Sunday, February 1, 2015

Penn State honors Bob Marshall

Dr. Robert C. Marshall Named Distinguished Professor

"Robert C. Marshall, Department of Economics recently was named Distinguished Professor by Penn State. Distinguished professors have demonstrated significant leadership in raising the standards of the University with respect to teaching, research or creative activity, and service; and contributed significantly to the education of students who subsequently have achieved recognition of excellence in their fields.
Dr. Marshall is Head of the Department of Economics and Co-Director of the Center for the Study of Auctions, Procurements, and Competition Policy at Penn State. He is a recognized leader in the areas of industrial organization, collusion, applied game theory, auctions, and procurements. His 2011 Michigan Law Review paper, “Plus Factors in Agreements in Antitrust Law” won the Jerry S. Cohen Memorial Fund Writing Award for best antitrust scholarship of 2011.
His book co-authored with Leslie M. Marx is titled The Economics of Collusion: Cartels and Bidding Rings (MIT Press, 2012). He has served on two panels for the National Research Council and he is on the editorial board of the Journal of Antitrust Enforcement."

Continued troubles in German organ donation and transplantation

From Spiegel online: Vor Organspende: Schwerer Fehler bei Hirntod-Diagnose  (Before Organ Donation: A fatal error occurred brain death diagnosis) translation via Google Translate

The article goes on to speak of a transplant that was canceled (at some point) because of "ambiguity with regard to the diagnosis of brain death and its documentation".


HT: Rosemarie Nagel

Saturday, January 31, 2015

Financial compensation for living kidney donation: survey at departments of motor vehicles

Here's another contribution to the ongoing discussion...

 2015 Jan;15(1):265-73. doi: 10.1111/ajt.13004. Epub 2014 Nov 25.

Does financial compensation for living kidney donation change willingness to donate?

Abstract

The potential use of financial compensation to increase living kidney donation rates remains controversial in potentially introducing undue inducement of vulnerable populations to donate. This cross-sectional study assessed amounts of financial compensation that would generate motivation and an undue inducement to donate to family/friends or strangers. Individuals leaving six Departments of Motor Vehicles were surveyed. Of the 210 participants who provided verbal consent (94% participation rate), respondents' willingness to donate would not change (70%), or would increase (29%) with compensation. Median lowest amounts of financial compensation for which participants would begin to consider donating a kidney were $5000 for family/friends, and $10 000 for strangers; respondents reporting $0 for family/friends (52%) or strangers (26%) were excluded from analysis. Median lowest amounts of financial compensation for which participants could no longer decline (perceive an undue inducement) were $50 000 for family/friends, and $100 000 for strangers; respondents reporting $0 for family/friends (44%) or strangers (23%) were excluded from analysis. The two most preferred forms of compensation included: direct payment of money (61%) and paid leave (21%). The two most preferred uses of compensation included: paying off debt (38%) and paying nonmedical expenses associated with the transplant (29%). Findings suggest tolerance for, but little practical impact of, financial compensation. Certain compensation amounts could motivate the public to donate without being perceived as an undue inducement.

Sandholm on kidney exchange

Tuomas Sandholm writes:

"I just today updated my web page with my new papers.  Here are the main kidney exchange papers that I have been involved with.  This is not a complete list, but these are the main ones."

  • Dickerson, J. and Sandholm, T. 2015. FutureMatch: Combining Human Value Judgments and Machine Learning to Match in Dynamic Environments. In Proceedings of the AAAI Conference on Artificial IntelligenceExtended version with appendix.
  • Hajaj, C., Dickerson, J., Hassidim, A., Sandholm, T., and Sarne, D. 2015. Strategy-Proof and Efficient Kidney Exchange Using a Credit Mechanism. In Proceedings of the AAAI Conference on Artificial Intelligence.
  • Dickerson, J. and Sandholm, T. 2014. Multi-Organ Exchange: The Whole is Greater than the Sum of its Parts. In Proceedings of the AAAI Conference on Artificial IntelligenceEarly version in IJCAI-13 workshop on Constraint Reasoning, Planning and Scheduling Problems for a Sustainable Future (GREEN-COPLAS).
  • Dickerson, J., Procaccia, A., and Sandholm, T. 2014. Price of Fairness in Kidney Exchange. In Proceedings of the International Conference on Autonomous Agents and Multiagent Systems (AAMAS).
  • Dickerson, J. and Sandholm, T. 2014. Balancing Efficiency and Fairness in Dynamic Kidney Exchange. In Proceedings of the Modern Artificial Intelligence for Health Analytics (MAIHA) workshop at AAAI-14.
  • Dickerson, J., Procaccia, A., and Sandholm, T. 2014. Empirical Price of Fairness in Failure-Aware Kidney Exchange. Towards Better and more Affordable Healthcare: Incentives, Game Theory, and Artificial Intelligence (HCAGT) workshop at AAMAS-14.
  • Leishman, R., Stewart, D., Monstello, C., Cherikh, W., Sandholm, T., Formica, R., Aeder, M. 2014. The OPTN Kidney Paired Donation Pilot Program (KPDPP): Reaching the Tipping Point in 2013. World Transplant Congress (WTC)Abstractpresentation.
  • Aeder, M., Stewart, D., Leishman, R., Sandholm, T., Formica, R. 2014. Early Outcomes of Transplant Recipients in the OPTN Kidney Paired Donation Pilot Program.
    World Transplant Congress (WTC)Abstractpresentation.
  • Stewart, D., Leishman, R., Kucheryavaya, A., Formica, R., Aeder, M., Bingaman, A., Gentry, S., Sandholm, T., and Ashlagi, I. 2014. Exploring the Candidate/Donor Compatibility Matrix to Identify Opportunities to Improve the OPTN KPD Pilot Program's Priority Point Schedule. World Transplant Congress (WTC)Abstractposter.
  • Dickerson, J., Procaccia, A., and Sandholm, T. 2013. Failure-Aware Kidney Exchange. In Proceedings of the ACM Conference on Electronic Commerce (EC)Extended version.
  • Leishman, R., Formica, R., Andreoni, K., Friedewald, J., Sleeman, E., Monstello, C., Stewart, D., and Sandholm, T. 2013. The Organ Procurement and Transplantation Network (OPTN) Kidney Paired Donation Pilot Program (KPDPP): Review of Current Results. American Transplant Congress (ATC). Abstract of talk.
  • Leishman, R., Formica, R., Andreoni, K., Friedewald, J., Sleeman, E., Monstello, C., Stewart, D., and Sandholm, T. 2013. An Early Look at Transplant Outcomes from the OPTN KPD Pilot Program: Comparing Cold Times and DGF Rates with Other Living and Deceased Donor Transplants. American Transplant Congress (ATC). Abstract of talk.
  • Stewart, D., Leishman, R., Sleeman, E., Monstello, C., Lunsford, G., Maghirang, J., Sandholm, T., Gentry, S., Formica, R., Friedewald, J., and Andreoni, K. 2013. Tuning the OPTN's KPD Optimization Algorithm to Incentivize Centers to Enter Their "Easy-to-Match" Pairs. American Transplant Congress (ATC). Abstract of talk.
  • Dickerson, J., Procaccia, A., and Sandholm, T. 2012. Dynamic Matching via Weighted Myopia with Application to Kidney Exchange. In Proceedings of the National Conference on Artificial Intelligence (AAAI).
  • Dickerson, J., Procaccia, A., and Sandholm, T. 2012. Optimizing Kidney Exchange with Transplant Chains: Theory and Reality. In Proceedings of the International Conference on Autonomous Agents and Multiagent Systems (AAMAS).
  • Woodle, S., Daller, J., Aeder M., Shapiro, R., Sandholm, T., Casingal, V., Goldfarb, D., Lewis, R., Goebel, J., and Siegler, M. 2010. Ethical Considerations for Participation of Nondirected Living Donors in Kidney Exchange Programs. American Journal of Transplantation 10: 1460-1467.
  • Awasthi, P. and Sandholm, T. 2009. Online Stochastic Optimization in the Large: Application to Kidney Exchange. In Proceedings of the International Joint Conference on Artificial Intelligence (IJCAI).
  • Rees, M., Kopke, J., Pelletier, R., Segev, D., Fabrega, A., Rogers, J., Pankewycz, O., Hiller, J., Roth, A., Sandholm, T., Ünver, U., Nibhanubpudy, R., Bowers, V., VanBuren, C., and Montgomery, R. 2009. Six Nonsimultaneous Extended Altruistic Donor (NEAD) Chains. American Transplant Congress (ATC).
  • Rees, M., Kopke, J., Pelletier, R., Segev, D., Rutter, M., Fabrega, A., Rogers, J., Pankewycz, O., Hiller, J., Roth, A., Sandholm, T., Ünver, U., and Montgomery, R. 2009. A Nonsimultaneous, Extended, Altruistic-Donor Chain. New England Journal of Medicine 360(11), 1096-1101.
  • Abraham, D., Blum, A., and Sandholm, T. 2007. Clearing Algorithms for Barter Exchange Markets: Enabling Nationwide Kidney Exchanges. In Proceedings of the ACM Conference on Electronic Commerce (EC).

Friday, January 30, 2015

Barcelona in June: experimental macro-economics and matching and market design (different events:)

Rosemarie Nagel writes to announce the

6th LeeX International Workshop co-organized with
Barcelona GSE Summer Forum on Theoretical and Experimental Macroeconomics, June 9/10, 2014.  Keynote speakers are: Roger Guesnerie (Collège de France), Pradeep Dubey (Stony Brook University).
The conference organizers are: John Duffy, University of California Irvine, Frank Heinemann, Technical University of Berlin, Rosemarie Nagel, ICREA and Universitat Pompeu Fabra, BGSE, and Shyam Sunder (Yale University). Deadline January 31, 2015 


 and
logo_leex_2logo_gse                                                          logo_upf_p                                     
Macroeconomic theories have traditionally been tested using non-experimental "field" data. However, modern, micro-founded macroeconomic models can also be tested in the laboratory, and researchers have begun to pursue such experimental tests. This June, graduate students specializing in macroeconomics or experimental economics, as well as junior faculty members and researchers of macroeconomic are invited to attend the third LeeX summer school devoted to experimental macroeconomics research.  This year's program will focus on laboratory studies that are relevant to current global financial crisis.
The intensive 5 days summer school will be held from June 8 to 14, 2015 at Universitat Pompeu Fabra (UPF) in Barcelona. Students will be taught experimental methods and exposed to a number of macroeconomic applications that have been tested experimentally. Students will be asked to participate in experiments and to develop their own experimental macroeconomic projects. Faculty will assist with and critique these projects. The different links on the top of this page will give you access to details regarding the particulars of the summer school in experimental macroeconomics.
We invite summer school students to present their ongoing research during the summer school. Such presentations may take the form of presentations during the summer school or a poster session during the associated conference workshop, depending on the number of students seeking to present their work. Such presentations will be at the discretion of the summer school organizers. Students can submit research proposals as part of their summer school application, though this is not a requirement for participation in the summer school.  Indeed, one purpose of the summer school is to think of macroeconomic topics and models that can be implemented in the laboratory in a way that advances our knowledge of behavior.
Summer school students are also invited to attend the 2 day 6th LeeX International Workshop co-organized with Barcelona GSE Summer Forum on Theoretical and Experimental Macroeconomics  from June 10-11, 2015 that will also take place at UPF.
The deadline for applications is Friday, April 10 2015.  
Summer school in experimental macroeconomics faculty:
Lecturers
Summer school organizers
  • John Duffy (University of Pittsburgh)
  • Frank Heinemann (Technische Universität Berlin)
  • Rosemarie Nagel (Universitat Pompeu Fabra)
  • Shyam Sunder (Yale university)

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

While you're there, don't miss

Workshop: Matching in Practice

Dates: June 8-9, 2015

This workshop will bring together the growing community of researchers in Europe working on the various aspects of assignment and matching in education and related labor markets, with a view to actively foster the interactions between the different strands of approaches used by these researchers (theory, experiments, analysis of field data, policy/market design) and aggregate expertise about the actual functioning of these markets in Europe.

Keynote Speaker

Christopher Avery (Kennedy School of Government, Harvard University)

Workshop Organizer

Antonio Miralles (UAB and Barcelona GSE)

Scientific Committee

  • Dorothea Kübler (Berlin Social Science Center)​
  • Antonio Miralles (UAB and Barcelona GSE)
  • Joana Pais (Lisbon School of Economics and Management)

Speaker Schedule

Summer Forum workshop schedules for 2015 will be posted as they become available.
The workshop “Matching in Practice” is supported by the Severo Ochoa Research Program (SEV2011-0075).

Thursday, January 29, 2015

The App Economy: at SIEPR

I'm looking forward to spending the day tomorrow at SIEPR, learning about how apps are changing the internet and the world. (That's one of the perks of working in Silicon Valley...)

SIEPR Policy Forum, The App Economy, Friday, January 30th, 2015.


Once again the Valley is buzzing with startups, new ventures, and concerns about a bubble.  Our next Forum will look at how the move to mobile and the explosion of entrepreneurial activity is once more driving innovation.

For the App Economy, we want to look at two big questions:

1.  What drives the Mobile and App Economy?   
2.  How is the rise of the App Economy - and mobile technology more generally - changing the rest of the economy?


Agenda

10:00-11:00:  The Mobile App Economy
Simon Khalaf, CEO, Flurry from Yahoo, "The App Economy 2015"
 
Tim Bresnahan, Stanford Economics & SIEPR, Pai-Ling Yin, SIEPR, "How Mobile Platforms Compete"
 

11:00-12:15:  Apps and Data
 "How Mobile and Big Data Change Travel"

Amir Ghodrati, AppAnnie – "App + Data"
 
Steve Tadelis – UC Berkeley Economics, "Consumer Mobile Payments and Finance Big Data"
 
 
1:00-2:15:  The Next 3 Billion Users
Rick Osterloh, CEO, Motorola Mobility,  "Reaching The Next 3 Billion Users"
Ming Zeng, Chief Strategy Officer, Alibaba
Ethan Yeh, Lead Economist, Twitter,  "Apps for the Developing World"
 
 
 
2:15-3:15:  Apps and Profits
Anna Bager,  Senior VP, Internet Advertising Bureau,  "Mobile Ads and Video"
Liran Einav, Stanford Economics,  "Mobile's Impact on Ecommerce at EBay"
 
 
3:15-4:00: Investing in Connected Commerce
Ashwini Chhabra, Uber
Simon Rothman, Partner, Greylock Venture Capital 
 
Reception following conclusion. 


A printable agenda, with biography links, is here.

Registration is available here.    

All current Stanford students are welcome, as well as members of the Stanford community with a Stanford ID.  Others are welcome by invitation.   The event is free   It begins at 10am, Friday January 30th at the Stanford Institute for Economic Policy Research, 366 Galvez Street, Stanford.

New reports that China to stop harvesting executed prisoners' organs

But no word on how they propose to manage the transition from executed prisoners to developing a voluntary source of donated organs for transplant.

Here's a BBC story: China to stop harvesting executed prisoners' organs

China has promised to stop harvesting organs from executed prisoners by 1 January, state media report.
It has said for many years that it will end the controversial practice. It previously promised to do so by November last year.
Death row inmates have long served as a key source for transplants.
China has been criticised for taking their organs without consent, but has struggled to encourage voluntary donations due to cultural concerns.
Prisoners used to account for two-thirds of transplant organs, based on previous estimates from state media.
For years, China denied that it used organs from executed prisoners and only admitted to the practice a few years ago.
The Chinese authorities put more prisoners to death every year than the rest of the world combined - an estimated 2,400 people in 2013 - according to the San Francisco-based prisoners' rights organisation, Dui Hua.
'Fair, just and transparent'
State media reported on Thursday that the head of the country's organ donation committee Huang Jiefu said that by 1 January 2015, only voluntarily donated organs from civilians can be used in transplants.
So far 38 organ transplant centres around the country, including those in Beijing, Guangdong and Zhejiang, have already stopped using prisoners' organs, according to reports.
Dr Huang, who was addressing a seminar, said that every year about 300,000 people in China need transplanted organs, but only 10,000 operations are carried out.
Grey line
Analysis: Celia Hatton, BBC News, Beijing
It's taken years for the Chinese authorities to end their own practice of harvesting organs from executed prisoners.
In 2006, Dr Huang admitted China must reduce its reliance on prisoners' organs. He repeated that again in 2009, when announcing the establishment of a national organ donation network. And finally, in 2012, Dr Huang surfaced in Chinese state media once more with a promise to end all prisoners' donations within a few years.
Why did it take so long? Thousands of people are on China's transplant waiting list in desperate need of organs, with no clear solution in sight. Attempts to address the need, by encouraging public organ donations, have faltered.
But many in China believe that bodies should remain intact after death. China's also home to a thriving illegal trade in body parts, making would-be donors nervous they will contribute to a wider problem.
A 2012 poll conducted in the southern city of Guangzhou revealed that 79% of respondents believed organ donation was "noble". However, 81% were concerned the donations "inevitably feed the organ trade."
Clearly, Chinese health officials have a lot of work to do to change public perceptions.
Grey line
With a donation rate of only 0.6 per 1 million people, China has one of the world's lowest levels of organ donation. Dr Huang compared it to Spain, which has a rate of 37 per 1 million.
"Besides traditional beliefs, one of the major roadblocks to the development of our organ donation industry is that people are concerned that organ donation will be fair, just and transparent," he was quoted as saying.
Dr Huang, who used to be the vice minister for health, had last year pledged to phase out prisoner organ transplants by the end of 2013.
Amnesty International's William Nee told the BBC that halting prisoner organ transplants would be "a positive step forward in China's human rights record", although some challenges remain.
"It will be worth seeing not only how effective a new voluntary organ donation system is, but it will also be crucial that the government becomes fully transparent about the number of people sentenced to death, the number of executions per year, and how the executions are carried out," he said.

More on This Story

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Wednesday, January 28, 2015

Is the medical match fair?

MIT News reports on a forthcoming paper by Nikhil Agarwal:

An Empirical Model of the Medical Match | Online Appendix
American Economic Review, forthcoming
(NBER Working Paper 20767 - includes analysis of government interventions for rural programs)

Here's the MIT News report:

Is the medical match fair?

Study finds the demand for positions strongly influences medical residents’ salaries.


When medical-school graduates apply for their residencies, they use a centralized clearinghouse that matches applicants with jobs. This system has sometimes been challenged, such as in a lawsuit several years ago that claimed salaries of residents were reduced by this centralized matching method.
But a forthcoming study by an MIT economist indicates that demand for a limited number of desirable residency positions can keep salaries low — and introduces a new way of assessing that demand despite incomplete data that has previously restricted analysis of the issue.
“Salaries will likely remain low unless residency programs can increase the number of positions,” says Nikhil Agarwal, an assistant professor of economics at MIT, and author of the paper on the subject.
On average, Agarwal’s study finds, salaries of medical residents are lowered by an average of $23,000 due to the demand for slots. As the study puts it, residents are willing to accept an “implicit tuition” in their wages in return for experience and prestige. In the long run, residencies may be a worthwhile tradeoff for doctors establishing themselves in the profession, even with seemingly reduced wages.  
Determining demand
Agarwal’s paper, to be published in the American Economic Review, is based on data from 2003 to 2011 gathered by the National Graduate Medical Education census.
The central clearinghouse — the National Residency Matching Program (NRMP) — matches about 25,000 medical residents annually. Incoming residents rank the positions they would most like to have, and an algorithm matches these choices with the ranked preferences of the medical programs.
A 2002 lawsuit asserted that the residents have limited bargaining power because they are assigned to positions and cannot receive multiple job offers, unfairly lowering their compensation. That suit was eventually dismissed in 2004, a few months after Congress passed an antitrust exemption for the NRMP system.
But that resolution of the lawsuit did not resolve the question of whether or not the clearinghouse does affect residency salaries. As of 2010, residents had a mean salary of about $47,000, compared to $86,000 for physician assistants, who do comparable work. Medical residents also have notably long workweeks and shifts, which themselves are the subject of intermittent public debate.
Agarwal’s study finds a new way of analyzing the compensation issue in the face of limited information. He did not have access to the ranked lists of jobs that applicants submit to the NRMP, nor to the lists of preferred candidates that medical programs submit. Even so, Agarwal was able to study the matched pairs of residents and positions, along with some additional descriptive data, such as geographic location, and determine demand on that basis.
The key to the analysis, Agarwal says, is “the fact that there are multiple residents in the same program. That tells you a lot about the residency program’s preferences for residents. Once you figure out that side of the market, you’re in business.”
For instance, Agarwal adds, “If a program [decides] to hire residents from [highly ranked] medical schools with similar licensing-exam test scores, then everybody it’s matched with will be similar on those characteristics. But if it doesn’t care about prestige of the medical school as much, there might be people from all kinds of medical schools, but their licensing-exam scores will be similar.” Partly by building a picture of those preferences and measuring it against the characteristics of the class of applicants, it is possible to estimate how many qualified applicants are available for residency positions.
An ‘imperfect’ market
An underlying implication of Agarwal’s conclusions is that the idea of a perfectly competitive, uniform market driving salaries does not ultimately hold up to scrutiny when it comes to medical residencies. There appear to be clumps of jobs considered particularly desirable, leading to uneven relationships between supply and demand within the overall residency job market.
“In [my] theory, you get a situation where people are not indifferent” in terms of job preferences, Agarwal notes.
For his part, Agarwal, who focuses on the growing field of market design, believes this method of determining preferences can be applied to other domains as well.  He is continuing to do research in the area of school choice, among other topics.

Tuesday, January 27, 2015

Choice prediction competition:

From Anomalies to Forecasts: Choice Prediction Competition for Decisions under Risk and Ambiguity 
(CPC2015)

Supported by the Max Wertheimer Minerva Center for Cognitive Processing and Human Performance
Organized by: Ido Erev, Eyal Ert, and Ori Plonsky
Submission deadline: May 17th, 2015  |  Early registration until April 1st, 2015

Here is your chance to show how to model choice behavior better than anyone else.

Ido Erev writes:

"Dear colleagues and friends,

I write to invite you to participate in a choice prediction competition that Eyal Ert, Ori Plonsky and I organize.  The goal of this competition is to facilitate the derivation of models that can capture the classical choice anomalies (including Allais, St. Petersburg, and Ellsberg paradoxes, and loss aversion) and provide useful forecasts of decisions under risk and ambiguity (with and without feedback).

The rules of the competition are described in http://departments.agri.huji.ac.il/cpc2015.  The submission deadline is May17, 2015.  The prize for the winners is an invitation to be a co-author of the paper that summarizes the competition (the first part can be downloaded from http://departments.agri.huji.ac.il/economics/teachers/ert_eyal/CPC2015.pdf).

Here is a summary of the basic idea.  We ran two experiments (replication and estimation studies, both are described in the site), and plan to run a third one (a target study) during March 2015.  To participate in the competition you should email us (to eyal.ert@mail.huji.ac.il) a computer program that predicts the results of the target study. 

The replication study replicated 14 well-known choice anomalies. The subjects faced each of 30 problems for 25 trials, received feedback after the 6th trial, and were paid for a randomly selected choice. The estimation study examined 60 problems randomly drawn from a space of problems from which the replication problems were derived.  Our analysis of these 90 problems (see http://departments.agri.huji.ac.il/cpc2015) shows that the classical anomalies are robust, and that the popular descriptive models (e.g., prospect theory) cannot capture all the phenomena with one set of parameters. We present one model (a baseline model) that can capture all the results, and challenge you to propose a better model.  The models will be compared based on their ability to predict the results of the new target experiment. You are encouraged to use the results of the replication and estimation studies to calibrate your model.  The winner will be the acceptable model (see criteria details in the site) that provides the most accurate predictions (lowest mean squared deviation between the predicted choice rates and the choice rates observed in the target study)."




Benefits--and risks--of nondirected living kidney donation

Here's a news article focusing on nondirected donation in Canada:

Desperately needed organs from anonymous living donors are saving lives but raise ethical concerns

"Ms. Vanneste’s gesture is part of a developing trend in transplant medicine: anonymous donors of kidneys or liver parts who are expanding the pool of desperately needed organs but also generating controversy.

"Some critics worry that living donors generally receive too little information about the potential risks, and that the long-term effects have not been properly studied, issues that arguably become more acute when there is no relationship with the recipient.

"The promise is alluring, though, given that the alternative — taking organs from recently expired bodies — can never come close to meeting the huge demand.
...
"Living donation has taken place since 1954, initially restricted to close family members, later expanded to include friends. Then came “chains,” where people who were not a match to a sick relative donated to another patient, and their loved one received an organ from someone else. The number of live donors in Canada now exceeds that of dead people whose organs are used.

"The transplant world used to stop short at taking an organ from living people who had no link to the eventual recipient, and some U.S. hospitals still refuse to do so. Yet dozens of volunteers a year have been approaching transplant centres across Canada about donating an organ to people they do not know.
...
"On the surface, at least, the practice seems to violate one of health care’s fundamental tenets — the Hippocratic pledge to “do no harm” — because it’s a procedure that, for the donor, is all hazard and no benefit.

"Doctors argue, however, that the risk to donors is minimal and the benefit to those suffering end-stage kidney or liver disease enormous, helping chip away at transplant wait lists on which thousands of patients languish — and many die.

"Kidneys from living donors also work better and longer than those from people who have died.

"Still, surgeons such as Dr. Robinette acknowledge they owe a special duty to people like the Vanneste sisters, unique among OR patients in that they have no medical issues themselves.
...
"As for the physical risks, specialists call them almost negligible. A 2010 study based on decades of data — only partially reflecting ongoing improvements in surgical technique — suggested just three living kidney donors out of 10,000 die within 90 days of the operation, and long-term mortality is no higher than among non-donors.

“That’s a very tiny risk,” says Dr. Ghanekar. “That’s much less than a lot of other things people do, like getting in a car and driving on the [freeway].”

"According to Statistics Canada, the death rate in traffic accidents for the general population in 2011 was actually somewhat lower, about .6 per 10,000, though that would encompass people who rarely travel by road.

"Other, recent research suggests that donating a kidney is generally safe, but not completely risk-free. A Johns Hopkins University study last year estimated that the rate of end-stage kidney disease among living donors was 30 per 10,000 — small, yet about eight times the rate among equivalent non-donors. A 2014 study by Ontario’s Institute for Clinical Evaluative Sciences indicated that women who donate a kidney have a one in 10 chance of developing high blood pressure during pregnancy, twice the risk among non-donors.

"The equation is somewhat less favourable for those who donate a piece of their liver. Though the organ has a unique ability to regenerate, about one in 300 living donors dies.

“The magnitude of risk is so much greater with [donating] livers than with kidneys, it raises a concern about the ethical soundness of the procedure,” argues Elisa Gordon, a medical anthropologist at Chicago’s Northwestern University who studies the field.
...
"Even for kidney donors, there is a general paucity of long-term data on safety, she says. And Prof. Gordon says interviews she and others have conducted with donors suggest many are not adequately informed before consenting to the procedure.

Risk, for instance, is sometimes not clearly communicated, while some donors complain they received little advice on how to protect their health following the operation, she says.

Help after the fact is generally scant for donors, echoes Cristy Wright, who gave up a kidney for her sister five years ago. When the organ failed in her sister’s body, the Ohio donor suffered an emotional fallout that left her in therapy for two years.

“There’s a lot of things on the back end that people are not prepared for,” says Ms. Wright. “Donors experience depression, they do grieve a lot of times for their lost kidney. … They experience anxiety and anger.”

"And beforehand, the pressure some face, coupled with vocabulary that tends to characterize them as “heroes,” makes it difficult to back out if they have doubts, she says."

Monday, January 26, 2015

Boxing becoming legal in Norway again (but still not in Iceland)

The Economist has the story: Laws on boxing--Bouncing back

"More countries are allowing professional boxing, despite the risks

FIRST Sweden in 2007, then Cuba in 2013, and now Norway have left the small club of countries that ban professional boxing. The centre-right coalition in power since 2013 promised to cut taxes and red tape—and to let Norwegians indulge in pastimes its predecessors deemed too dangerous, including cheaper wine and spirits, jetskis and Segways. And last month 33 years without pro boxing came to an end, leaving Iceland with the Nordic region’s sole boxing ban.

Health concerns lay behind the Norwegian ban. (Cuba had considered the violence—and prize money—incompatible with Marxism.) The World Medical Association has long called for the sport to be outlawed everywhere. But Norway’s pugilists are delighted, as they can fight at home and earnings will rise."

HT: Mike Ostrovsky