's the picture on the USA TODAY front page: Tamar Ashkenazi flew from Israel to UAE with an Israeli kidney, and flew back with the UAE kidney...

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

Here's a USA Today 1-minute video collage of pictures and video accompanying the story:

Daughters from the UAE and Israel put differences aside to save lives in kidney exchange. Three pairs of kidney donors and recipients in Israel and the UAE saved each other in a series of pay-it-forward surgeries known as a cyclic exchange. by Harrison Hill, USA TODAY

I'll have more to say soon, and will link back and forth between posts to make the whole story accessible.

Marcella Alsan and Jesse Shapiro are 2021 MacArthur Fellows

Two economists, Marcella Alsan at Harvard and Jesse Shapiro at Brown have been recognized for their innovative and influential work. (These are very good choices, imho...)

 The 2021 MacArthur Fellows

"In order for the medical care system to be trusted, it has to become more trustworthy."  Marcella Alsan, Physician-Economist | Class of 2021

 

"I think a fundamental premise of social science is that by better understanding our social world, we can figure out ways to make things work better." Jesse Shapiro, Applied Microeconomist | Class of 2021

Liver transplantation in the Middle East

 Here's a chapter on transplantation in a book about liver cancer.  The countries in the Middle East that can do liver transplants can also transplant kidneys, with living donors being the majority of donors across the region.

Liver Transplantation in the Middle East by Sezai Yilmaz,  In: Carr B.I. (eds) Liver Cancer in the Middle East. Springer, Cham. https://doi.org/10.1007/978-3-030-78737-0_12

It contains some interesting summaries by country.  Here is the summary of the transplant situation in the UAE (about which I expect to be able to say more soon).

"6 LT in the United Arab Emirates

"The United Arab Emirates (UAE) is an Arabian Gulf country located at the southeast end of the Arabian Peninsula with a population of about 9.3 million. It has made great strides in healthcare over the past several years and has among the highest life expectancy in the region. However, one of the key lacking areas of medical care in the country was the availability of solid organ transplantation. Collaborative efforts began a few years ago aiming to establish thoracic and abdominal solid organ transplantation from deceased donors in addition to continued development of the existing program on kidney transplantation from living donors. The UAE played an important role in efforts leading up to the declaration of Istanbul on organ trafficking and transplant tourism in 2008, the groundwork for which was laid in a steering committee meeting organized by the Transplantation Society and the International Society of Nephrology in Dubai in December 2007. This landmark declaration helped establish a framework of ethical principles to guide the practice of transplantation worldwide. The legal definition of brain death in the UAE was confirmed in May 2017, paving the way for deceased donor organ transplantation [42].

"The Cleveland Clinic Foundation was instrumental in the accelerated path to establishment of a multi-organ transplant center at Cleveland Clinic Abu Dhabi. Cleveland Clinic Abu Dhabi, which began clinical operations in early 2015, was established as a partnership between Mubadala Healthcare, Abu Dhabi, and Cleveland Clinic Foundation in Cleveland, Ohio. A meticulous and thoughtful collaborative approach, which began with identifying key operational needs, resulted in the establishment of transplant services within 2.5 years with the establishment of Cleveland Clinic Abu Dhabi. The first multi-organ procurement and transplant from a brain-dead donor in the UAE occurred at Al Qassimi Hospital in Sharjah on July 15, 2017 [42]. Also noteworthy was a regional organ sharing agreement with SCOT that enabled the utilization of deceased donor grafts for potential recipients in Saudi Arabia while awaiting full operational readiness for thoracic and LT at Cleveland Clinic Abu Dhabi. The overall organ donation rate remains low in terms of the number of organs recovered (3.66) and transplanted (3.57) per donor.

"Shortage of deceased donors remains one of the primary challenges facing the transplant community in the UAE. This mandated establishment of LDLT to complement ongoing efforts to improve DDLT. An extensive collaborative effort, with Cleveland Clinic’s main campus in Cleveland, Ohio, resulted in the first successful LDLT in the UAE on July 29, 2018. Since that time, an additional 13 LDLTs were performed (overall: four right lobe and ten left lobe grafts) over the past year and a half [42]."

Beware survivorship bias in advice on science careers

 Here's a 'career column' from Nature, with advice that I think academic advisors should keep in mind, especially in view of the growing number of attractive non-academic options for some kinds of Ph.D.s

Beware survivorship bias in advice on science careers. For objective careers advice, talk to those who left science as well as those who stayed.  by Dave Hemprich-Bennett , Dani Rabaiotti & Emma Kennedy

"A major flaw in much scientific and academic career advice is survivorship bias. This is a common logical error, involving drawing conclusions based on those who have ‘survived’ a process — and are thus more visible than those who did not. In the case of science careers advice, the bias arises because those who manage to stick to their chosen career path are there to advise the next generation of researchers on how to stay in their field.

...

"

Doctors and guns

 Americans are divided about  guns, and so are American doctors. While the American Medical Association regards guns as a public health crisis (https://www.ama-assn.org/press-center/press-releases/ama-calls-gun-violence-public-health-crisis), a recent survey of the American College of Surgeons reveals that many surgeons are gun owners who store loaded guns unlocked at home.

Firearm Storage Practices of US Members of the American College of Surgeons  by Brendan T.CampbellMD, MPH, FACS, Deborah A.KuhlsMD, FACS, Cynthia L.TalleyMD, FACS, Eileen M.BulgerMD, FACS, Ronald M.StewartMD, FACS, Journal of the American College of Surgeons, Volume 233, Issue 3, September 2021, Pages 331-336  ttps://doi.org/10.1016/j.jamcollsurg.2021.05.024

Background: As a part of its firearm injury prevention action plan, the American College of Surgeons (ACS) surveyed the entire US ACS membership regarding individual members' knowledge, experience, attitudes, degree of support for ACS Committee on Trauma (COT) firearm programs, and degree of support for a range of firearm injury prevention policies. This survey included questions regarding members' prevalence of firearm ownership, type of firearm(s) owned, type of firearm(s) in the home, personal reasons for firearm ownership, and methods of firearm/ammunition storage.

...

Conclusions: A significant percentage of ACS members keep firearms in their home, and nearly one-third store firearms in an unlocked and loaded fashion. Safe storage is a basic tenet of responsible firearm ownership. These data present opportunities for engaging surgeons in efforts to improve safe firearm storage.

HT: Irene Wapnir

Stanford celebrates Irene Lo

 Stanford's School of Engineering celebrates Irene Lo, in an interview and video:

"Engineer Irene Lo studies markets, but not traditional marketplaces based in cash.

Instead, she studies markets for goods/resources that place a high value on social goods like diversity, fairness and equity.

Thus, Lo came to help San Francisco create an algorithm to assign kids more fairly to public schools across geographic, social, racial and economic boundaries. As it turns out, math is just the first step. The most challenging part was getting families to trust in the system, begetting a multi-year community engagement effort.

Lo is now turning her attention to other markets with social impact, like her work on the system that places medical students in residency programs across the country or one trying to make the palm oil supply chain fairer for farmers.

Listen in as Irene Lo explains the changing face of markets to host Russ Altman in this episode of Stanford Engineering’s The Future of Everythingpodcast. Listen and subscribe here."

Muriel Niederle wins the 2021 Oskar Morgenstern Medal

 Oskar Morgenstern medal for Muriel Niederle, September 24, 2021

Muriel Niederle from Stanford University is this year's winner of the Oskar Morgenstern Medal. (© Manuel Amador)

"The Stanford professor receives the fifth Oskar Morgenstern medal

"The Faculty of Economics will award the Oskar Morgenstern Medal for the fifth time on October 7, 2021. This year's winner is Muriel Niederle, Levin Professor at Standford University and a leading expert in experimental economics and gender differences in competitive behavior in the labor market.

"Muriel Niederle is a Levin Professor in the School of Humanities in the Economics Department at Stanford University, California, and a leading global expert in experimental economics and market design. With her research on gender differences in competitive situations, Niederle made a significant contribution to the discussion about application behavior on the labor market. For her extensive research, Muriel Niederle, who studied at the University of Vienna and did her doctorate at Harvard, was awarded the Oskar Morgenstern Medal for outstanding research achievements in economics.

"Niederle's experiments on gender differences in competitive behavior are known internationally beyond the scientific community: Why women negotiate differently and what effects this behavior shows on the labor market, for example in salary negotiations, reported on, among others, by the Wall Street Journal, Forbes Magazine and The Atlantic. As one of the leading experts on gender equality and funding issues, Niederle is a sought-after speaker at international meetings and conferences. Her most cited works to date deal with norms of gender competition, such as "Do Women Shy away from Competition? Do Men Compete too Much?" (2007) in cooperation with Lise Vesterlund and "Performance in competitive environments: Gender differences" (2003) in cooperation with Uri Gneezy and Aldo Rustichini.

"The research focus on market design is dedicated to the question of how problems in non-self-regulating markets can be solved. Muriel Niederle carries out extensive studies and experiments in this area, for example on "Signaling in Matching Markets", a technique that is intended to bring companies and suitable applicants together more quickly.

"Muriel Niederle currently teaches at Stanford University in the fields of Experimental and Behavioral Economics and Gender.

"About the Oskar Morgenstern medal

"The Faculty of Economics is committed to conducting research at the highest level and promoting the reputation of top international research: The Oskar Morgenstern Medal, named after Oskar Morgenstern, co-founder of game theory and until 1938 professor at the University of Vienna, was awarded the title in 2013 Honoring the great Austrian economist and launched to celebrate the 250th anniversary of the faculty. The previous winners are Roger B. Myerson (2013), Robert F. Engle (2015), Ernst Fehr (2017) and Sir Christopher A. Pissarides (2019). The medal is endowed with 10,000 euros and is awarded by the faculty every two years.

"Martin Kocher, Federal Minister of Labor, will present the award with Dean Gerhard Sorger at the award ceremony.

"Awarding of the Oskar-Morgenstern-Medal and subsequent Celebratory Speech.  Date: Thursday, October 7, 2021, 10:00 am - 11:30 am  Location: Skylounge (12th floor), Oskar-Morgenstern-Platz 1, 1090 Vienna

"The event is due to of the Covid-19 measures take place on a small scale and by prior arrangement. Interested parties can be there via live stream: oskar-morgenstern-medaille.univie.ac.at/

******

And here's Muriel's webpage: Muriel Niederle

The Transplantation Society reaffirms the value of organ donation and transplantation, even for the poor

 You wouldn't think it would be news that TTS, The Transplantation Society, felt that transplantation is valuable for patients who need it, and would "stand against any form of barriers in access, ... particularly that related to gender, race, religion and income."  

But I think their statement yesterday to that effect, below, may be a reversal of the position adopted by some previous presidents of TTS, who, in arguing against black markets run by criminals, also argued that citizens of poor countries should be denied access to kidney exchange, i.e. that kidney exchange is repugnant when offered to poorer patients.

Here is the new statement (and I include links to some history  below it.)

 A Reaffirmation of Organ Donation (The Tribune Pulse, September 23, 2021)*

"Recent events call for a reaffirmation of essential values held by the worldwide community of transplant providers.

"Indeed, in this period when inequities in access to healthcare are stretched and emphasised, we feel compelled to highlight the universal value of organ donation and the immense success achieved by transplantation. Donation implies generosity and solidarity, and should take place daily, routinely and peacefully around the globe regardless of age, gender, race, education or income of donors. This Gift of Life is gratefully accepted by recipients in dire need of an organ to continue to live regardless of their age and gender, among others. International Medical Societies representing Transplantation Professionals across the globe support and nurture diversity and inclusion among their members, fostering education, and stand against any form of barriers in access, knowledge, transition and required training around the "Gift of Life", particularly that related to gender, race, religion and income. We embrace a call of action to support equitable access to transplantation for all patients with end-stage organ diseases, and the value of gender and race equality in access to education and career development in the diverse fields of transplant healthcare professions."

That sounds like a statement we can all support.

But those of you who have been following how Global Kidney Exchange can remove financial barriers to transplantation know that it has met with considerable opposition to allowing citizens of middle and low income countries access kidney exchange. 

Here's the original article on GKE:

Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation
by M. A. Rees, T. B. Dunn, C. S. Kuhr, C. L. Marsh, J. Rogers, S. E. Rees, A. Cicero, L. J. Reece, A. E. Roth, O. Ekwenna, D. E. Fumo, K. D. Krawiec, J. E. Kopke, S. Jain, M. Tan, S. R. Paloyo
American Journal of Transplantation, Volume 17, Issue 3 March 2017, Pages 782–790

And here is a letter from two former TTS presidents saying that GKE is essentially organ trafficking…

Opposition to Irresponsible Global Kidney Exchange

Francis L. Delmonico and Nancy L. Ascher

For a history lesson, see e.g.

Tuesday, September 12, 2017

Global kidney exchange and repugnance in the AJT: comments and replies

Monday, December 18, 2017

More on the endorsement of Global Kidney Exchange by the ASTS

Monday, December 25, 2017

Three stories of kidney donations (and one of a grinch that wants to limit them)

Monday, January 29, 2018

Italy recommends Global Kidney Exchange to the World Health Organization

Tuesday, November 20, 2018

Global kidney exchange celebrated together with the Declaration of Istanbul, in the AJT

Thursday, October 31, 2019

Global Kidney Exchange in the Lancet, by Minerva, Savulescu and Singer

Thursday, January 2, 2020

Global kidney exchange: continued controversies, perhaps moving towards resolution

* It looks like the statement of reaffirmation of organ donation may have originated with the International Liver Transplant Society, which has a Sept. 20th version, endorsed by many sister societies, here: https://ilts.org/news/reaffirmation-of-organ-donation/ 

Police assignments by seniority in Chicago

 Here's a recent NBER working paper reporting a study of the assignment of police officers in Chicago, where some officers can choose to transfer to newly vacant positions, with priority determined by seniority. The resulting allocation reveals that more senior officers move to assignments with lower levels of violent crime.

Police Officer Assignment and Neighborhood Crime  by Bocar Ba, Patrick Bayer, Nayoung Rim, Roman Rivera & Modibo Sidibé  WORKING PAPER 29243, DOI 10.3386/w29243,  September 2021

Abstract: We develop an empirical model of the mechanism used to assign police officers to Chicago districts and examine the efficiency and equity of alternative allocations. We document that the current bidding process, which grants priority based on seniority, results in the assignment of more experienced officers to less violent and high-income neighborhoods. Our empirical model combines estimates of heterogeneous officer preferences underlying the bidding process with causal estimates of the effects of officer experience on neighborhood crime. Equalizing officer seniority across districts would reduce violent crime rate by 4.6 percent and significantly decrease inequality in crime, discretionary arrests, and officer use of force across neighborhoods. Moreover, this assignment can be achieved in a revenue-neutral way while resulting in small welfare gains for police officers, implying that it is more equitable and efficient.

Congratulations to 51 new Econometric Society Fellows of 2021

 This year there are 51 new Fellows of the Econometric Society:

Congratulations to our 2021 Fellows  

Jaap Abbring, Tilburg University

Chunrong Ai, Chinese University of Hong Kong, Shenzhen

Ufuk Akcigit, University of Chicago

Simon Board, University of California, Los Angeles

Antonio Cabrales, Universidad Carlos III, Madrid

Arnaud Costinot, Massachusetts Institute of Technology

Peter Cramton, University of Cologne and University of Maryland (Emeritus)

Stefano Dellavigna, University of California, Berkeley

Prosper Dovonon, Concordia University, Montreal

Christian Dustmann, University College London

Graham Elliot, University of California, San Diego

Marcella Eslava, Universidad de los Andes

Armin Falk, University of Bonn

Oded Galor, Brown University

Yuriy Gorodnichenko, University of California, Berkeley

Veronica Guerrieri, University of Chicago

Luigi Guiso, Einaudi Institute for Economics and Finance

Bard Harstad, University of Oslo

Erik Hurst, University of Chicago

Patrick Kline, University of California, Berkeley

Fuhito Kojima, University of Tokyo

Botond Koszegi, Central European University

Rim Lahmandi-Ayed, University of Carthage

John Leahy, University of Michigan

Sydney Ludvigson, New York University

Ulrike Malmendier, University of California, Berkeley

Ramon Marimon, European University Institute

Alexandre Mas, Princeton University

Atif Mian, Princeton University

Magne Mogstad, University of Chicago

Benjamin Moll, London School of Economics

Sendhil Mullainathan, University of Chicago

Victor Murinde, SOAS University of London

Emi Nakamura, University of California, Berkeley

Volker Nocke, University of Mannheim

Nathan Nunn, Harvard University

Rohini Pande, Yale University

Bruce Preston, University of Melbourne

James Robinson, University of Chicago

Christina Romer, University of California, Berkeley

Antoinette Schoar, Massachusetts Institute of Technology

Matthew Shum, California Institute of Technology

Rohini Somanathan, Delhi School of Economics and University of Gothenberg

Stefanie Stantcheva, Harvard University

Wing Suen, University of Hong Kong

Balazs Szentes, London School of Economics

Silvana Tenreyro, London School of Economics

Aleh Tsyvinski, Yale University

Nicolas Vieille, HEC, Paris

Ebonya Washington, Yale University

Ekaterina Zhuravskaya, Paris School of Economics

 The Society is grateful for the work of its 2021 Fellows Nominating Committee consisting of Dirk Bergemann (Chair), Xiaohong Chen, Itzhak Gilboa, Kate Ho, Dilip Mookherjee, Monika Piazzesi, and Hélène Rey. 

Publication Date: Wednesday, September 22, 2021