A naturally occurring deceased-donor-initiated kidney exchange chain, by Maghen and Veale

 Here's an interesting case report, from the innovative UCLA transplant center, about a kidney exchange chain actually, if not officially, initiated by a deceased donor.

With “reverse engineering” were some living donor kidney chains in actuality triggered by deceased donors?  by Ariella Maghen and Jeffrey Veale, Clinical Transplantation, First published: 21 September 2021 https://doi.org/10.1111/ctr.14491

"Mr. M is a 58-year-old polycystic kidney disease patient waiting for a kidney transplant in the United States (US). Although his wife Mrs. M offered to donate her kidney to him, they were not a compatible match. While waiting to be “exchanged or swapped” with another donor/recipient pair facilitated by the National Kidney Registry (NKR), Mr. M received a rare offer for a “perfectly-matched” (zero-mismatch) deceased donor (DD) kidney. Only 5% of candidates receive a perfectly matched kidney from a DD; Mr. M accepted the offer and underwent transplantation in February 2020. Currently, his allograft is functioning beautifully, and he states never feeling better. 

"One may think Mrs. M feels relief now and that she is “off-the-hook” to donate. But au contraire as she has completed the extensive donor evaluation and remains in the mindset to donate. Mrs. M's gratitude towards the DD family's gift to her husband motivated her to “pay-their-generosity-forward” and now donate her kidney.

"Mrs. M's donation performed on October 21, 2020, brings greater awareness to the concept of a DD triggered kidney chain, a relatively novel phenomenon in the United States.

...

"This case elucidates how transplant chains, believed to be initiated by non-directed living donors, when reverse-engineered may in actuality have been triggered by DDs who were at the pole position. Although this may be one of the first reported cases, it is possible that other transplant centers have been encouraging the allocation of donors in this fashion. There are likely more living donors who may still want to donate their kidney even after their intended recipient received a DD transplant via “zero-mismatch” or “high-PRA” offers."

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Italy seems to be among the first places to formally follow up on the idea of deceased donor chains. See:

Transplant InternationalVolume 33, Issue 10 p. 1177-1184, Kidney exchange strategies: new aspects and applications with a focus on deceased donor-initiated chains, by Lucrezia Furian,Antonio Nicolò,Caterina Di Bella,Massimo Cardillo,Emanuele Cozzi,Paolo Rigotti  First published: 09 August 2020  https://doi.org/10.1111/tri.13712

Summary: Kidney paired donation (KPD) is a valuable way to overcome immunological incompatibility in the context of living donation, and several strategies have been implemented to boost its development. In this article, we reviewed the current state of the art in this field, with a particular focus on advanced KPD strategies, including the most recent idea of initiating living donor (LD) transplantation chains with a deceased donor (DD) kidney, first applied successfully in 2018. Since then, Italy has been running a national programme in which a chain-initiating kidney is selected from a DD pool and allocated to a recipient with an incompatible LD, and the LD’s kidney is transplanted into a patient on the waiting list (WL). At this stage, since the ethical and logistic issues have been managed appropriately, KPD starting with a DD has proved to be a feasible strategy. It enables transplants in recipients of incompatible pairs without the need for desensitizing and also benefits patients on the WL who are allocated chain-ending kidneys from LDs (prioritizing sensitized patients and those on the WL for longer).

...

"Melcher et al. [10] suggested merging DD programmes with KPD programmes in 2016, an idea explored more recently in a concept paper issued by the Organ Procurement and Transplantation Network (OPTN) [11]. 

...

10 M. L. Melcher, J. P. Roberts, A. B. Leichtman, A. E. Roth, M. A. Rees Utilization of deceased donor kidneys to initiate living donor chains. Am J Transplant 2016; 16: 1367.

11Rock Haynes C, Leishman R. Allowing deceased donor-initiated kidney paired donation (KPD) chains. OPTN/UNOS Kidney Transplantation Committee. Concept Paper; July 31–October 2, 2017.

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Earlier:

Tuesday, August 7, 2018

Deceased donor chains: Market design language is entering transplantation

Monday, April 11, 2016

Using deceased donor kidneys to start living donor kidney exchange chains

Online and Matching-Based Market Design (forthcoming in 2022), edited by Echenique, Immorlica, and Vazirani

 What to read in 2022? Here's a teaser...

Online and Matching-Based Market Design, forthcoming in 2022 from Cambridge University Press

Editors: Federico Echenique, Nicole Immorlica, Vijay V. Vazirani  

With a Foreword by Alvin E. Roth

The publisher's leaflet describes the book this way:

"The field of matching markets is, due to a unique confluence of circumstances, at the same time mature and yet in its infancy. Its birth goes back to the seminal 1962 paper of Gale and Shapley on stable matching. Over the decades, this field has become known for its highly successful applications, having economic as well as sociological impact. Its recent resurgence, with the revolutions of the Internet and mobile computing, has opened up altogether new avenues of research and novel, path-breaking applications. The distinctive feature of this book lies in treating this field in its true interdisciplinary spirit --- the field veritably sits at the intersection of economics, computer science, operations research and discrete mathematics, and this viewpoint has already led to a sequence of fundamental research results. Comprised of chapters written by over 50 top researchers, it still has the clarity, cohesiveness and organization of a textbook."

CONTRIBUTORS: Atila Abdulkadiroglu, Nikhil Agarwal, Samson Alva, Itai Ashlagi, Mariagiovanna Baccara, Gabriel Carroll, Hector Chade, Jiehua Chen, Yan Chen, Nikhil Devanur, Federico Echenique, Lars Ehlers, Matthew Elliott, Michal Feldman, Zhe Feng, Tamas Fleiner, Alfred Galichon, Renato Gomes, Aram Grigoryan, Guillaume Haeringer, Hanna Halaburda, John Hatfield, Zhiyi Huang, Nicole Immorlica, Ravi Jagadeesan, Philipp Kircher, Bettina Klaus, Robert Kleinberg, Scott Kominers, Soohyung Lee, Jacob Leshno, Shengwu Li, Irene Lo, Brendan Lucier, David Manlove, Aranyak Mehta, Paul Milgrom, Jamie Morgenstern, Thanh Nguyen, Alexandru Nichifor, Michael Ostrovsky, David Parkes, Alessandro Pavan, Marek Pycia, Aaron Roth, Bernard Salanie, Aleksandrs Slivkins, Paulo Somaini, Sai Srivatsa Ravindranath, Eduard Talamas, Alexander Teytelboym, Thorben Tröbst, Vijay Vazirani, Andrew Vogt, Rakesh Vohra, Alexander Westkamp, Leeat Yariv

Oocyte ethics: financial compensation for human eggs

 New ethical guidance on egg donation, following an antitrust settlement regarding price fixing.

Financial compensation of oocyte donors: an Ethics Committee opinion.  by The Ethics Committee of the American Society for Reproductive Medicine, American Society for Reproductive Medicine, Birmingham, Alabama, Fertility and Sterility® Vol. 116, No. 2, August 2021

"Financial compensation of women donating oocytes for reproductive or research purposes is justified on ethical grounds and should acknowledge the time, inconvenience, and discomfort associated with screening, ovarian stimulation, oocyte retrieval, and postretrieval recovery and not vary according to the planned use of the oocytes or the number or quality of oocytes retrieved. This document replaces the document of the same name published in 2016. (Fertil Steril
2021;116:319-25. 2021 by American Society for Reproductive Medicine.)

"ESSENTIAL POINTS:

Financial compensation of women donating oocytes for reproductive or research purposes is justified on ethical grounds.

Compensation is in accord with principles of fairness, occurring within the framework of a professional relationship.

Compensation should acknowledge the donor’s time, inconvenience, and discomfort associated with screening, ovarian stimulation, oocyte retrieval, and postretrieval recovery. Compensation should not vary according to the planned use of the oocytes (reproductive or research) or the number or quality of oocytes retrieved.

Compensation should be fair and should not be an undue enticement that negatively impacts a donor’s ability to make an informed decision about the donation process and the risks involved with donation.

All oocyte-donor recruitment programs, including agencies, egg banks, and fertility clinics, should individually adopt and implement effective processes for information disclosure and counseling in order to promote informed decision-making by prospective donors.

Treating physicians owe the same professional duties to oocyte donors as to all other patients.

Programs should ensure equitable and fair provision of services to oocyte donors.

Programs should individually adopt and disclose policies regarding coverage of an oocyte-donor’s medical costs should she experience complications associated with the oocyte retrieval process."

...

" Because the burdens of donation are similar regardless of the ultimate use of the oocytes, compensating donors of oocytes for research is also ethically justified. There has been some movement at the state level to permit compensation to research donors, which stands in contrast to the approach articulated by the National Academy of Sciences with respect to compensation for oocyte donation for stem-cell research (21). In 2009, New York became the first US state to implement a policy permitting researchers to use public funds to reimburse women who donate oocytes directly and solely for stem-cell research, not only for the woman’s outof-pocket expenses, but also for the time, burden, and discomfort associated with the donation process (22). A law enacted in California in 2019 likewise requires women who provide human oocytes for research to be compensated for their time, discomfort, and inconvenience in the same manner as other research subjects, removing a previous prohibition of compensation of research donors (11).

...

"It is ethically permissible for a program to refuse to accept a prospective oocyte donor if they become aware that a prospective oocyte recipient or recruiting agency has offered gifts or payments that the program, in the exercise of its own ethical judgment, believes compromise the donor’s free choice or are otherwise ethically inappropriate. Programs should not assume that known donors, such as family or friends, are not being financially compensated. In one study of recipients using both known and anonymous donors, 19 of 20 of the known donors had been compensated, and there were no differences in the amounts provided to known and anonymous donors (27).

...

"This report was developed under the direction of the Ethics Committee of the American Society for Reproductive Medicine (ASRM) as a service to its members and other practicing clinicians. Although it reflects appropriate management of a problem encountered in the practice of reproductive medicine, it is not intended to be the only approved standard of practice or to dictate an exclusive course of treatment. Other plans of management may be appropriate, taking into account the needs of the individual patient, available resources, and institutional or clinical practice limitations. 

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

That last paragraph may be a bow to the antitrust settlement discussed in the post below:

Friday, May 3, 2019

Donating eggs for fertility: an update

Can it be made safe for drug users to call for help when a friend overdoses?

There are lots of ways that drug laws contribute to the design of the black market for drugs, and the behavior of its participants. Here's a recent post from the blog Bill of Health:

New Data Highlights Complexity of Good Samaritan Overdose Law Landscape, By David Momjian

 "To combat the rising death toll from drug overdoses, 47 state legislatures and the District of Columbia have passed Good Samaritan laws (GSLs) to protect bystanders from criminal prosecution if they call for medical assistance during a drug overdose. Bystanders to a drug overdose are often worried that by calling for help, they could be arrested for drug possession or evicted by the police, who often arrive first at the scene of a 911 call, even if it is a medical emergency.

A new dataset built by the Center for Public Health Law Research at Temple University’s Beasley School of Law and funded by Vital Strategies, covers the evolution of GSLs in the United States from January 1, 2007, to June 1, 2021."

Drug overdose deaths between April 2020 and 2021 reach 100,000

 The Washington Post has the story:

100,000 Americans died of drug overdoses in 12 months during the pandemic  By Dan Keating and Lenny Bernstein

"The U.S. drug epidemic reached another terrible milestone Wednesday when the government announced that more than 100,000 people had died of overdoses between April 2020 and April 2021. It is the first time that drug-related deaths have reached six figures in any 12-month period.

...

"The new data shows there are now more overdose deaths from the illegal synthetic opioid fentanyl than there were overdose deaths from all drugs in 2016."

We should be thinking about harm reduction...

John Morgan (1967-2021)

 Here's his obituary from Berkeley Haas, that I learned of only recently:

‘A giant of a person’: Economist John Morgan dies at 53 OCTOBER 29, 2021| BY LAURA COUNTS

"Professor John Morgan, an economist who found elegant new ways to analyze the world through the lens of game theory, and whose popular classes and sage mentorship made a deep impression on his students, passed away Oct. 6 at age 53. He died peacefully at his Walnut Creek home.

"During his nearly two decades at Berkeley Haas, Morgan left his mark through his prolific and wide-ranging research, his unconventional teaching that drew on strategy games he invented, and his generous leadership. He had been struggling with a painful autoimmune disease that put him on medical leave, but he continued with his research and had planned to resume teaching in the spring."

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

A paper of his that springs to mind is this one:

... plus shipping and handling: Revenue (non) equivalence in field experiments on ebay, by Tanjim Hossain and John Morgan, 2006, The B.E. Journal of Economic Analysis & Policy, https://doi.org/10.2202/1538-0637.1429

Abstract: Many firms divide the price a consumer pays for a good into two pieces---the price for the item itself and the price for shipping and handling. With fully rational customers, the exact division between the two prices is irrelevant---only the total price matters. We test this hypothesis by selling matched pairs of CDs and Xbox games in a series of field experiments on eBay. In theory, the ending auction price should vary inversely with the shipping charge to leave the total price paid constant. Contrary to the theory, we find that charging a high shipping cost and starting the auction at a low opening price leads to higher numbers of bidders and higher revenues when the shipping charge is not excessive. We show that these results can be accounted for by boundedly rational bidding behavior such as loss-aversion with separate mental accounts for different attributes of the price or disregard for shipping costs.

Here's his Google Scholar page: John Morgan

Freakonomics MD on deceased donor organs for transplants

 Freakonomics MD has a podcast focusing on the scarcity of deceased donor kidneys for transplant, and why recovered organs are sometimes discarded. They interview (separately) Dr. Sumit Mohan at Columbia, and me. (I was in fact interviewed by Jessica Wapner, not by the narrator, Dr. Bapu Jena, using a fancy microphone which they FedExed to me beforehand and I FedExed back to them afterwards...so my snippets probably sound like me...)

You can listen to it right below, or at the link...

x  x

Why Do So Many Donated Kidneys End Up in the Trash? (Freakonomics, M.D. Ep. 11)

November 11, 2021 @ 11:00pm

by Dr. Bapu Jena
Produced by Jessica Wapner

  

LISTEN NOW:

Every year, thousands of people in the U.S. die while they’re waiting for a new kidney, yet thousands of available organs get thrown away. Bapu talks to a kidney doctor and an economics Nobel laureate about why this happens and how the system could improve.

Follow Freakonomics, M.D. on Apple Podcasts, Spotify, Stitcher, or wherever you get your podcasts.

Market design course for health policy and medical students, at Stanford, taught by Alex Chan and Kurt Sweat

 Starting tomorrow, a short course in market design:

BIOS 203, Fall 2021: Market Design and Field Experiments for Health Policy and Medicine 

Primary Instructor: Alex Chan chanalex@stanford.edu | Office Hours: By appointment

Secondary Instructor: Kurt Sweat kurtsw@stanford.edu | Office Hours: By appointment

Description. Market design is an emerging field in economics, engineering and computer science about how to organize systems to allocate scarce resources. In this course, we study (1) the theory and practice of market design in healthcare and medicine, and (2) methods to evaluate the impact of such designs. Students will be provided with the necessary tools to diagnose the problems in markets and allocation mechanisms that render them inefficient, and subsequently develop a working toolbox to remedy failed markets and finetune new market and policy designs.

With a practical orientation in mind, we will learn how to construct rules for allocating resources or to structure successful marketplaces through successive examples in healthcare and medicine: medical residency matching, kidney exchange, allocation of scarce medical resources like COVID vaccine and tests, medical equipment procurement, online marketplace for doctors, and, if time permits, reward system for biopharmaceutical innovation. Guest lectures by practicing market designers and C-suite healthcare executives (CEO, CFO) would feature in the course as well.

An important goal of the class is to introduce you to the critical ingredients to a successful design: a solid understanding of institutions, grasps of economic theory, and well-designed experiments and implementation. In the final sessions, students will also learn how to design and deploy one of the most powerful tools in practical market design: A/B testing or randomized field experiments. These techniques are widely used by tech companies like UBER, Amazon, eBay, and others to improve their marketplaces.

At the end of the course, students should have acquired the necessary knowledge to become an avid consumer and user, and potentially a producer, of the market design and field experimental literature (recognized by 4 recent Nobel Prizes in Economics: 2007/2012/2019/2020).

Time & Location.

● Tue, Thu 6:30 PM - 8:00 PM (beginning November 16, 2021) at Encina Commons Room 119

Course Webpage. ● https://canvas.stanford.edu/courses/145148

Schedule and Readings

(* required readings, others are optional)

Session 1. Market design and Marketplaces – November 16

1. * Roth, A. E. (2007). The art of designing markets. harvard business review, 85(10), 118.

2. Kominers, S. D., Teytelboym, A., & Crawford, V. P. (2017). An invitation to market design. Oxford Review of Economic Policy, 33(4), 541-571.

3. Roth, A. E. (2002). The economist as engineer: Game theory, experimentation, and computation as tools for design economics. Econometrica, 70(4), 1341-1378

Session 2. Matching Markets: Medical Residents and the NRMP – November 18

1. * Chapter 1 in Gura, E. Y., & Maschler, M. (2008). Insights into game theory: an alternative mathematical experience. Cambridge University Press.

2. * Fisher, C. E. (2009). Manipulation and the Match. JAMA, 302(12), 1266-1267.

3. * National Resident Matching Program. (2021). Feasibility of an Early Match NRMP Position Statement

4. Roth, A. E., & Peranson, E. (1997). The effects of the change in the NRMP matching algorithm. JAMA, 278(9), 729-732.

5. Gale, D., & Shapley, L. S. (1962). College admissions and the stability of marriage. The American Mathematical Monthly, 69(1), 9-15.

Session 3. Kidney Exchange and Organ Allocation – November 30

1. * Wallis, C. B., Samy, K. P., Roth, A. E., & Rees, M. A. (2011). Kidney paired donation. Nephrology Dialysis Transplantation, 26(7), 2091-2099.

2. * Chapter 3 in Roth, A. E. (2015). Who gets what—and why: The new economics of matchmaking and market design. Houghton Mifflin Harcourt.

3. Gentry, S. E., Montgomery, R. A., & Segev, D. L. (2011). Kidney paired donation: fundamentals, limitations, and expansions. American journal of kidney diseases, 57(1), 144-151.

4. Salman, S., Gurev, S., Arsalan, M., Dar, F., & Chan, A. Liver  Exchange: A Pathway to Increase Access to Transplantation.

5. Sweat, K. R. Redesigning waitlists with manipulable priority: improving the heart transplant waitlist.

6. Agarwal, N., Ashlagi, I., Somaini, P., & Waldinger, D. (2018). Dynamic incentives in waitlist mechanisms. AEA Papers & Proceedings, 108, 341-347.

Session 4. 1 st Half: Repugnance as a Constraint on Markets – December 2

1. * Roth, A. E. (2007). Repugnance as a Constraint on Markets. Journal of Economic perspectives, 21(3), 37-58.

2. * Minerva, F., Savulescu, J., & Singer, P. (2019). The ethics of the Global Kidney Exchange programme. The Lancet, 394(10210), 1775-1778.

3. Chapter 11 in Roth, A. E. (2015). Who gets what—and why: The new economics of matchmaking and market design. Houghton Mifflin Harcourt.

2 nd Half: Market Design and Allocation during COVID-19 – December 2

1. * Emanuel, E. J., Persad, G., Upshur, R., Thome, B., Parker, M., Glickman, A., ... & Phillips, J. P. (2020). New England Journal of Medicine. Fair allocation of scarce medical resources in the time of Covid-19.

2. Piscitello, G. M., Kapania, E. M., Miller, W. D., Rojas, J. C., Siegler, M., & Parker, W. F. (2020). Variation in ventilator allocation guidelines by US state during the coronavirus disease 2019 pandemic: a systematic review. JAMA network open, 3(6), e201

3. Schmidt, H., Pathak, P., Sönmez, T., & Ünver, M. U. (2020). Covid-19: how to prioritize worse-off populations in allocating safe and effective vaccines. British Medical Journal, 371.

4. Schmidt, H., Pathak, P. A., Williams, M. A., Sonmez, T., Ünver, M. U., & Gostin, L. O. (2020). Rationing safe and effective COVID-19 vaccines: allocating to states proportionate to population may undermine commitments to mitigating health disparities. Ava

5. Neimark, J. (2020). What is the best strategy to deploy a COVID-19 vaccine. Smithsonian Magazine.

Session 5. 1 st Half: Auction Design and Procurement in Medicine – December 7

1. * The Committee for the Prize in Economic Sciences in Memory of Alfred Nobel. (2020). Improvements to auction theory and inventions of new auction formats. Scientific Background on the Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel 20

2. * Song, Z., Cutler, D. M., & Chernew, M. E. (2012). Potential consequences of reforming Medicare into a competitive bidding system. Jama, 308(5), 459-460.

3. Newman, D., Barrette, E., & McGraves-Lloyd, K. (2017). Medicare competitive bidding program realized price savings for durable medical equipment purchases. Health Affairs, 36(8), 1367-1375.

4. Cramton, P., Ellermeyer, S., & Katzman, B. (2015). Designed to fail: The Medicare auction for durable medical equipment. Economic Inquiry, 53(1), 469-485.

5. Ji, Y. (2019). The Impact of Competitive Bidding in Health Care: The Case of Medicare Durable Medical Equipment.

6. Thaler, R. H. (1988). Anomalies: The winner's curse. Journal of economic perspectives, 2(1), 191-202.

7. Chapter 2 in Haeringer, G. (2018). Market design: auctions and matching. MIT Press.

2 nd Half: (GUEST LECTURE) Ralph Weber, CEO, MediBid Inc. on “The Online Marketplace for Medicine” – December 7

Session 6. A/B Testing and Field Experiments to Test Designs – December 9

1. * Chapters 1, 4 in List, John. (2021). A Course in Experimental Economics (unpublished textbook, access on course website)

2. * Gallo, A. (2017). A refresher on A/B testing. Harvard Business Review, 2-6.

3. Chan, A. (2021). Customer Discrimination and Quality Signals – A Field Experiment with Healthcare Shoppers.

4. Kessler, J. B., Low, C., & Sullivan, C. D. (2019). Incentivized resume rating: Eliciting employer preferences without deception. American Economic Review, 109(11), 3713-44.

5. Chapters 3, 5, 6, 7, 8 in List, John. (2021). A Course in Experimental Economics (unpublished textbook, access on course website)

6. The Committee for the Prize in Economic Sciences in Memory of Alfred Nobel. (2019). Understanding development and poverty alleviation. Scientific Background on the Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel 2019.

Bonus Session (optional). (GUEST LECTURE) Donald Lung, CFO, Antengene on “Designing Markets to Access Biopharmaceutical Intellectual Property Across Regulatory Regimes – the Case of China” – Date TBD

Bonus Session (optional). (GUEST LECTURE) TBD – Date TBD

Nervousness and confusion about residency applications

 Medpage Today has the story, which has been active on medical twitter for a while--some residency candidates are finding that their applications are incomplete, and blame the common application service ERAS, which in response reports that incomplete applications are the result of errors by the candidates.

Is ERAS Glitch Impeding Residency Interviews?  — Several students are missing letters of recommendation, but AAMC calls reports "unsubstantiated"

"MedPage Today spoke to several residency applicants who believe they experienced ERAS tech issues when submitting their applications. A majority of these applicants requested anonymity due to fear of retribution.

While many say a potential bug is not surprising, students are frustrated that they cannot pin down when "their documents went missing -- and whether or not it jeopardized their chances of matching with some programs.

"In each case, the glitch is almost identical: an applicant's letters of recommendation (or other documents) were uploaded to ERAS, and the applicant was certain they assigned the right materials to each program before they hit submit. But weeks later, applicants checked the platform to see that these documents had never been assigned nor delivered to the right programs -- rendering their applications incomplete."

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

Related:

Med Students Filed Nearly 70 Residency Applications Each— "I don't think this is sustainable at all" by Amanda D'Ambrosio, MedPage Today October 27, 2021

"Across all medical specialties, this cycle MD applicants submitted an average of 68 applications, DO applicants submitted 92, and international medical graduates submitted 139, according to data provided to MedPage Today by the Association of American Medical Colleges (AAMC).

"Medical graduates applying to orthopedic surgery in the 2022 cycle submitted an average of 88 applications -- the highest across all medical specialities. Candidates to urology, otolaryngology, and dermatology -- some of the most competitive specialties -- all applied to around 80 programs each.

"More than 46,000 medical graduates have applied for the 2022 residency match so far: approximately 23,000 MDs, 8,000 DOs, and 15,000 international graduates. The preliminary data from ERAS -- the centralized system that medical graduates use to apply to residency -- includes all applications submitted through the beginning of October."

Non-fungible tokens (NFTs), in Harvard Business Review, by Kaczynski and Kominers

 Can a new form of property rights created by blockchains also create valuable new kinds of markets? Or even communities?  

How NFTs Create Value, by Steve Kaczynski and Scott Duke Kominers, Harvard Business Review November 10, 2021

Summary.   How much could a cluster of pixels possibly be worth? More pointedly, why is it worth anything at all? The explosion of NFTs and their accompanying marketplaces have left many baffled, incredulous, and deeply skeptical. But while NFTs may be fetching eye-popping, eyebrow-raising valuations, there is a logic to how — and when — they create value. By creating a system of verifiable digital ownership NFTs fundamentally changed the market for digital assets, creating the possibility for new types of transactions. Amidst a flood of new ventures, however, it can be hard to tell which are creating value and which are just riding the hype. The companies that have been most successful on this new frontier have a few things in common: They make meaningful use of the NFT technology itself, leverage a community of users, generate confidence that they can continue executing on the project to maintain ongoing community engagement, offer accessible “on-ramps” for new users, and are able to weather crypto market swings.

...

"Many emerging NFT applications, meanwhile, are seeking to more explicitly blend online NFT ownership with offline use cases. A few restaurants, for example, have started using NFTs for reservations. And the ticketing industry has a major opportunity here: By issuing tickets as NFTs, venues can give a variety of benefits to purchasers, creating more of an incentive to buy, as well as providing the venues an opportunity to collect royalties on secondary sales.

"Other companies are exploring how NFTs could be used in establishing and recording people’s identity and reputation online. MIT recently started offering blockchain-based digital diplomas, which are effectively non-transferable NFTs. Meanwhile, both established players like Facebook (now Meta) and new ventures like POAP and koodos are providing ways for individuals to create and share NFTs around activities, affinities, and interests."

Blockchain job, with Sven Seuken, at Worldcoin

 Sven Seuken, a practical market designer for whom I have great respect, writes to ask that I advertise a job for a market designer.  Here is his email.

"I was wondering if you could advertise a market designer job on your blog. About six months ago, I have joined the Blockchain start-up Worldcoin (https://worldcoin.org/) and am now their Head of Economics and Chief Economist. We already have a team of six economists and computer scientists. But we are currently greatly expanding our team, looking for market designers, crypto economists, experimental economists, statisticians, etc., who are interested in developing practical incentive mechanisms that scale to more than a billion participants of the Worldcoin network. I believe that this is a fantastic opportunity for anyone interested in applying market design in practice. The positions are available on the junior and senior level, and they are available full-time or part-time. Anyone interested can contact me directly, or even better, directly apply here: https://worldcoin.org/job/4111358004

 Thank you very much!

Best,

Sven

 Prof. Dr. Sven Seuken

Head of Computation and Economics Research Group

University of Zurich

 Web: https://www.ifi.uzh.ch/en/ce/people/seuken.html

 Associated Faculty at the ETH AI Center

Co-Director of the Zurich Center for Market Design

Head of Economics and Chief Economist at Worldcoin"

Counterbalancing Learning and Strategic Incentives in Allocation Markets by Kang, Monachou, Koren, and Ashlagi

 Here's a model with a new perspective on deceased organ waiting lists...

Counterbalancing Learning and Strategic Incentives in Allocation Markets by Jamie Kang, Faidra Monachou, Moran Koren, and Itai Ashlagi

Abstract: Motivated by the high discard rate of donated organs in the United States, we study an allocation problem in the presence of learning and strategic incentives.We consider a setting where a benevolent social planner decides whether and how to allocate a single indivisible object to a queue of strategic agents.  The object has a common true quality,  good or bad,  which is ex-ante unknown to everyone.  Each agent holds an informative, yet noisy, private signal about the quality.  To make a correct allocation decision the planner attempts to learn the object quality by truthfully eliciting agents’ signals. Under the commonly applied sequential offering mechanism, we show that learning is hampered by the presence of strategic incentives as herding may emerge. This can result in incorrect allocation and welfare loss. To overcome these issues, we propose a novel class of incentive-compatible mechanisms.  Our mechanism involves a batch-by-batch, dynamicvoting process using a majority rule. We prove that the proposed voting mechanisms improve the probability of correct allocation whenever agents are sufficiently well informed. Particularly, we show that such an improvement can be achieved via a simple greedy algorithm. We quantify the improvement using simulations.

The labor market that is the United States Marine Corps

 Armed forces around the world have some unique labor force problems, since by and large they do no lateral hiring...every senior officer was once a junior officer. (Doctors and lawyers are exceptions in the U.S. services--they can enter at a high rank without having spent years learning when and whom to salute...)  As we start to think about other specialties (e.g. cyber warriors, economic warriors), lateral hiring may become more important.  

A related problem faced by armed forces is retention: if all senior personnel have to be brought up through the system, it's especially costly to lose a (therefore) hard to replace, expensively trained operator.  Intelligent matching of people to positions is important for retention, particularly as they become more senior and have no further military service obligation (i.e. as their private sector opportunities become more salient).

The US Marines are thinking about this, and here's a recent report:

Talent Management 2030 November 2021, Department of the Navy, United States Marine Corps

Here are some highlighted snippets:

"The  core  objectives  of  all  modern  personnel  management  systems  are  to  recruit  individuals  with  the  right  talents,  match  those  talents  to  organizational  needs,  and  incentivize  the  most  talented and high performing individuals to remain with the organization"

"Our modern operational concepts and organizations cannot reach their full warfighting potential without a talent management system that recruits, develops, and retains the right Marines."

"Matching talents to duties maximizes performance."

"Incentives power the system."

"In this current era of heightened global competition, the Marine Corps requires a vehicle for rapidly recruiting mature, seasoned experts. We can no longer afford the cost in time – measured in years, and sometimes decades – to train and educate all our technical leaders, particularly given the extraordinary pace of technological change."

"We should have an open door for exceptionally talented Americans who wish to join the Marine Corps, allowing them to laterally enter at a rank appropriate to their education, experience, and ability."

"For Marines, a talent marketplace will increase available information about billet openings, improve transparency, and provide individuals with far greater influence over their future assignments."

"A talent management system relies on incentives, not coercion. While the needs of the Marine Corps are always paramount, we cannot afford to push the most talented young officers out the door after investing years in their leadership development, education, and training. "

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

Earlier (including some obstacles to implementing effective talent marketplaces):

Tuesday, December 1, 2020

The labor market that is the military: a report from the National Academies of Science, Engineering, and Medicine

Marijuana black markets are coexisting with (poorly designed, over-regulated, highly taxed) legal markets in California

 The Guardian has the story:

California legalized weed five years ago. Why is the illicit market still thriving? by Amanda Chicago Lewis

"Voters passed a law in November 2016 making recreational marijuana legal. But today, the vast majority of the market remains underground – about 80-90% of it, according to experts.

"Because that 2016 law, known as Proposition 64, gave municipalities the power to ban weed as they see fit, the majority of cities and counties still don’t allow the sale of cannabis, inhibiting the growth of the legal market.

"In the places that do allow pot shops and grows, business owners say high taxes, the limited availability of licenses, and expensive regulatory costs have put the legal market out of reach. 

...

"The story of California’s legal weed chaos dates back to 1996, when voters passed a law allowing medical marijuana. At the time, Bay Area Aids activists saw the way pot relieved pain and stimulated hunger among their emaciated and desperately ill friends. That led to a grassroots campaign to get Proposition 215, a measure legalizing the medical use of cannabis, on the California ballot.

"However, Prop 215 only allowed doctors to recommend that patients and their caregivers grow their own weed. Essentially, it legalized a commodity without legalizing the business side of it.

"For the next 20 years, a laissez-faire, gray market for medical marijuana flourished and became entrenched. With doctors’ recommendations for medical marijuana easy and cheap to come by, cannabis entrepreneurs practiced a lucrative form of civil disobedience, opening dispensaries, manufacturing edibles and growing acres of plants that brought in enough money to offset intermittent law enforcement crackdowns. The industry developed protocols to get a business back up and running right after a raid, such as keeping cash offsite and obscuring ownership through a series of management companies.

"If you could withstand the legal uncertainty, it was a good time to make money in marijuana. By 2010, the city of Los Angeles had about 2,000 pot shops illegally selling cannabis. Statewide, the total illicit market surged, causing Mexican cartels to either stop growing weed or to relocate their grows to California.

...

"For a marijuana enterprise today, becoming legal has often meant sacrificing a good deal of profit. Businesses frequently pay an effective tax rate of 70%, in part because they are breaking federal law and therefore aren’t able to take tax deductions, but also because politicians see the industry as a source of tax revenue and set higher rates.

...

"But the longer we allow cannabis to remain state-legal and federally illegal, the harder it will be to fix. Though botching weed legalization sounds like a trivial issue, it intersects with many of the issues that are fundamental to our lives, from criminal justice to public health, gang violence to economic inequality, the opioid crisis to the wellness craze. Cannabis is the second-most-valuable crop in the country, after corn and ahead of soybeans. It’s the most common reason for arrest in America. And despite marijuana’s dubious reputation, research has shown the plant “may have therapeutic potential in almost all diseases affecting humans”.

Approximating large games

One of the big lessons of market design is that market participants may have big strategy sets.  This means that analyzing naturally occurring strategic settings may exceed our ability to model and analyze them as fully specified games.

Here's a paper that explores an interesting, somewhat related idea:

Christian Kroer, Alexander Peysakhovich, Eric Sodomka, Nicolas E. Stier-Moses (2021) Computing Large Market Equilibria Using Abstractions. Operations Research, Articles in Advance 01 Oct 2021, https://doi.org/10.1287/opre.2021.2163

"Abstract. Computing market equilibria is an important practical problem for market design, for example, in fair division of items. However, computing equilibria requires large amounts of information (typically the valuation of every buyer for every item) and computing power. We consider ameliorating these issues by applying a method used for solving complex games: constructing a coarsened abstraction of a given market, solving for the equilibrium in the abstraction, and lifting the prices and allocations back to the original market. We show how to bound important quantities such as regret, envy, Nash social welfare, Pareto optimality, and maximin share/proportionality when the abstracted prices and allocations are used in place of the real equilibrium. We then study two abstraction methods of interest for practitioners: (1) filling in unknown valuations using techniques from matrix completion and (2) reducing the problem size by aggregating groups of buyers/items into smaller numbers of representative buyers/items and solving for equilibrium in this coarsened market. We find that in real data allocations/prices that are relatively close to equilibria can be computed from even very coarse abstractions."

Marilda Sotomayor: a career in matching

 Pesquisa FAPESP has a good interview with Marilda Sotomayor, about her career in game theory, and matching theory in particular, and how she came to work with David Gale.  Google translate does a good job (except that it gives her the pronouns he and his...)

Marilda Sotomayor: Uma pensadora dos jogos, by Yuri Vasconcelos, Pesquisa FAPESP, Edition 309, nov. 2021

[GT: Marilda Sotomayor: A game thinker]

[With] Researcher and mathematician Alvin Roth, with whom he wrote a book in 1990

A step towards kidney exchange in Germany

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

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

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

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

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

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

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

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

HT: Axel Ockenfels

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

First kidney exchange in Hong Kong

 The Standard has the story:

First paired kidney donation in Hong Kong completed successfully,   3 Nov 2021

"The first paired kidney donation has been successfully completed in Hong Kong, with the two patients involved discharged from hospital by the end of September.  

"The Hospital Authority launched the Paired Kidney Donation Pilot Programme in 2018, allowing cross matches between two patients waiting for kidney transplants and their respective family m"embers.  

"The families could not donate a kidney to their own loved ones due to incompatible blood groups or human leucocyte antigens.  

"The first case was successfully matched in June this year, and the two pairs of patients and their families were discharged from the hospital by the end of September. 

...

""The number of successful cadaveric and living kidney transplants is fewer than 80 per year, but the number of people waiting for transplant has reached 2,300," Lee said. "Each of them can only live for an average of 54 months longer if they fail to get a transplant.” 

...

"The team said the biggest challenge was to ensure the operations of both families are carried out at the same time. 

"In addition, to make sure that the patients would not know the identity of the other, there should also be special arrangements for admission registration and their entry into operating theaters. "

Lawsuits involving NKR's kidney exchange contracts

 Kim Krawiec, the Sullivan & Cromwell Professor of Law at the University of Virginia, sheds some light on recent legal exchanges between the kidney exchange nonprofit National Kidney Registry and some of the Transplant Centers that are (or were) members of its network. Both suits (which seem to have been settled out of court) involved the TC's desire to withdraw (or partially withdraw) from NKR's system, and NKR's attempt to charge them $1000/kidney/month in perpetuity (or until they supply the kidneys) for kidneys they received in excess of kidneys they supplied. (In particular, NKR wanted $8000 per month from Colorado forever, or until they supplied 8 kidneys.)  Her post is long and learned, and well worth reading in its entirety, but here are some snippets.

She leads off with this graphic of a judge's gavel hammering a stethoscope

Recent Contract Disputes In The Transplant World November 3, 2021 / By Kimberly Krawiec 

"Readers may be interested in two relatively recent lawsuits involving the National Kidney Registry (NKR) and the University of Colorado Hospital Authority (“UCH,” filed 3/26/21) and the University of Maryland Medical Center (“UMMC”, filed 4/2/2018), respectively. (Citations and links to both lawsuits are at the end of this post)

...

This option to specifically perform is interesting in its own right, and I may say more about it later, but what if a Member Center couldn’t deliver kidneys to the network, say because the UCH kidney transplant program had been closed? Or because they determined that kidney exchange was bad for their patients? In the event that delivering kidneys to NKR is impossible, is a court likely to award NKR these fees into perpetuity – a present value of nearly $5 million? (using an interest rate of 2%, which may understate the amount, given the current low interest rate environment)

"Under the penalty doctrine, NKR would have to describe its loss, and why $1000/kidney/month is a reasonable estimate of it, even if it can’t provide a precise amount. Here, the “in perpetuity” aspect may be troubling to courts, even if the present value is not high relative to whatever the alleged loss is, as it seems unlikely that NKR is harmed in perpetuity if a member center backs out.

...

"when federal law prohibits the exchange of valuable consideration for a kidney, by definition there is no market price for either the court or the contracting parties to reference. Here, the parties attempted to overcome that problem by specifying a recurring charge, but it’s continuation into perpetuity may raise eyebrows, even if the present value of the charges is otherwise reasonable.

***********

The various legal documents can be found at these links

https://kimberlydkrawiec.org/wp-content/uploads/2021/11/Member-Terms-and-Conditions.pdf

 https://kimberlydkrawiec.org/wp-content/uploads/2021/11/Complaint.pdf

 https://kimberlydkrawiec.org/wp-content/uploads/2021/11/May-7-motion-to-dismiss.pdf

 https://kimberlydkrawiec.org/wp-content/uploads/2021/11/1Summons-Complaint.pdf

***********

Given NKR's non-profit status, paragraph 30 of the Colorado complaint caught my eye:

Selection of Dutch doctors by lottery

 Here's a recent article describing the once and future Dutch selection of medical students by lottery. (I believe that residency positions may also have or have had selection by lottery.)

Rationales for a Lottery Among the Qualified to Select Medical Trainees: Decades of Dutch Experience by Olle ten Cate, J Grad Med Educ (2021) 13 (5): 612–615. https://doi.org/10.4300/JGME-D-21-00789.1

"The Dutch Lottery for Medical School Selection

"A lottery, as a method to determine who will be admitted to medical school or residency, may sound an absurd proposition to many. A lottery appears to devalue motivation, disregard high effort and talent, and randomly block freedom of career choice. However, The Netherlands has decades of experience with this method. The Dutch government applied a lottery system nationally for admission to all medical schools in 1972. This system was abandoned in 2017 after an appeal but will now be reinstalled in 2023 as a legitimate procedure for the selection of students.

"Until 1972, the admission to Dutch medical schools, which have a 6-year program not preceded by baccalaureate education, was freely accessible for applicants with the proper secondary schooling (note that the Dutch government pays for most of medical education). When applicants increased in number and their costs became substantial, the Dutch government introduced a numerus fixus, a restricted total number of positions, derived from predictions of future physician need. After years of debate, politicians settled on a “weighted lottery” system for admissions. The average score on a national final secondary examination determined the weighting. Students with an outstanding score would triple their chances compared to those with a just-pass score. Declined candidates could reenter the lottery for 2 subsequent years. For decades schools and the public were generally satisfied with this procedure to determine the one-third of all applicants (on average across decades) for whom there was space at a Dutch medical school. The lottery procedure was smoothly conducted by a government agency, until 1996. That year an outstanding high school graduate was turned down 3 times and appealed the decision. Political and societal anger arose and led to a gradual replacement of the lottery, initially with a local qualitative selection process in parallel with a national weighted lottery. In 2 decades, the national lottery system was abandoned altogether; legislation prohibited medical schools from using a lottery as of 2017. Surprisingly, in 2020, a parliamentary majority voted to allow schools to use a lottery system, and thus reinstalled lottery processes as a legitimate method of selection. The law is effective in 2023."

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

Related:

Lottery Admissions System in the Netherlands, FL Meijler, J Vreeken - Science, 1975 - science.org

The weighted lottery in the admission to ‘restricted’ university studies in the Netherlands,      

Ben Wilbrink

The use of lottery systems in school admissions

C Stasz, C Von Stolk, R Europe, C Rand, TW Sutton - 2007 - researchgate.net

Venus of Willendorf, on OnlyFans

 The NY Times has the story:

OnlyFans May Be a Refuge for Nude Fine Art. The Vienna Tourist Board has joined the adults-only site to display artworks that other social platforms have censored.  By Valeriya Safronova

"OnlyFans has a surprising new member: the Vienna Tourist Board.

"No, its account will not feature after-hours photos of employees. Instead, the board will use the adults-only site to show images of paintings and sculptures displayed in the Austrian capital that have been blocked by social media sites for nudity or sexual content.

"The offending artworks include the Venus of Willendorf, a 25,000-year-old limestone figurine of a woman. Facebook removed a photo of it from the Vienna Museum of Natural History’s page several years ago for being “pornographic.”

...

"Vienna is hardly the only city whose art has been censored online. Many artworks, from all over the world, have been incorrectly identified by A.I. as pornography. Facebook has taken down pictures posted by the Museum of Fine Arts in Boston (of Imogen Cunningham’s photographs of nude bodies), the Philadelphia Museum of Art (of a painting by Evelyne Axell in which a woman is licking an ice cream cone) and the Metropolitan Museum of Art in New York (of a 1917 painting of a nude woman by Amedeo Modigliani).

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

Here's the Wikipedia page for Venus of Willendorf

Contract design (by lawyers for users...)

 Here's an interview from the legal blog Above the Law:

Why The Time For Better Contract Design Is Now. Q&A with Stefania Passera and Paula Doyle. By OLGA V. MACK

"In an age of fast-growing complexity, the winners are those who simplify the lives of others.

As part of its mission to promote ease of doing business for social and economic benefit, World Commerce & Contracting has long been a vocal advocate for simpler, user-centered contracts. But what does good contract design look like, in practice? And how do you make a compelling business case for it in your organization?

I caught up with Stefania Passera, contract designer in residence, and Paula Doyle, chief legal innovation officer — the leading ladies behind WorldCC’s design and simplification initiatives — to discuss their most recent initiatives.

Olga Mack: So, I hear you love contracts. How did this happen to you? 

Stefania Passera: I don’t actually love contracts per se, but I love the challenge of transforming them into something clear, useful, and engaging for all stakeholders. I love seeing business people look at contracts with new eyes and understand them for the first time! I love seeing lawyers realizing that they don’t need contracts to be full of legalese for it to be binding and that sticking in everything, including the kitchen sink just in case, is not actually good risk management. My background is in information design, which is the art and science of making complex information usable and understandable. There is a lot of work to be done in the world of contracts!

Paula Doyle: I completely agree with all that Stefania has said. I have been a lawyer in industry for more than 20 years. Frankly, I am bewildered, given all of the other advances in the world during that time period, that contracts remained largely static up until about 5 years ago! Contracts are in essence instruments to help organizations and individuals get things done. At their core they should be understandable. They should not be the domain of only lawyers! 

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

Here's a Contract Design Pattern Library on the WC&C website.