Monday, September 18, 2017

School choice in Chile (deferred acceptance algorithm)

There are new school choice systems being used this year in Chile, based on the deferred acceptance algorithm.

"La ciencia detrás del nuevo sistema--
Algoritmo promete terminar con filas y discriminación en la admisión escolar")

(Google Translate: The science behind the new system--
Algorithm promises to end rows and discrimination on school admission)


Here's a sentence that gives an indication of the old system the new school choice system replaces (courtesy of Google Translate):
"What is changing is the night and the long lines because it is a centralized postulation system that guarantees that all those who register in the agreed term do not have to queue and can apply from home."

Sunday, September 17, 2017

Yemenis selling kidneys in Egypt: Al Jazeera

Al Jazeera has the (nuanced) story:
Desperate Yemenis sell organs to survive
Victims of trafficking rings say the networks operate anonymously in shisha bars and coffee shops in Yemen and Egypt.

"Ali - who is unemployed, divorced and in his early thirties - recently found himself facing a stark choice. He could either sign up to fight with the Houthi rebels on the front lines of the war in Yemen, seek work in neighbouring Saudi Arabia, or sell his organs.

"There are no jobs, and my wife left me for another man," Ali said despondently from his postoperative bed in Yemen's Bani Matar district, southwest of the capital Sanaa.

"After more than two years of war, many working-class Yemenis have turned to selling grocery items and khat - a mild, chewable narcotic - to make a meagre living. Others have opted to sell their organs to survive.
...
"Ali said that the doctor who performed his operation did not warn him of the potential consequences and there was no postoperative care. Patients are compelled to sign a contract that states, "It is not our responsibility if complications arise after the surgery," he added.

"Once the surgery was done, and I received the money, I was on my own," Ali said.
...
"A few operations are done in big hospitals with proper medical care; the majority are done in unlicensed or makeshift operation theatres with inadequate equipment or staff, Maqtari added. Only 45 percent of the healthcare facilities in Yemen are fully functional.
...
"As Yemen's war drags on, the future is anything but certain. But for Adnan Ali, who will soon enter his second marriage with the woman of his dreams and launch a taxi service, there are signs of a brighter future.

"Arrangements are under way for the wedding," he said, "and I am planning to buy a car to run a taxi."

Saturday, September 16, 2017

Sven Seuken appointed Chief Economist of BandwidthX

Here's the press release:

BandwidthX Appoints Sven Seuken as Chief Economist
Prof. Seuken’s appointment underlines the importance of market design in BxMarket

"BandwidthX, the operator of the cloud-based mobile data market, today announces Prof. Sven Seuken as its Chief Economist. Professor Seuken is one of the world's experts in electronic market design. He is a tenured Associate Professor of Computation and Economics at the University of Zurich in Switzerland where he supervises a team of seven PhD students and Postdocs, conducting research on market design topics. At BandwidthX, Professor Seuken enjoys a broad mandate including the design and analysis of market mechanisms and trading rules to drive new efficiencies in BxMarket. The appointment comes at an exciting moment as BandwidthX is expanding its platform across various data networks and global offerings.

"Professor Seuken holds a PhD in Computer Science from Harvard University. Since 2006, he has been conducting research on electronic market design. His main focus lies on designing marketplaces with complex combinatorial constraints. Applications he has worked on include peer-to-peer backup markets, electricity markets, matching markets, spectrum auctions, data markets, financial markets, cloud computing markets, and bandwidth markets.  Prof. Seuken has received several awards, including a Google Faculty Research Award, a Microsoft Research PhD Fellowship, and a Fulbright Fellowship."
...
"BandwidthX operates an advanced connection management service and a cloud-based marketplace where both Mobile Operators and Network Service Providers can define their value for data capacity in real time and are automatically matched when their values align. BxMarket gives the Mobile Operators incremental data capacity at lower cost, while allowing the Network Service Providers to profit from new revenue streams from their underutilized data networks. With this new form of micro-commerce, everyone in the mobile data ecosystem wins: from Mobile Operators and Network Service Providers to equipment and software vendors, aggregators and financial clearing companies and, of course, the end user of the device. Learn more about BandwidthX at http://www.bandwidthx.com.

Friday, September 15, 2017

An optimistic view of transplants in China from the Washington Post

I've written a number of posts linking to optimistic stories about China's move away from using executed prisoners as sources of organs for transplants, and others expressing some skepticism. The Washington Post has some elements of reporting that indicates that they explored and discounted some of the reasons for skepticism, so I think this is the most credibly optimistic assessment I've seen to date.

Here's the Washington Post story:
China used to harvest organs from prisoners. Under pressure, that practice is finally ending.

"China had more than 600 organ transplant centers in a sprawling, unregulated system. That number was whittled down to about 160 registered and approved centers in 2007, when legislation was also introduced to outlaw organ trafficking and ban foreigners from coming to the country to receive Chinese organs.
...
"Chinese law does not explicitly rule out using organs of prisoners condemned to death by the criminal courts, and Huang himself was quoted in Chinese media in late 2014 and early 2015 as saying prisoners could “voluntarily” donate organs.
Huang now disavows those comments, insisting there is “zero tolerance” for using any prisoners’ organs in the hospital system. But in a country of 1.3 billion people, he said at a Vatican conference in February, “I am sure, definitely, there is some violation of the law.”
Lawyer Yu Wensheng said that one of his clients had shared a Beijing prison cell with a man facing the death penalty last November and that the condemned man was given a form to sign to “voluntarily” donate his organs.
Death-row prisoners, he said, were “given the choice not to sign the forms, but they would receive much more mistreatment and suffer much more. If they sign, their last days of life would pass more easily.”
Yet the supply of organs from executed prisoners seems to have been drying up because the number of death sentences appears to have fallen dramatically after a 2007 mandate requiring the Supreme Court to review all capital cases."
...
"Transplant patients must take immunosuppressant drugs for life to prevent their bodies from rejecting their transplanted organs. Data compiled by Quintiles IMS, an American health-care-information company, and supplied to The Post, shows China’s share of global demand for immunosuppressants is roughly in line with the proportion of the world’s transplants China says it carries out.
Xu Jiapeng, an account manager at Quintiles IMS in Beijing, said the data included Chinese generic drugs. It was “unthinkable,” he said, that China was operating a clandestine system that the data did not pick up.
Critics counter that China may also be secretly serving large numbers of foreign transplant tourists, whose use of immunosuppressant drugs would not appear in Chinese data. But this assertion does not stand up to scrutiny.
Jose Nuñez, head of the transplantation program at the World Health Organization, which collects information on transplants worldwide, says that in 2015 the number of foreigners going to China for transplants was “really very low,” compared with the traffic to India, Pakistan or the United States, or in comparison with transplant-visitor numbers in China’s past.
Chapman and Millis say it is “not plausible” that China could be doing many times more transplants than, for instance, the United States, where about 24,000 transplants take place every year, without that information leaking out as it did when China used condemned prisoners’ organs.
And lawyers who have defended Falun Gong practitioners also reject allegations that those prisoners’ organs are being harvested.
“I have never heard of organs being taken from live prisoners,” said Liang Xiaojun, who said he had defended 300 to 400 Falun Gong practitioners in civil cases and knew of only three or four deaths in prison.
In China, despite state repression, family members can be determined in speaking out and seeking justice when relatives vanish.
If tens of thousands of Falun Gong practitioners were being executed every year, that information would emerge, experts say.
A U.S. congressional commission on China, the State Department and the Falun Gong community website have separately tried to estimate the number of political prisoners in China, and the figures range from 1,397 to “tens of thousands” — and even that upper number is significantly lower than the 500,000 to 1 million claimed by Gutmann and others."

Thursday, September 14, 2017

An Invitation to Market Design by Kominers, Teytelboym and Crawford

Scott, Alex and Vince have written an introduction to what I gather is a special issue of the Oxford Review of Economic Policy devoted to market design.  It is also a concise and easy to read introduction to the field, with some guesses about where we're going.

An Invitation to Market Design
Scott Duke Kominers, Alexander Teytelboym, Vincent P. Crawford
 September 4, 2017

Abstract: Market design seeks to translate economic theory and analysis into practical solutions to real-world problems. By redesigning both the rules that guide market transactions and the infrastructure that enables those transactions to take place, market designers can address a broad range of market failures. In this paper, we illustrate the process and power of market design through three examples: the design of medical residency matching programs; a scrip system to allocate food donations to food banks; and the recent “Incentive Auction” that reallocated wireless spectrum from television broadcasters to telecoms. Our lead examples show how effective market design can encourage participation, reduce gaming, and aggregate information, in order to improve liquidity, efficiency, and equity in markets. We also discuss a number of fruitful applications of market design in other areas of economic and public policy

Wednesday, September 13, 2017

Kidney exchange proposed for Qatar

Here's a story from the Gulf Times.

Kidney donation: Qatar study reveals incompatibility

"Kidney Paired Donation (KPD) has emerged as an attractive option for donor-recipient pairs who are not immunologically compatible with each other.
The study 'Safe and ethical living kidney donation in Qatar: A national health system’s approach', recently appeared on Qatar Medical Journal which is part of the publications on QScience.com, an online publishing platform from Hamad Bin Khalifa University Press.
The study was conducted by three Hamad Medical Corporation (HMC) officials, Mohamed Asim, Yousuf al-Maslamani, and Hassan al-Malki.
The study suggests that establishment of a national KPD registry and perhaps a unified registry in the Gulf region will have the potential to maximise living donor transplant rates. Collaboration with international societies such as Transplantation Society, International Society of Nephrology, and European Society for Organ Transplantation would facilitate the establishment of desensitisation and KPD programmes to optimise living kidney transplantation in Qatar.
Successful implementation of these programmes will invariably require resources and expertise and in return, it will ensure that maximum number of LKDs achieve their noble ambition.
The study highlights that LKDs are a unique group of people who should be carefully and respectfully evaluated to determine their suitability for donation.
As per the study, HMC offers a culturally and linguistically tailored living kidney transplant programme that focuses on protecting the rights and best interests of the LKDs. The programme’s legal and policy framework prohibits organ commercialism while providing a safe, supportive, and compassionate environment for those who come forward.
The study also points out that incidence of dialysis therapy for end-stage renal disease in Qatar has increased from 82 per million population in 2013 to 104 in 2016. The increasing incidence of end-stage kidney disease in Qatar has led to growing demand for donor kidneys.
The deceased donor kidney programme has yet to achieve its full potential. Although many of the barriers to deceased donor transplantation related to legislation and infrastructure have been overcome, unfavourable public attitudes toward deceased organ donation still prevail, leading to desperately low consent rates for organ donation.
Hence, living kidney donation has been widely adopted as an appropriate alternative. The reliance on living kidney donors however, raises a number of social, ethical, and legal concerns surrounding informed consent, voluntarism, psychosocial evaluation, perioperative care, and long-term follow-up of the donors. Many of these concerns become heightened in a multicultural, multilingual society such as Qatar, the study says."

Tuesday, September 12, 2017

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

The forthcoming issue of the American Journal of Transplantation is going to have a number of conflicting views about Global Kidney Exchange (GKE).  Just as yesterday's post showed how Kidney Exchange faced some repugnance at the turn of this century, these interactions show that GKE will have to overcome some repugnance too. (I just returned from Geneva where I talked about GKE among other things, in an attempt to start bridging this divide.)


It all started with our article proposing GKE and reporting the case of a Philippine patient-donor pair, which came out in March, along with an accompanying editorial suggesting that maybe the whole idea is repugnant.

Here's the original article:

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's the accompanying editorial:
Walking a Tightrope or Blazing a Trail?
by A. C. Wiseman, J. S. Gill


Here is our forthcoming reply to the editorial
Global kidney exchange: Financially incompatible pairs are not transplantable compatible pairs
M. A. Rees, S. R. Paloyo, A. E. Roth, K. D. Krawiec, O. Ekwenna, C. L. Marsh, A. J. Wenig and T. B. Dunn
Version of Record online: 1 SEP 2017 | DOI: 10.1111/








And here is a letter saying that GKE is essentially organ trafficking…

Francis L. Delmonico and Nancy L. Ascher
Accepted manuscript online: 21 AUG 2017 09:05AM EST | DOI: 10.1111/ajt.14473
·        Abstract  Article  PDF(63K)

And our replies:

You have free access to this content
People should not be banned from transplantation only because of their country of origin
Alvin E. Roth, Kimberly D. Krawiec, Siegfredo Paloyo, Obi Ekwenna, Christopher L. Marsh, Alexandra J. Wenig, Ty B. Dunn and Michael A. Rees
Accepted manuscript online: 1 SEP 2017 09:25AM EST | DOI: 10.1111/ajt.14485

  1. You have free access to this content
    Open dialogue between professionals with different opinions builds the best policy
    Ignazio R. Marino, Alvin E. Roth, Michael A. Rees and Cataldo Doria
    Version of Record online: 11 SEP 2017 | DOI: 10.1111/ajt.14484
  2. Here's the text of the Roth et al. letter:

"Previously [1,2], we described how a Filipino husband-and-wife patient–donor pair were included in an American kidney exchange.1,2 Delmonico and Ascher object in the strongest terms.3 They write that ethical Global Kidney Exchange (GKE) with patient–donor pairs from the developing world “is not feasible when the culture is so experienced with organ sales.”

Among the proposers of GKE are experienced surgeons and clinicians, a senior lawyer, and a veteran market designer. We take black markets with the utmost seriousness. That’s why the first GKE pair was started with a husband and wife. We think the right course of action is to proceed carefully, slowly at first, and with constant monitoring. The second GKE pair from Mexico were cousins cared for by Dr. Ricardo Correa-Rotter, a world-renowned nephrologist and signatory of the Declaration of Istanbul.4,5

We also take seriously long-term postoperative care for both patients and donors. That’s why we propose GKE in partnership with developing countries that already have some first-rate hospitals that perform living donor transplantation. Rees et al. describe how we coordinated care with the Philippine General Hospital and St. Luke’s Medical Center in Manila.2 We also provided an escrow fund for long-term continuing care. Ivan Carrillo describes our care of the donor and recipient in the second GKE and it is clearly celebrated by Mexican media as a beautiful way to help citizens of both Mexico and the United States.4,5

Kidney exchange (KE) itself is a relatively new “matching market,” of a kind that does not involve any payments to donors. It has been successfully launched in many countries, and proposals for international cooperation are underway.6 What makes KE special is that two or more patient–donor pairs help each other. What makes GKE special is that helping first-world patients get transplants saves money, because dialysis is so expensive, and these savings can benefit poor patients and donors in poor countries who would otherwise be unable to help themselves, but can participate in GKE for free.

Delmonico and Ascher propose that poor people with ESRD in poor countries, and the donors who love them, must all be regarded as potential criminals who would inevitably corrupt first-world medicine by being included in it. In the current political climate this is a bit like proposing a blanket ban on granting asylum to refugees from some countries. We do not adopt this point of view. On the contrary, GKE is a proposal that says there are many deserving patients who need our help, who we can help, and who can help us—if we invite them carefully and take care of them attentively.

Fear is not the path forward. Bold, careful innovation has led transplantation to where it is today, and remains our best collective future.

Disclosure The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

References
1. Rees MA, Paloyo S, Roth AE, et al. Global Kidney Exchange: Financially Incompatible Pairs Are Not Transplantable Compatible Pairs. Am J Transplant. 2017;17:782-90.
2. Rees MA, Dunn TB, Kuhr CS, et al. Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation. Am J Transplant 2017;17:782-90.
3. Delmonico FL, Ascher NL. Opposition to Irresponsible Global Kidney Exchange. Am J Transplant 2017;17:IN PRESS THIS ISSUE.
4. A bridge of life: Global kidney exchange between Mexico and the U.S. (Accessed 8/23/2017, at http://marketdesigner.blogspot.com/2017/04/a-bridge-of-life-global-kidney-exchange.html.)
5. Carrillo I. Un puente de vida (English Translation: A bridge of life). Newsweek en Español 2017 April 14, 2017:16-25.
6. Biró P, Burnapp L, Haase B, et al. Kidney Exchange Practices in Europe, First Handbook of the COST Action CA15210: European Network for Collaboration on Kidney Exchange Programmes (ENCKEP)2017.
**********

Today I'm in D.C. at a meeting of NLDAC, the National Living Donor Assistance Center.