Saturday, August 27, 2016

The Iranian market for kidneys

The AP has published this descriptive story about the Iranian market for kidneys:

Some paragraphs from the story:

"The AP gained rare access to Iran's program, visiting patients on dialysis waiting for an organ, speaking to a man preparing to sell one of his kidneys and watching surgeons in Tehran perform a transplant. All of those interviewed stressed the altruistic nature of the program - even as graffiti scrawled on walls and trees near hospitals in Iran's capital advertised people offering to sell a kidney for cash.
Iran started kidney transplants in 1967 but surgeries slowed after the 1979 Islamic Revolution and the storming of the U.S. Embassy in Tehran, in part due to sanctions. Iran allowed patients to travel abroad through much of the 1980s for transplants - including to America. But high costs, an ever-growing waiting list of patients and Iran's grinding eight-year war with Iraq forced the country to abandon the travel-abroad program.

In 1988, Iran created the program it has today. A person needing a kidney is referred to the Dialysis and Transplant Patients Association, which matches those needing a kidney with a potential healthy adult donor. The government pays for the surgeries, while the donor gets health coverage for at least a year and reduced rates on health insurance for years after that from government hospitals.

Those who broker the connection receive no payment. They help negotiate whatever financial compensation the donor receives, usually the equivalent of $4,500. They also help determine when Iranian charities or wealthy individuals cover the costs for those who cannot afford to pay for a kidney.

Today, more than 1,480 people receive a kidney transplant from a living donor in Iran each year, about 55 percent of the total of 2,700 transplants annually, according to government figures. Some 25,000 people undergo dialysis each year, but most don't seek transplants because they suffer other major health problems or are too old.

Some 8 to 10 percent of those who do apply are rejected due to poor health and other concerns. The average survival rate of those receiving a new kidney is between seven to 10 years, though some live longer, according to Iranian reports.

In the United States, about a third of kidney donations come from living donors. The average kidney from a deceased donor lasts 10 years, while one from a living donor averages about 15 years, according to Dr. David Klassen of the United Network for Organ Sharing, or UNOS, which oversees the U.S. transplant system. Recipients of living-donor kidneys in the U.S. fare better in part because they haven't been on dialysis as long before their transplant."

Friday, August 26, 2016

John Dickerson defends his Ph.D. thesis at CMU, on kidney exchange

John Dickerson will defend today:
Computer Science Thesis Defense, Friday, August 26, 2016 - 2:00pm to 3:30pm
8102 Gates-Hillman Center (or, via Skype, for those of us who are far away).

Here's his summary of what he's preparing to defend:

"The exchange of indivisible goods without money addresses a variety of constrained economic settings where a medium of exchange — such as money — is considered inappropriate. Participants are either matched directly with another participant or, in more complex domains, in barter cycles and chains with many other participants before exchanging their endowed goods. This thesis addresses the design, analysis, and real-world fielding of dynamic matching markets and barter exchanges. We present new mathematical models for static and dynamic barter exchange that more accurately reflect reality, prove theoretical statements about the characteristics and behavior of these markets, and develop provably optimal market clearing algorithms for models of these markets that can be deployed in practice. We show that taking a holistic approach to balancing efficiency and fairness can often practically circumvent negative theoretical results. We support the theoretical claims made in this thesis with extensive experiments on data from the United Network for Organ Sharing (UNOS) Kidney Paired Donation Pilot Program, a large kidney exchange clearinghouse in the US with which we have been actively involved. Specifically, we study three competing dimensions found in both matching markets and barter exchange: uncertainty over the existence of possible trades (represented as edges in a graph constructed from participants in the market), balancing efficiency and fairness, and inherent dynamism. For each individual dimension, we provide new theoretical insights as to the effect on market efficiency and match composition of clearing markets under models that explicitly consider those dimensions. We support each theoretical construct with new optimization models and techniques, and validate them on simulated and real kidney exchange data. In the cases of edge failure and dynamic matching, where edges and vertices arrive and depart over time, our algorithms perform substantially better than the status quo deterministic myopic matching algorithms used in practice, and also scale to larger instance sizes than prior methods. In the fairness case, we empirically quantify the loss in system efficiency under a variety of equitable matching rules. Next, we combine all of the dimensions, along with high-level human-provided guidance, into a unified framework for learning to match in a general dynamic model. This framework, which we coin FutureMatch, takes as input a high-level objective (e.g., "maximize graft survival of transplants over time") decided on by experts, then automatically (i) learns based on data how to make this objective concrete and (ii) learns the "means" to accomplish this goal — a task that, in our experience, humans handle poorly. We validate FutureMatch on UNOS exchange data and make policy recommendations based on it. Finally, we present a model for liver exchange and a model for multi-organ exchange; for the latter, we show that it theoretically and empirically will result in greater social welfare than multiple individual exchanges. Thesis Committee: Tuomas Sandholm (Chair) Avrim Blum Zico Kolter Ariel Procaccia Craig Boutilier (Google/University of Toronto) Alvin Roth (Stanford University)"

He'll be teaching CS at Maryland in the Fall.

Thursday, August 25, 2016

Compensating bone marrow (blood stem cell) donors: still in legal limbo

Whether it will remain legal to compensate donors of bone marrow (blood stem cells) remains in limbo (see my various posts on the subject here).  The WSJ has an op-ed that summarizes the situation: 

Briefly, the 9th Circuit Court of Appeals lifted the ban on paying blood stem cell donors (if the technology was non-surgical), but the Department of Health and Human Services proposed a new regulation that would restore the ban. The regulation went out for public comment, and many comments were received, mostly against reinstating the ban.  The WSJ op-ed writes about that this way (in a way that makes me reflect on some of the oddities of news coverage):

"But a year after Ms. Flynn won her case, the Department of Health and Human Services announced that it might enact a regulation effectively nullifying the court’s ruling—and thus Ms. Flynn’s victory. In September 2013, HHS sought public comment. Hundreds of comments poured in favoring compensation for blood stem-cell donors who use apheresis, including support from Nobel Prize-winning economist Alvin Roth, who has long written on organ-donation policy. Only a handful of comments were opposed."

As you can imagine, I was one among many signers of the comment that I supported (which you can read here): the others, all economists, were
Theodore Bergstrom, University of California at S. Barbara, Stefano DellaVigna, University of
California at Berkeley, Julio J. Elias, Universidad del CEMA, Argentina,
Rodney Garratt, University of California at S. Barbara,
Michael Gibbs, University of Chicago, Judd Kessler, University of Pennsylvania, Nicola Lacetera,
University of Toronto, Stephen Leider, University of Michigan, John List, University of Chicago,
Mario Macis, Johns Hopkins University, Daniel McFadden, University of California at Berkeley, Matthew Rabin, University of California at Berkeley, Alvin Roth, Stanford University, Damien Sheehan-Connor, Wesleyan University, Robert Slonim, University of Sydney, Alex Tabarrok, George Mason University

If you have the time, you can read all 527 comments here.

Wednesday, August 24, 2016

Economists getting jobs as engineers

Bloomberg (Noah Smith) notices market design: All of a Sudden, Economists Are Getting Real Jobs

" Instead of holding forth on policy issues or the welfare of nations, many  are working with companies to create the kind of ideal markets that were previously confined to the pages of their academic papers. In other words, Keynes’ dream of economic dentistry -- or, more accurately, economic engineering -- might at last be coming true."

Tuesday, August 23, 2016

More on starting kidney exchange chains with deceased donor kidneys

Here's a forthcoming letter to the editor in the American Journal of Transplantation: We need to take the next step, by Marc L. Melcher, John P. Roberts, Alan B. Leichtman, Alvin E. Roth, and Michael A. Rees

It replies to another letter: A potential solution to make best use of living donor- deceased donor list exchange by VB Kute, HV Patel, PR Shah, PR Modi, VR Shah, HL Trivedi

which was prompted by our earlier article: Melcher, Marc L., John P. Roberts, Alan B. Leichtman, Alvin E. Roth, and Michael A. Rees, “Utilization of Deceased Donor Kidneys to Initiate Living Donor Chains,” American Journal of Transplantation, 16, 5, May 2016, 1367–1370.

Here's a post about that earlier article:

Using deceased donor kidneys to start living donor kidney exchange chains

and here's a post about the followup we hope to do:

Monday, August 22, 2016

Quality control of transplant centers, and the choice of who to transplant (and which organs to accept)

Transplant centers are regulated by measures such as their one-year graft-survival rate, so they feel pressure not to transplant patients, or organs, that have too high a risk to meet the required measure of success.

Here's a recent paper from the Journal of the American College of Surgeons that discusses some of the consequences:


The central tenet of liver transplant organ allocation is to prioritize the sickest patients first. However, a 2007 Centers for Medicare and Medicaid Services regulatory policy, Conditions of Participation (COP), which mandates publically reported transplant center performance assessment and outcomes-based auditing, critically altered waitlist management and clinical decision making. We examine the extent to which COP implementation is associated with increased removal of the “sickest” patients from the liver transplant waitlist.

Study Design

This study included 90,765 adult (aged 18 years and older) deceased donor liver transplant candidates listed at 102 transplant centers from April 2002 through December 2012 (Scientific Registry of Transplant Recipients). We quantified the effect of COP implementation on trends in waitlist removal due to illness severity and 1-year post-transplant mortality using interrupted time series segmented Poisson regression analysis.


We observed increasing trends in delisting due to illness severity in the setting of comparable demographic and clinical characteristics. Delisting abruptly increased by 16% at the time of COP implementation, and likelihood of being delisted continued to increase by 3% per quarter thereafter, without attenuation (p < 0.001). Results remained consistent after stratifying on key variables (ie, Model for End-Stage Liver Disease and age). The COP did not significantly impact 1-year post-transplant mortality (p = 0.38).


Although the 2007 Centers for Medicare and Medicaid Services COP policy was a quality initiative designed to improve patient outcomes, in reality, it failed to show beneficial effects in the liver transplant population. Patients who could potentially benefit from transplantation are increasingly being denied this lifesaving procedure while transplant mortality rates remain unaffected. Policy makers and clinicians should strive to balance candidate and recipient needs from a population-benefit perspective when designing performance metrics and during clinical decision making for patients on the waitlist.
It drew this headline in the news:
Hospitals are throwing out organs and denying transplants to meet federal standards

Sunday, August 21, 2016

Who Gets What and Why shortlisted for German Business Book Prize (to be announced in October)

Deutscher Wirtschaftsbuchpreis 2016: Die Shortlist

Google translates: Dusseldorf (ots) - The finalists of the German Business Book Prize have been announced: Ten books have made ​​it to the final round for 2016th A distinguished jury selected this year for the tenth time from the titles shortlisted the best business book of the year. The Executive Jury has Gabor Steingart, publisher of Handelsblatt. The prize will be awarded on 21 October at the Frankfurt Book Fair.
The German Business Book Award is themed "Understanding Business".Handelsblatt, the Frankfurt Book Fair and the investment bank Goldman Sachs award the prize to promote the economic literature. The three partners aim to emphasize the distinction the importance of economy section in mediating economic relationships. The selection criteria therefore include not only innovative agenda-setting or a new perspective and understanding and readability. The prize is endowed with 10,000 euros.
The ten books shortlisted provides Handelsblatt in the weeks prior to the literature page in the weekend edition. All other information on the award, the jury and of the initiators can be found at:

Die Shortlist 2016:
George Akerlof, Robert Shiller: Phishing for Fools. Manipulation und Täuschung in der freien Marktwirtschaft. Econ, Berlin 2016, 416 Seiten, 24 Euro
Adam Grant: Nonkonformisten. Warum Originalität die Welt bewegt. Droemer, München 2016, 384 Seiten, 22,99 Euro
Christoph Keese: Silicon Germany. Wie wir die digitale Transformation schaffen. Knaus, München 2016, 368 Seiten, 22,99 Euro
Paul Mason: Postkapitalismus. Grundrisse einer kommenden Ökonomie. Suhrkamp, Berlin 2016, 430 Seiten, 26,95 Euro
Alec Ross: Die Wirtschaftswelt der Zukunft. Plassen, Kulmbach 2016, 400 Seiten, 24,99 Euro
Alvin E. Roth: Wer kriegt was und warum? Bildung, Jobs und Partnerwahl: Wie Märkte funktionieren. Siedler, München 2016, 304 Seiten, 24,99 Euro
Wolfgang Schäuble (und Michel Sapin): Anders gemeinsam (im Gespräch mit Ulrich Wickert). Hoffmann und Campe, Hamburg 2016, 256 Seiten, 22 Euro
Mark C. Schneider: Volkswagen. Eine deutsche Geschichte. Berlin Verlag, 2016, 304 Seiten, 22 Euro
Hans-Werner Sinn: Der Euro. Von der Friedensidee zum Zankapfel. Hanser, München 2016, 560 Seiten, 24,90 Euro
Sahra Wagenknecht: Reichtum ohne Gier. Wie wir uns vor dem Kapitalismus retten. Campus, Frankfurt 2016, 292 Seiten, 19,95 Euro