Showing posts with label Italy. Show all posts
Showing posts with label Italy. Show all posts

Friday, August 18, 2023

Kidney exchange between Portugal and Italy

 Italy-Portugal cross transplants. that click that saved two

"Thanks to a complex work of intervention planning and logistics, managed by the National Transplant Center, the Veneto Regional Transplant Center and the Portuguese institutions, the kidney of the Italian donor was removed in Vicenza and transplanted in Porto in a 41-year-old man while the Italian patient was transplanted with a kidney donated by a 36-year-old woman. The organs were harvested in the two centers simultaneously on the morning of 20 July. The Portuguese kidney arrived at Treviso airport at 2.10 pm on board a Lusitanian Air Force flight: the military delivered the organ to the regional transplant coordinator of the Veneto, Dr. Giuseppe Feltrin, receiving the Italian kidney in exchange. The 118 of Vicenza immediately transported the organ to San Bortolo where the transplantation began immediately. Both surgeries were successful and all recipients and donors went home in excellent condition."

Wednesday, April 5, 2023

Surrogacy under siege in Italy

 Opposition to surrogacy in Italy has taken aim at the babies of same sex couples.

The NYT has the story:

Surrogacy Emerges as the Wedge Issue for Italy’s Hard Right. Prime Minister Giorgia Meloni has ordered municipalities to stop certifying foreign birth certificates for same-sex couples who used surrogacy, leaving some babies in a legal limbo.  By Jason Horowitz

"the government of Prime Minister Giorgia Meloni ordered municipalities to obey a court ruling made in December and stop certifying foreign birth certificates of children born to Italian same-sex couples through surrogacy, which is illegal in Italy.

"The decision has left Martino Libero and several other children suspended in a legal limbo, depriving them of automatic Italian citizenship and residency rights like access to the country’s free health care system and nursery school.

...

"Milan, a city that has long served as a cosmopolitan haven for same-sex couples in Italy, has for now complied with the Meloni government order and suspended issuing Italian birth certificates.

"Without official recognition, Libero Martino, 2 months old this month, will have to leave and re-enter the country every few months to remain legal. A court could eventually recognize one of the men as the biological father — they decline to say which one is the sperm donor — and then they could start a separate adoption process for the other.

...

"Ms. Meloni’s government has sought to shift the issue away from the status of the children to the practice of surrogacy, which, while legal in the United States and Canada, is illegal or restricted in much of Europe outside of Greece, Ukraine and a few other countries. In Italy, home of the Vatican, it is not only illegal, but it is also widely opposed, including among Catholic corners of the center-left opposition.

...

"Prominent members of Ms. Meloni’s Brothers of Italy party have called surrogacy a crime “even worse than pedophilia,” in which gay couples, one of whom is usually the biological father, seek to “pass off” children as their own and mistake “children for Smurfs,” saying gay couples can uniquely afford surrogacy, even though it is overwhelmingly used more by heterosexual couples.

"The party is floating a proposal, made by Ms. Meloni when she was a member of Parliament, to make Italians’ seeking of surrogate births abroad — what she had called “procreative tourism” — illegal and “punishable with three months to two years of prison and a fine of 600,000 to a million euros.”

...

"In an interview shortly before her election, as her young daughter ran around her in a Sardinia courtyard, Ms. Meloni said she opposed gay marriage, not because she was homophobic — “I’ve got many, many homosexual friends” — but because she saw it as a step to same-sex adoption, which she opposed, and which the Roman Catholic Church successfully lobbied to exclude from a civil unions law passed in 2016.

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Earlier:

Monday, February 20, 2023

Monday, February 20, 2023

Will Italy criminalize foreign surrogacy?

 It's hard to ban something that people want and need and is legally available in other jurisdictions, but it looks like Italy might try it regarding surrogacy.  Here's a story from Britain's Sunday Times:

Italian families seeking surrogates abroad could face jail or €1 million fines by Tom Kington

"Italians travelling abroad to seek surrogate mothers to start families could face jail time and a million euro fine thanks to a new bill introduced by senators close to Giorgia Meloni, the Italian prime minister.

"The proposed law, which must be approved by the Italian parliament, describes surrogacy as “an execrable example of the commercialisation of the female body and the treatment of babies as merchandise”.

...

"An Italian law passed in 2004 banned surrogate pregnancies in Italy, forcing couples to travel to countries such as the United States and Canada to find surrogate mothers."

Saturday, September 10, 2022

Kidney exchange launched between the U.S. and Italy

 Here's the announcement from Italy (in Italian), on the site of the Centro Nazionale Trapianti, the National Transplant Center: 

Al via programma di trapianti incrociati di rene tra Italia e Usa, firmato l'accordo

Google translate: "The pilot phase will cover the first three cases and will be limited to  three hospitals : for Italy, the kidney transplant center of the  Agostino Gemelli Polyclinic in Rome will participate, directed by Professor Franco Citterio, present at the signing of the agreement, while for the USA the  University of Toledo Medical Center  and the hospitals of  Thomas Jefferson University in Philadelphia will be involved . Once the operational and management experimentation has been completed, the program will be re-evaluated for a possible consolidation of the protocol and for the progressive expansion to other living kidney transplant centers of the Italian network. 

"The one with the United States is  the second international exchange protocol  activated by our country: since 2018 an agreement has been in force involving France, Portugal and  Spain  and which has resulted in three cross transplants with the latter nation. From 2015 to date, the Italian national crossover kidney transplant program has allowed  77 interventions to be carried out . Overall, 2,043 kidney transplants were performed in Italy in 2021, of which 341 from living donors: of these, 5 were carried out through an exchange between donor and recipient pairs. "

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Here's the announcement from the Alliance for Paired Kidney donation, the U.S. partner (in English):

PILOT KIDNEY EXCHANGE TRANSPLANT PROGRAM LAUNCHED BETWEEN US, ITALY

""The goal of the memorandum of understanding, which was signed at the Ministry of Health in Rome, is to provide for the possible treatment of thousands of patients awaiting kidney transplants in both the U.S. and Italy. The agreement was signed on behalf of CNT by its director, Massimo Cardillo, and by Michael A. Rees, MD, PhD, the CEO of APKD and the surgical director of kidney transplantation at the University of Toledo Medical Center in Ohio.

"The new US-Italy program concerns kidney exchange transplantation, in which incompatible living donor and recipient pairs are matched with other incompatible pairs for kidney transplants. Thanks to the agreement between APKD and CNT, incompatible American and Italian donor-recipient pairs will be able to exchange with each other based on a shared algorithm that will verify the level of compatibility between those on the countries’ transplant waiting lists. In this way, patients with kidney failure, who also have an incompatible volunteer donor, will have a greater chance of receiving the transplant they need.

"In addition to the technical-operational aspects – such as the requirements of the participating hospitals, matching algorithm and overall governance of the transplant process – the agreement provides that the costs related to the transplant procedure are borne by the U.S. insurance coverage for the U.S. recipient and the Italian donor, while the Italian National Health Service will cover the expenses for the Italian recipient and the American donor. Transplant surgeries will take place in the country where the recipient is located.

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A critical role was played by Dr. Ignacio Marino, the transplant surgeon who took time off to be the mayor of Rome and is now at Jefferson Hospital in Philadelphia.

His facebook post yesterday describes some details of the proceedings (first in Italian and then in English:

"The agreement was signed by the Italian National Transplant Centre (NTC), represented by director Massimo Cardillo, and the Alliance for Paired Kidney Donation (APKD), a non-profit organisation that runs one of the largest living kidney exchange programmes in the United States, represented by its CEO, Professor Michael A. Rees, MD PhD, director of the Kidney Transplant Centre at the University of Toledo Medical Center, Ohio. The signing of the protocol was attended by the Italian Deputy Minister for Health Pierpaolo Sileri, who has wholeheartedly supported this innovative project from the outlet."

Drs. Mike Rees and Ignazio Marino

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Update, October 3:
Here's an Italian news article from Sanita24 taking note of the agreement.

G translate of first paragraph: "In no country in the world is there a sufficient number of donors to cover the transplant needs of all patients suffering from end-stage renal failure and who therefore have to resort to dialysis. To address this need, a memorandum of understanding was signed for the launch of an organ donation program in a “cross” mode between different continents, to offer a new possibility of treatment to patients on dialysis."

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Related earlier posts

Tuesday, September 4, 2018

Wednesday, June 29, 2022

Medical aid in dying in Italy--a first

 The NYT has the story:

Man Paralyzed 12 Years Ago Becomes Italy’s First Assisted Suicide  By Elisabetta Povoledo

"Paralyzed 12 years ago in a traffic accident, “Mario” faced a series of legal, bureaucratic and financial hurdles in his pursuit of death

"On Thursday, “Mario,” identified for the first time by his real name, Federico Carboni, ended his life, becoming Italy’s first legal assisted suicide, in his home in the central Italian port town of Senigallia.

"Mr. Carboni, an unmarried truck driver, was surrounded by his family, friends, and people who had helped him to achieve his goal, including officials with the Luca Coscioni Association, a right-to-die advocacy group that assisted Mr. Carboni during the past 18 months and announced his death.

...

"An Italian court ruling has declared assisted suicide permissible in Italy under certain limited circumstances, but there is no legislation enshrining the practice, which for Mr. Carboni, led to delays.

...

"In a landmark ruling in 2019, Italy’s Constitutional Court said that assisted suicide could not be considered a crime as long as certain conditions were met.

...

"The Constitutional Court ruled that in some cases assisting someone could not be considered a crime as long as the person requesting aid met certain conditions: they had to have full mental capacity and suffer from an incurable disease that caused severe and intolerable physical or psychological distress. They also had to be kept alive by life-sustaining treatments.

...

"The Roman Catholic Church is firmly opposed to assisted suicide and euthanasia, which it has called “intrinsically evil” acts “in every situation or circumstance.” 

Sunday, August 23, 2020

More on Deceased donors as non‐directed donors in kidney exchange chains

I anticipate that we  will be reading more in the future about kidney exchange chains started by a deceased donor kidney.  In the meantime, here are two recent papers:

From the American Journal of Transplantation:

Deceased donors as non‐directed donors in kidney paired donation

First published: 16 August 2020
 

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/ajt.16268

Abstract

As proof of concept, we simulate a revised kidney allocation system that includes deceased donor (DD) kidneys as chain‐initiating kidneys (DD‐CIK) in a kidney paired donation pool (KPDP), and estimate potential increases in number of transplants. We consider chains of length 2 in which the DD‐CIK gives to a candidate in the KPDP, and that candidate’s incompatible donor donates to the deceased donor (DD) waitlist. In simulations, we vary initial pool size, arrival rates of candidate/donor pairs and (living) non‐directed donors (NDDs), and delay time from entry to the KPDP until a candidate is eligible to receive a DD‐CIK. Using data on candidate/donor pairs and NDDs from the Alliance for Paired Kidney Donation, and the actual DDs from the Scientific Registry of Transplant Recipients (SRTR) data, simulations extend over two years. With an initial pool of 400, respective candidate and NDD arrival rates of two per day and 3 per month, and delay times for access to DD‐CIK of 6 months or less, including DD‐CIKs increases the number of transplants by at least 447 over two years, and greatly reduces waiting times of KPDP candidates. Potential effects on waitlist candidates are discussed as are policy and ethical issues.

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And from Transplant International: 

Kidney exchange strategies: New aspects and applications with a focus on deceased‐donor‐initiated chains

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

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/tri.13712

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Abstract: "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 program 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)."

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Previous posts:

Monday, October 14, 2019  A kidney exchange chain initiated by a deceased donor, in Italy

Tuesday, September 5, 2017 UNOS proposal: Allowing Deceased Donor-Initiated Kidney Paired Donation (KPD) Chains

Monday, April 11, 2016 Using deceased donor kidneys to start living donor kidney exchange chains

 

  1. M. L. Melcher1
  2.  
  3. J. P. Roberts2,*
  4.  
  5. A. B. Leichtman3
  6.  
  7. A. E. Roth4 and
  8.  
  9. M. A. Rees


 

Saturday, August 15, 2020

Social distancing during the plague

 The Washington Post has the story (as a tourist destination...)

Restaurants in Italy are reopening ancient ‘wine windows’ used during the plague

The coronavirus pandemic has inspired a comeback for the socially distant invention.

By Natalie B. Compton Add to list

"In the 1300s, Europeans lived in fear of the plague claiming lives across the continent. In 2020, Europeans face the threat of the coronavirus, a pandemic that has killed more than 728,000 worldwide.

..."Between the wrath of the Black Death in the 1300s and the Italian Plague in the 1600s, wine merchants in the Italian region of Tuscany built “wine windows” to protect buyers and sellers from coming into close contact."

"The socially distant precaution was ahead of its time."


Sunday, April 26, 2020

City of Science museum in Naples

Last June I gave some talks in Italy (back when there were airplanes, and in-person talks--remember?) One side trip took me to the City of Science museum in Naples.  I've just now come across a web page that memorialized that visit, with some pictures that reminded me of what a fine science museum it is.  (I still enjoy science museums, even though I'm temporarily out of kids to bring with me...)

Il Premio Nobel per l’Economia 2012 Alvin Eliot Roth in visita a Città della Scienza
19 giugno 2019



Monday, October 14, 2019

A kidney exchange chain initiated by a deceased donor, in Italy

 Deceased Donor–initiated Chains
First Report of a Successful Deliberate Case and Its Ethical Implications
Furian, Lucrezia MD1; Cornelio, Cristina PhD2; Silvestre, Cristina MD, PhD1; Neri, Flavia MD1; Rossi, Francesca PhD2,3; Rigotti, Paolo MD1; Cozzi, Emanuele MD, PhD4; Nicolò, Antonio PhD

Transplantation: October 2019 - Volume 103 - Issue 10 - p 2196–2200
doi: 10.1097/TP.0000000000002645

Background. It has been suggested that deceased donor kidneys could be used to initiate chains of living donor kidney paired donation, but the potential gains of this practice need to be quantified and the ethical implications must be addressed before it can be implemented.

Methods. The gain of implementing deceased donor–initiated chains was measured with an algorithm, using retrospective data on the pool of incompatible donor/recipient pairs, at a single center. The allocation rules for chain-ending kidneys and the characteristics and quality of the chain-initiating kidney are described.

Results. The benefit quantification process showed that, with a pool of 69 kidneys from deceased donors and 16 pairs enrolled in the kidney paired donation program, it was possible to transplant 8 of 16 recipients (50%) over a period of 3 years. After obtaining the approval of the Veneto Regional Authority’s Bioethical Committee and the revision of the Italian National Transplant Center’s allocation policies, the first successful case was completed. For the recipient (male, aged 53 y), who entered the program for a chain-initiating kidney with a Kidney Donor Risk Index of 0.61 and a Kidney Donor Profile Index of 3%, the waiting time was 4 days. His willing donor (female, aged 53 y) with a Living Kidney Donor Profile Index of 2, donated 2 days later to a chain-ending recipient (male, aged 47 y) who had been on dialysis for 5 years.

Conclusions. This is the first report of a successfully completed, deliberate deceased donor–initiated chain, which was made possible after a thorough assessment of the ethical issues and the impact of allocation policies. This article includes a preliminary efficacy assessment and describes the development of a dedicated algorithm.
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See earlier post:

Monday, April 11, 2016

Tuesday, June 18, 2019

Surrogacy law in Italy (moderated by subsequent court decisions)

The Italian law governing reproductive technology and surrogacy dates from 2004, but (although I don't think the law has been amended), some of the things it forbids have been modified by subsequent court decisions.

"This law prohibits research and reproductive cloning, the manipulation of embryos, the use of donated eggs or sperm for ART, and the cryopreservation of embryos (with the exception of severe injury/illness preventing embryo transfer). A maximum of three eggs can be fertilized and transferred per reproductive cycle. Sex-selection is only permitted through sperm sorting for sex-lined genetic diseases. All forms of surrogacy are prohibited. The use of preimplantation genetic diagnosis for the selection of embryos is generally prohibited, but has been allowed through the courts on a case-by case basis. Genetic testing for non-medical purposes is prohibited. The use of ART is restricted to stable heterosexual couples who live together, are of reproductive age, are over the age of 18, have documented infertility, and have been first provided the opportunity for adoption.”
(From G12 Country Regulations of Assisted Reproductive Technologies)

Monday, June 17, 2019

Matching markets and market design at the University of Campania, Luigi Vanvitelli

I'll be speaking today on matching markets and market design at the
Università degli studi della Campania Luigi Vanvitelli

Here's the announcement: Premio Nobel alla Vanvitelli, in cattedra c'è Alvin Roth,
and here's another.

"Alvin Roth - Premio Nobel per l'economia 2012 - all'Università Vanvitelli con una conferenza dal titolo "Matching markets and market design".

"L'evento, organizzato dal Dipartimento di Scienze politiche dell'Ateneo, si terrà il 17 giugno presso l'Aula Magna del Centro residenziale e studi della SNA, Corso Trieste a Caserta alle ore 10.30. Economista statunitense già noto per i suoi fondamentali contributi nella teoria dei giochi e dell'economia sperimentale, attualmente è Professore di Economia, presso il Dipartimento di Economia della Stanford University ed è Professore Emerito di Economia e Business Administration presso la Harvard University.


"Roth è leader mondiale nelle aree di ricerca della teoria dei giochi, economia sperimentale e market design, in particolare del disegno dei matching markets.
Il problema del combinare diversi giocatori (agenti) nel miglior modo possibile, è un problema economico molto rilevante. Lloyd Shapley (che ha condiviso il Nobel con Alvin Roth) ha studiato i diversi metodi di matching teoricamente e, a partire dagli anni ’80, Alvin Roth ha usato i risultati teorici di Shapley per spiegare come funziona una certa tipologia di mercati (i matching markets). Attraverso studi empirici ed esperimenti economici, Alvin Roth ha dimostrato che la stabilità è una caratteristica essenziale per ottenere un metodo di matching di successo. Roth ha sviluppato algoritmi per combinare medici con ospedali, studenti con scuole, donatori di organi con pazienti. Nel 2000, nell’ospedale di Rhode Island avvenne il primo scambio di reni negli Stati Uniti e la teoria sviluppata da Alvin Roth sui cicli di scambio sembrò avere un ottimo potenziale per questo tipo di applicazione. Roth e i suoi collaboratori hanno disegnato un algoritmo per lo scambio di reni sia tra pazienti e donatori diretti, sia per integrare questo tipo di scambio con donatori non diretti (come donatori deceduti o altri donatori non diretti ancora in vita). "

Sunday, April 22, 2018

Deceased donor kidney exchange chain in Italy (and some Italian kidney politics)

First, some excellent transplant news from Italy: A deceased donor kidney exchange transplant chain has been conducted there. Here's some of the (English language) press release.


PRESS RELEASE
ITALIAN NATIONAL TRANSPLANT CENTRE
THE FIRST CROSSOVER TRANSPLANT CHAIN TRIGGERED BY A CADAVERIC DONOR WAS LAUNCHED YESTERDAY IN ITALY
"On March 14th, for the first time in the world, the first live kidney transplantation chain between incompatible donor-recipient pairs (the so-called "cross over" program) triggered by a deceased donor was successfully launched in Italy.
 ....
The complex study phase for implementing the program, presented by Dr. Lucrezia Furian, member of the kidney transplant team of Padua University hospital, during the General Meeting of the Transplant Network, requested a careful retrospective evaluation of the data related to incompatible donors-recipient couples, a scrupulous analysis of the aspects related to efficacy, ethical and logistical problems and the development of algorithms for optimization of crossover chains. This study was conducted as part of an interdisciplinary research project funded by the University of Padua which involved, together with the transplant center team, researchers from the Department of Economics and Business Sciences and the Padua University Mathematics Department, led by Prof. Antonio Nicolò, scientific director of the research project. "
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Antonio NicolòProfessor of Economics at the University of Padua, has written about kidney exchange.
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Here are some of my earlier posts about starting kidney exchange chains with deceased donors:

Tuesday, June 14, 2016

The announcement also drew from the depths some curious parts of transplant politics in Italy (and in Europe more generally), where Global Kidney Exchange (GKE) has received both strong support, and organized opposition.
Here's an article from Corriere Della Sera (MARCH 16, 2018), which quotes the director of the Italian National Transplant Center as celebrating that the chain did not benefit any patient-donor pairs from poor countries, as in the proposal for GKE, which he condemns. In particular, he attacks one of the transplant surgeons involved in GKE, Ignazio Marino, a former Mayor of Rome.


This led to the following reply (in Italian, of which I am a coauthor:)

Here's the google translate of our letter:
"On 16/3 the Corriere described the transplant a Padova of a kidney taken from one deceased person for a patient who he had the wife's willingness to donate the organ but could not do it being incompatible from the immune point of view.
The lady then donated one kidney to another patient, thus helping another person. Congratulations to the living donor and to the family of the deceased donor: they are the real heroes of transplant surgery. They go also praised the doctors who performed the interventions. We must however rectify several incorrect information. It is important that the team by Paolo Rigotti has turned into reality an idea, but it is not true what the Corriere and, apparently also the Head of the National Transplant Center, that "so far nobody had thought of it". The concept was known to the whole scientific world since 2016 because published, by two signatories of this letter, on the American Journal of Transplantation. It is not even true that there are no algorithms or studies.
They have existed for years and on their basis one of the signatories of this letter received in 2012 the Nobel Prize. It is also false as written that "in the US the hypothesis among the polemics is the recourse to living Filipino donors who in exchange could take advantage of a transplant free for the sick relative ». And then defamatory to affirm that "ours surgeon Ignazio Marino "(our of whom?) would support this practice. It is true instead that there is a project (Global Kidney Exchange) that in the US has not seen any conflict, but the endorsement, in 2017, of the American Society for Transplant Surgeons, the society which brings together all the transplant surgeons. Furthermore, on January 22, 2018, the President of the Istituto Superiore di Sanità, Prof. Walter Ricciardi, in his role as a member of the Executive Board of the Organization World Health Organization has promoted this idea which has since been viewed on the WHO website. Is an idea born from the desire to help the the largest possible number of patients. In practice, if one of us wanted to give a kidney a a loved one, but can not because he has a blood group B, and the person who loves needs a kidney from a donor with a blood group A, that transplant impossible can be achieved because in there are two others in the world people who love each other and have groups opposing blood. Making them meet yes they can transplant patients otherwise they will not transplantable. This is what we illustrated in Rome, in a conference promoted by the Italian NIH, January 15, 2018. Yes it is a revolutionary project if one thinks that only in sub-Saharan Africa every year about 5 million people die because they have no access to hemodialysis or to kidney transplantation.
Ignazio R. Marino Professor of Surgery,
Jefferson University
Cataldo Doria Professor of Surgery,
Jefferson University
Michael Rees, Professor of Urology,
University of Toledo
Alvin E. Roth Professor of Economics, University
of Stanford and Harvard, Nobel Economics 2012
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And here are some previous blog posts relating to kidney exchange politics in Italy, as discussed in the letter.

Monday, January 29, 2018

Monday, January 29, 2018

Italy recommends Global Kidney Exchange to the World Health Organization

Global Kidney Exchange (GKE) was presented last week  in the executive session of the World Health Organization (WHO), the UN agency concerned with public health policy.   

Among the Statements submitted by Member States and other participants of the 142th session of the Executive Board  was this Statement from Italywhich encourages the WHO to include  in the 2019-2023 program the development of kidney transplantation  in low and middle income countries through cooperation, assistance and GKE, and proposes that the WHO should consider and implement a pilot project GKE program.  

  Here's the statement in full (points 6-10 are the action items):

Statement from Italy
Italy fully aligns with the statement carried out by Malta on behalf of European Union and its Member States.

Italy commends the DG and the Secretariat for the refined version of the Draft General Programme.

In particular Italy appreciates the additional attention given to migrants’ health in the new version of the programme of work.

In this session we would like to echo Spain’s remark and raise the EB and Member States’ attention to the problem of kidney transplantation globally.

In the past and in the current draft programme considerable attention has been correctly paid by WHO to TB, HIV and malaria,

However:

1. According to reliable international data, 2-7 million people die annually from kidney failure - more than from TB, HIV, and malaria combined. Transplantation is by far the most cost-effective treatment for kidney failure, particularly in low/middle income countries (LMIC)
2. Non-communicable diseases such as heart disease, diabetes, and kidney disease have replaced communicable diseases as the most common causes of premature death worldwide. An estimated 80% of this burden occurs in LMIC.
3. Billions of dollars are spent in LMIC to reduce the burden of communicable diseases, but significantly less is spent on non-communicable diseases. Consequently, the gap in healthcare between High Income Countries (HIC) and LMIC has become particularly large for noncommunicable diseases such as kidney failure.
4. Transplantation is preferable to dialysis as a treatment for kidney failure. Transplant patients live on average 10 years longer, and have better quality of life than those on dialysis. In some LMIC, as many as 75% of patients who start dialysis die within one year. Moreover, transplantation is much less expensive than dialysis over time. This is very much limited by the limited availability of organs that can be addressed with kidney exchange.
5. Kidney exchange extends the reach of living donation because some healthy living donors are not able to give a kidney to a loved one for reasons outside of their control. However, they could exchange their kidney with another such pair so that both patients are able to receive a living donor kidney transplant. Kidney exchange is practiced routinely in HIC and preliminary clinical experience indicates it could be expanded globally to increase access to living donor kidney
transplantation. Kidney exchange is equitable, mutually beneficial, and has been carefully developed to be ethical, legal, and transparent.
6. We encourage WHO to include organs and in particular kidney transplantation in its programme as we believe that oversight, cooperation and assistance of the WHO to carry out a pilot program with strong international governance that is consistent with the highest ethical and legal standards, and that carefully approves participating countries, facilities, healthcare providers, and patient-donor pairs should be conceived and implemented.
7. Given that transplantation is more cost effective than dialysis, the savings attained in HIC from transplantation affords LMIC patients the opportunity to participate in kidney exchanges with HIC patients. We refer to this as Global Kidney Exchange (GKE).
8. Consider the figure: the LMIC mother wishes to donate to her daughter, and the HIC brother wishes to donate to his sister, but neither pair is able to proceed. Without transplantation, the LMIC daughter will die and the HIC sister will remain on dialysis. However, through GKE each patient receives a compatible kidney from the other patient’s donor. Furthermore, the savings attained in the HIC can also support long-term care of the LMIC donor and recipient in their home country.
9. Preliminary clinical experience in a small sample of exchanges between LMIC and HIC pairs has achieved 100% patient and graft survival as well as donor safety with up to 3 years of follow-up.
10. The pilot program would establish a technical working group to develop a self-sustaining and scalable GKE program that will:
a. Execute planning meetings to carefully develop the criteria for participating countries, physicians and patient-donor pairs;
b. Design, create, and implement an international governance protocol; and
c. Perform and test Global Kidney Exchanges.


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Here's a link to the whole meeting:

142nd session of the WHO Executive Board

22 January 2018 – This week the WHO Executive Board is setting the agenda for the World Health Assembly, and determining how to best promote health, keep the world safe, and serve the vulnerable. The session takes place on
22–27 January 2018 in Geneva, Switzerland.

Update: you can watch the Italian representative, Professor Walter Ricciardi, deliver the statement  in the live webcast, afternoon session part 2 (in the links on the right), at minute 57 for about 3 minutes.
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Here are all my posts on GKE, which tell of its clinical success so far, and of some highly politicized opposition that it attracted. However as transplant professionals have had an opportunity to hear directly about the proposal, calmer, more practical discussions are taking place, and GKE is gaining support.  This most recent recommendation from Italy to the WHO seems like a responsible way to move forward.

I support the call for action in point 10 of the Statement of Italy, and I think that the need to establish careful rules around the issues included in point 6 are well considered. I'm cautiously optimistic that this will mark a turning point towards practical, evidence-based exploration of ways to extend the very considerable benefits of kidney exchange, transparently, ethically, and without undue delay.
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(Here are some pictures from our meeting in Rome, two weeks ago...)

Friday, June 2, 2017

Who can be parents in Italy? (Adoption by same sex couples...)

In Italy, Confusion and Division Over Same-Sex Parenting
Court ruling highlights conflicting views over the rights of homosexual couples as parents

"An Italian court’s decision to recognize two homosexual men as the fathers of twin children has exposed confusion and a deep divide in the country over parenting rights of same-sex couples.

It was disclosed earlier this week that a court in the northern Italian city of Trento granted the men full rights as parents to their six-year-old twins, who were born in Canada through surrogacy.

The gay community hailed the decision—the first to accord full parental rights to a non-biological father—as historic in a country that last year became one of the last in Europe to approve civil unions for gay couples. But the ruling kicked up controversy right away, with the head of the main group opposing the civil-unions bill saying it marked a “sad day for Italy.”
...
"The 2016 legislation approving civil unions stopped short of addressing broader questions of parental rights and other family law issues for same-sex couples. Political opposition was so fierce that lawmakers scotched any reference to adoption or parental rights to get the bill passed. As a result, Italian law today recognizes only the biological parent, and joint adoption by gay couples isn’t allowed.

Italian courts have been left to fill that gap in a haphazard way, with some judges approving adoption requests by gay partners of a biological parent and others turning them down. The result: up to 1,000 children of gay couples are caught in a legal limbo.
...
"Riccardo and Lorenzo, the Trento couple who released only their first names, sought to break new ground. The pair, an entrepreneur and a civil servant in their 50s who have been together for more than 20 years, were married in Canada. Their twins were born in Canada via surrogacy, a practice that is illegal in Italy. Canadian law allowed both men to be listed as the twins’ fathers on the birth certificate.

Once back in Italy, the couple sought to have the Italian state recognize the Canadian birth certificate, seeking a parental status that affords more rights than adoption in Italy. An adoptive parent’s relatives have no legal relation with the adopted children, who therefore have no legal status when it comes, for instance, to inheritance from grandparents. The court granted the couple’s request, effectively recognizing both men as fathers.

“[We] sought no more than to see our children’s legal family rights protected, just as with other families,” they said in a statement.

Nichi Vendola, a gay Italian politician and leader in the fight for same-sex rights, hailed the decision. “When you raise, care for and love a child, you’re a father, mother, parent,” he said.

In Italy, however, court decisions don’t set legal precedent, so the legislative gap remains for parliament to fill. With Italy headed to elections this year or next, there is little political appetite to take up the bruising battle over parenting rights again."

Monday, May 29, 2017

Matchmaking and market design: Italian interview

Here's an interview in Italian, largely on kidney exchange, published in advance of the Trento festival (which I plan to blog about tomorrow)
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Scambio di reni e matching markets, le ricette di Roth
Roth rivela l’intuizione e presenta l’ultimo libro: «Nei matching markets scegliamo e veniamo scelti»

Corriere di Verona28 May 2017Marika Damaggio

Monday, March 13, 2017

Matchmaking. La scienza economica del dare a ciascuno il suo: Who Gets What and Why in Italian


Matchmaking. La scienza economica del dare a ciascuno il suo  (or here or here)
(Matchmaking. The economics of giving to each his own).

I guess that's a pretty good way to translate Who Gets What and Why.

Nico Lacetera writes: "I like the subtitle  "a ciascuno il suo", which refers to a latin way of saying (suum cuique  ~ to each, their own) -- in turn, this is the title of a famous novel by a major Italian contemporary writer, Leonardo Sciascia."

Wednesday, January 25, 2017

Two California surrogacy stories from Europe, and a (pretty sad) one from Italy via Russia

Here's a late breaking story about an Italian couple that enlisted a surrogate in Russia, had the child taken from them by Italian authorities, and has just lost their appeal to the European Court of Human Rights.

ECHR rules in surrogate case--Court overrules its previous verdict
 "(ANSA) - Strasbourg, January 24 - The European Court of Human Rights said in a ruling Tuesday that Italy had not breached the rights of a couple after taking away a child born to a surrogate mother in Russia with whom they had no biological ties. The child was taken away from the couple after they returned from Russia following DNA testing showed that neither the man or the woman were its biological parent, even though a Russian birth certificate put them as parents.
    Tuesday's ruling overrides a previous decision made by the Strasbourg court in January 2015. "The Court considered that the contested measures had pursued the legitimate aims of preventing disorder and protecting the rights and freedoms of others," the ECHR said. "On this last point, it regarded as legitimate the Italian authorities' wish to reaffirm the State's exclusive competence to recognise a legal parent-child relationship - and this solely in the case of a biological tie or lawful adoption - with a view to protecting children".
    The child has been adopted by another family."

"PARADISO-CAMPANELLI VERSUS ITALY"
Surrogate motherhood: stopped by the European Court for Human Rights. The Chambre supports the Italian Court
"(Strasbourg) “The Court rules that the relationship between the applicants and the child is not part of family life”: this has been ruled by the Grande Chambre of the European Court of Human Rights, issued today about “Paradiso-Campanelli versus Italy”. The case is about an Italian couple living in the province of Campobasso, who went to Russia in 2011: through a private organisation, the married couple had had a child from a “surrogate mother” who has no biological relationship with the couple. Under Russian law, the couple could record the child as their own child, but, once back in Italy, the Court refused to record the child as the couple’s child and, after finding there was no biological relationship, it ruled that the child should be taken away from the applicants (the child was about eight months old back then) and then adopted by a different family. Today’s ruling overturns a ruling issued by the Court in January 2015: it claimed that taking the child away from the first couple breached article no. 8 of the Convention on Human Rights (right to private and family life), regardless of the child’s interest. The new ruling states, instead, that the Italian Court had actually ruled in the child’s interest and also stopped surrogate motherhood."

HT: Dorothea Kuebler
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Here are two earlier stories, set in England and Italy, from the blog Above the Law. about surrogacy as a repugnant transaction (at home) and the resulting fertility tourism (to California):

1."British aristocrats, the Viscountess and Viscount Weymouth... welcomed their second son on December 30, 2016. In what is likely a first for the British aristocracy, the child was born via surrogate.
The baby boy is the second grandson of the 7th Marquess of Bath. I’ll just assume this is kind of a big deal in England. Lady Weymouth suffers from medical complications that made a second pregnancy too dangerous. So the couple turned to a California surrogate. To their credit, they are reportedly* sharing their story to help remove some of the stigma associated with surrogacy. Welcome and all hail the Right Honourable Henry Thynn. No typo. Honorable is spelled that way on purpose."
*They explain the differences between surrogacy in California and Britain as follows:
"Ceawlin explains that the US state has the most advanced legal system for the procedure. 
For example, it allows money to be exchanged, while Britain insists no more than expenses can be paid to the woman who will carry the child.
‘Obviously, we would have preferred to do it closer to home, but the legal system in Britain has not evolved with medical technology, so any contract with a surrogate is not binding,’ he says. 
‘Even if the baby is 100 per cent yours (ie the sperm and egg) the surrogate still has the right to keep the baby. California has the most evolved legal system in the world [for surrogacy].’ 
2. "Italy Is Not A Great Place To Be Gay. The parents of the twins are a gay Italian couple. While the U.S. made the move to permit gay marriage in 2015, Italy still denies same-sex couples the right to marry. Italy also denies gay couples the right to adopt children. Italian same-sex couples can’t even adopt their own family members through kinship adoptions. And, unsurprisingly, there is no same-sex step-parent adoption since gays can’t marry in the first place.
Having limited family-building options, the couple turned to an egg donor and California surrogate to conceive their children, and complete the family they dreamed of. Two embryos were transferred to the same surrogate. One was a donor egg fertilized with sperm from dad 1; the second was a donor egg, but this time fertilized with sperm from dad 2. The twins are biologically half-siblings with the same birthday. The conditions for an Arnold Schwarzenegger/Danny DeVito situation probably couldn’t have been set any higher.
This Is What Partial A Victory Looks Like. The fathers returned from the United States to Italy with their twins in tow. But the Italian government initially refused to recognize the children as (1) sons of the fathers, and 2) eligible for Italian citizenship. The fathers’ appealed, and were able to obtain what many consider a victory.
The court determined that despite the children being born to a gay couple (strike 1), using donor eggs (strike 2 – donating eggs and/or sperm is illegal in Italy) and to a surrogate (strike 3 – surrogacy is also illegal in Italy), it would be in the children’s best interest for Italy to recognize the parent-child relationship. The court awarded parental rights of each individual twin to the genetically related father."  
(NB: the two twins aren't legally related in Italy...)
"It Could Have Been Much Worse. While this was not a complete victory, it was a step forward for Italy. In prior cases, an Italian court has denied parentage to both parents — or even taken away a surrogate-born child from the parents and made the child a ward of the state! In an infamous case from 2014, an infertile couple in their 50s — who had been turned down for adoption three times — turned to surrogacy. They paid a Ukrainian surrogate €25,000 to carry a child conceived with donated genetic material. When they brought the child back to Italy, the government refused to register the child as theirs and charged them with fraud. Sadly, the court went further, ruling that the child, whose genetic and surrogate parents were unknown, was a “child of no one.” Despite even an Italian prosecutor advising that the child be allowed to stay with the intended parents, the court ruled that the child must become a ward of the state and put up for adoption. Heartbreaking.
Europe’s Anti-Surrogate Tendencies. Italy is not an anomaly. Most of Western Europe (including France, Spain, and Germany, among others) bans surrogacy. This has led to a number of troubling cases when Europeans go elsewhere for surrogacy and then try to bring their children home. In France, for instance, several surrogacy cases have involved French courts denying parental rights. But couples have had success appealing to the European Court of Human Rights. There, a child’s right to his or her parents has prevailed over French domestic law."
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