Saturday, August 22, 2015

Storytellers prefer heroes, although research and development is done by teams...

I've spent some time helping my publisher(s) sell my book Who Gets What and Why since it came out in early June, so I have a renewed appreciation of how journalism works.

Stories are important. The easiest stories have heroes, and since books have authors, authors are even more likely to be painted as heroes in news stories about their book than in other kinds of stories. That's not crazy: authors are in many ways the heroes of the story of their book, even if the story in the book involves lots of people.

And off course, stories about science are more often stories about teams than about heroes.

Mentions of collaborators are relentlessly edited out of short pieces. That's one reason I liked writing a book (although, as it turns out, even books have editors who fight against "excessive detail"). But I've been very fortunate in my collaborators, and I was able to tell some of their stories.

If you haven't been keeping up, here are some of the stories about Who Gets What and Why that I've blogged about since the book came out: http://marketdesigner.blogspot.com/search/label/WGWaW 

Friday, August 21, 2015

Some pictures from the Econometric Society World Congress in Montreal

There were many market design talks in Montreal this week: see if you can identify these well known market designers..






Organ donation in Qatar

Here's a story from Al Jazeera:
Finding organ donors among Qatar's Muslim community
The Qatari government offers a series of incentives to those who donate their organs.

"In late 2012, the head of HMC's Organ Transplant Committee, Dr. Yousuf al-Masalamani, told the local Al Arab newspaper that expatriates made up 99 percent of people on Qatar's donor registry.

A report by Doha News last year said that of 20,000 new donor registrants that summer, less than 1,000 were Arab, including Qatari nationals.

Yosri said that superstitions and misunderstandings about religious opinions on the matter were behind low sign-up rates among those of Arab origin or Muslim faith.

"Some people believe that by signing up to give their organs after death, they are tempting fate and they will die … That's silly, obviously nobody is going to die before their time," Yosri told Al Jazeera, adding many were unaware of religious edicts encouraging the practise.

"I give most Muslims, who are unsure, a leaflet containing a fatwa by Yusuf al-Qaradawi, and the next day they've made their mind up and they're telling me they want to donate," Yosri said, referring to a religious decree by the Qatar-based Egyptian religious scholar, widely followed in Muslim-majority countries.
...
"Beyond religious arguments, the Qatari government offers a series of incentives for those who donate their organs. Living donors, who give parts of their liver or a kidney, benefit from comprehensive medical insurance for life, discounted plane tickets and compensation for loss of income during medical procedures.

"Families of deceased donors are given social care and support, as well as financial help to cover the cost of transferring the body to their home country.

Thursday, August 20, 2015

A privacy-preserving market design intervention to avoid Tay Sachs disease

Scott Kominers draws my attention to a 1987 news note in JAMA, with a privacy-sensitive market design for keeping people's sensitive genetic information private.

Tay Sachs disease is a lethal recessive-gene disease: when two carriers of the relatively rare gene have a child, they risk having a child who will be born with the disease. Genetic screening offers a chance to alert potential marriage partners if they both carry the gene. But in some of the Jewish communities in which the gene is relatively more common, there was a reluctance to be tested, for fear of being stigmatized as a carrier of the disease. An organization called Dor Yeshorim was formed to offer the following service:

 "All those taking the blood test would be assigned a number, and their test results filed at the screening center by number alone; names would not be recorded. Nor would those being tested be informed of the results, thus eliminating the anxiety of stigmatization. When a match was proposed, the matchmaker would call the screening center, revealing only the prospective couple's numbers. The matchmaker would then be informed whether the proposed match would involve two Tay-Sachs carriers.

"If the match were not to involve two carriers, marriage plans could proceed. If both parties were identified as carriers, the matchmaker would be told only that the two families should contact the center to verify the couple's numbers. The families would then be informed that both of the children were carriers and referred to counseling. Thus, carriers would learn their status only if they were to be matched with other carriers. Then both families could report that the match had failed to come about for other reasons and could look for new matches.

 by Beverly Merz, "Matchmaking Scheme Solves Tay-Sachs Problem," JAMA Nov 20, 1987, 2636-7 (Medical News and Perspectives)

Wednesday, August 19, 2015

The Hal and Al Show: Hal Varian interviews me about "Who Gets What — and Why," at Google (video)

I got to chat with Hal Varian at Google last week (Aug 10), about my book, Who Gets What and Why, and how computer science and economics come together in market design. Here's the video (55 minutes).




And here's a photo, taken by Yair Sakols

Tuesday, August 18, 2015

A look back at school choice in New Orleans

Here's an article discussing IIPSC's work in New Orleans, in the Fall issue of Education Next:

The New Orleans OneAppCentralized enrollment matches students and schools of choice, By Douglas N. Harris, Jon Valant and Betheny Gross

"In the immediate aftermath of Hurricane Katrina, New Orleans families could choose from an assortment of charter, magnet, and traditional public schools. The city initially took a decentralized approach to choice, letting families submit an application to each school individually and allowing schools to manage their own enrollment processes. This approach proved burdensome for parents, who had to navigate multiple application deadlines, forms, and requirements. Moreover, the system lacked a mechanism for efficiently matching students to schools and ensuring fair and transparent enrollment practices. The city has since upped the ante with an unprecedented degree of school choice and a highly sophisticated, centralized approach to school assignment.

"Today, New Orleans families can apply to 89 percent of the city’s public schools by ranking their preferred schools on a single application known as the OneApp (see Figure 1). The city no longer assigns a default school based on students’ home addresses. Instead, a computer algorithm matches students to schools based on families’ ranked requests, schools’ admission priorities, and seat availability. Experience with the OneApp in New Orleans reveals both the significant promise of centralized enrollment and the complications in designing a system that is technically sound but clear to the public, and fair to families but acceptable to schools. The OneApp continues to evolve as its administrators learn more about school-choosing families and school-choosing families learn more about the OneApp. The approach remains novel, and some New Orleanians have misunderstood or distrusted the choice process. The system’s long-term success will require both continued learning and growth in the number of schools families perceive to be high-quality options."

see also Opening Doors: OneApp Improves Enrollment Process but Shows Need for More Good Schools

Monday, August 17, 2015

It can be hard for parents to assemble information about schools

Here's a critique of the NYC high school choice system, from a former Dept of Ed administrator who now runs a public- and private-school admissions consulting firm that helps parents navigate the system. He calls for better advising...

Why high school admissions actually doesn’t work for many city students — and how it could
by Maurice Frumkin on August 7, 2015

"It was my pleasure to read Professor Alvin Roth’s recent piece on why New York City’s high school admissions process now works most of the time. And as the city’s former deputy director of high school enrollment and a current admissions consultant who has helped thousands of families navigate the process, I see his observations play out every day.
Given how massive the New York City process is, the mechanism of assigning students to schools after families have made their choices does, indeed, work well. But the process by which those choices are made remains complicated, and very much depends on expertise or the ability to spend an excessive amount of time understanding how it works. Many students still go without either.
...
"Part of my role at the DOE was to train middle school counselors, whose workloads, savvy, and degree to which their students’ parents were engaged in the process varied widely. Over time, many counselors have developed into admissions experts who do an outstanding job informing their families. A Manhattan school counselor entering her third year recently told me, though, that it was a challenge for her to become familiar with schools beyond the “brand name” schools that everyone talks about.
"It’s a problem Roth acknowledges. “Although it’s great to have a marketplace that gives you an abundance of opportunities, these may be illusory if you can’t evaluate them, and they can cause the market to lose much of its usefulness,” he writes.
 ...
"I speak with families every day who are convinced that although there are 5,000 applicants to a selective program with 100 seats, an offer is inevitable because their child meets the published selection criteria. They will, therefore, list fewer choices – and often only choices that represent the most sought-after, screened programs."
********
I'm reminded of this earlier post, and the advice I gave to "Jimmy," who had suffered from just this mistake...

Saturday, May 7, 2011


Sunday, August 16, 2015

The Richmond Fed on market design

 In the magazine of the Federal Reserve Bank of Richmond, in an article called
Economists and the Real World Tim Sablik, interviews Susan Athey and writes about market design.

"Many academic economists have begun collaborating more actively with private firms and public institutions. This practice has become common in the discipline of market design, for example. Robert Wilson of Stanford University helped design auctions for the oil, communications, and power industries. Along with his former student Paul Milgrom of Stanford University and with Preston McAfee, who is now the chief economist at Microsoft, Wilson received the 2014 Golden Goose Award for designing the first spectrum auctions used by the Federal Communications Commission in 1994. Alvin Roth of Stanford University and co-winner of the 2012 Nobel Prize in economics collaborated with public schools in New York City and Boston to design algorithms to improve student placement in preferred schools and with doctors to arrange kidney transplant exchanges between pairs of donors and recipients.

"Market design is a team sport," Roth said in his Nobel acceptance speech. "And it is a team sport in which it is hard to tell who are theorists or practitioners because it blurs those lines."

"Susan Athey of Stanford University says that it is "not an accident" that economists studying market design and industrial organization have collaborated heavily with real-world firms and institutions. "If you're trying to solve a real problem, you need to understand the full set of constraints to propose the best solution," she says. Her role as a consul­tant for Microsoft has influenced her research on Internet markets, such as online advertising.
...
"I got the impression that many of my peers thought I was selling out," she says. "They couldn't really understand why I was so confident my work with Microsoft was going to come back and improve my research."

"Today, many of the leading empirical studies rely on large datasets collected by firms and government agencies. As a result, more economists seem willing to risk some criticism to obtain access to these data. In a 2014 article in Science magazine, Liran Einav and Jonathan Levin of Stanford University reported that 46 percent of papers published in the American Economic Review in 2014 relied on private or non-public administrative datasets, compared with just 8 percent in 2006.
...

"I think the profession is starting to normalize the idea of working with a firm to get access to data," says Athey. "Increasingly, people are recognizing that without this private sector data, we're just not going to be able to get a complete picture of trends which could end up being very important to the economy."

Saturday, August 15, 2015

New papers on matching by Yeon-Koo Che and Olivier Tercieux (large markets and top trading cycles)

In the Cowles Foundation working paper series:

YEON-KOO CHE, Columbia University
Email: yc2271@columbia.edu
OLIVIER TERCIEUX,
Paris-Jourdan Sciences Economiques (PSE)
Email: Tercieux@pse.ens.fr
We study efficient and stable mechanisms in matching markets when the number of agents is large and individuals’ preferences and priorities are drawn randomly. When agents’ preferences are uncorrelated, then both efficiency and stability can be achieved in an asymptotic sense via standard mechanisms such as deferred acceptance and top trading cycles. When agents’ preferences are correlated over objects, however, these mechanisms are either inefficient or unstable even in an asymptotic sense. We propose a variant of deferred acceptance that is asymptotically efficient, asymptotically stable and asymptotically incentive compatible. This new mechanism performs well in a counterfactual calibration based on New York City school choice data.

YEON-KOO CHE, Columbia University
Email: yc2271@columbia.edu
OLIVIER TERCIEUX,
Paris-Jourdan Sciences Economiques (PSE)
Email: Tercieux@pse.ens.fr
We study top trading cycles in a two-sided matching environment (Abdulkadiroglu and Sonmez (2003)) under the assumption that individuals’ preferences and objects’ priorities are drawn iid uniformly. The distributions of agents’ preferences and objects’ priorities remaining after a given round of TTC depend nontrivially on the exact history of the algorithm up to that round (and so need not be uniform iid). Despite the nontrivial history-dependence of evolving economies, we show that the number of individuals/objects assigned at each round follows a simple Markov chain and we explicitly derive the transition probabilities.

YEON-KOO CHE, Columbia University
Email: yc2271@columbia.edu
OLIVIER TERCIEUX,
Paris-Jourdan Sciences Economiques (PSE)
Email: Tercieux@pse.ens.fr

We study Pareto efficient mechanisms in matching markets when the number of agents is large and individual preferences are randomly drawn from a class of distributions, allowing for both common and idiosyncratic shocks. We show that, as the market grows large, all Pareto efficient mechanisms -- including top trading cycles, serial dictatorship, and their randomized variants -- are uniformly asymptotically payoff equivalent “up to the renaming of agents,” yielding the utilitarian upper bound in the limit. This result implies that, when the conditions of our model are met, policy makers need not discriminate among Pareto efficient mechanisms based on the aggregate payoff distribution of participants. 


Friday, August 14, 2015

Repugnant markets watch: ISIS institutionalizes a market for sex slaves (NY Times)

The NY Times has a long article on sex slavery in the Islamic State, by Rukmini Callimachi, including some detail about the market's rules and institutional features:

ISIS Enshrines a Theology of Rape--Claiming the Quran’s support, the Islamic State codifies sex slavery in conquered regions of Iraq and Syria and uses the practice as a recruiting tool.

"The systematic rape of women and girls from the Yazidi religious minority has become deeply enmeshed in the organization and the radical theology of the Islamic State in the year since the group announced it was reviving slavery as an institution.
...
"The trade in Yazidi women and girls has created a persistent infrastructure, with a network of warehouses where the victims are held, viewing rooms where they are inspected and marketed, and a dedicated fleet of buses used to transport them.
...
"A growing body of internal policy memos and theological discussions has established guidelines for slavery, including a lengthy how-to manual issued by the Islamic State Research and Fatwa Department just last month.
...
"The Islamic State’s formal introduction of systematic sexual slavery dates to Aug. 3, 2014, when its fighters invaded the villages on the southern flank of Mount Sinjar, a craggy massif of dun-colored rock in northern Iraq.
...
"Their captors appeared to have a system in place, replete with its own methodology of inventorying the women, as well as their own lexicon. Women and girls were referred to as “Sabaya,” followed by their name. Some were bought by wholesalers, who photographed and gave them numbers, to advertise them to potential buyers.

"Osman Hassan Ali, a Yazidi businessman who has successfully smuggled out numerous Yazidi women, said he posed as a buyer in order to be sent the photographs. He shared a dozen images, each one showing a Yazidi woman sitting in a bare room on a couch, facing the camera with a blank, unsmiling expression. On the edge of the photograph is written in Arabic, “Sabaya No. 1,” “Sabaya No. 2,” and so on.
...
"The use of sex slavery by the Islamic State initially surprised even the group’s most ardent supporters, many of whom sparred with journalists online after the first reports of systematic rape."
...
"In a pamphlet published online in December, the Research and Fatwa Department of the Islamic State detailed best practices, including explaining that slaves belong to the estate of the fighter who bought them and therefore can be willed to another man and disposed of just like any other property after his death.

"Recent escapees describe an intricate bureaucracy surrounding their captivity, with their status as a slave registered in a contract. When their owner would sell them to another buyer, a new contract would be drafted, like transferring a property deed. At the same time, slaves can also be set free, and fighters are promised a heavenly reward for doing so.

"Though rare, this has created one avenue of escape for victims.

"A 25-year-old victim who escaped last month, identified by her first initial, A, described how one day her Libyan master handed her a laminated piece of paper. He explained that he had finished his training as a suicide bomber and was planning to blow himself up, and was therefore setting her free."

Thursday, August 13, 2015

Private and public sex, and prostitution

A thoughtful op-ed in the NY Times asks just what is prostitution, and how do we distinguish various kinds of private (as opposed to public) sexual behavior?
When Prostitution Is Nobody’s Business
By LAURIE SHRAGE

"But where, exactly, is the border between the private exchange of money or gifts and the impersonal profit-making of the market?

"When sexual partners exchange money and gifts between themselves, we generally see this as a private exchange. However, what do we do if a person has several sexual partners, and regularly receives money and gifts from each of them? Traditionally, a woman who had more than one sex partner from whom she received various forms of material support was likely to have been regarded as a “public woman,” that is, a prostitute, whore or sex worker. Although there has been significant social tolerance historically for men who have and support multiple mistresses, moral disapprobation for women who have multiple lovers has resulted in laws in which women who have several sex partners from whom they accept gifts can face arrest for prostitution.

"Having multiple, casual or ongoing partners from whom one receives monetary support is not the same as running a brothel, or setting up a home business that advertises publicly and accepts customers based on their ability to pay. Yet the line between these kinds of activities may be hard, at times, to make out. For example, should a person who is, say, polyamorous, and has multiple lovers who economically support her, have a right to physical, informational and decisional privacy in regards to her sex life?

Wednesday, August 12, 2015

Credit cards in Who Gets What and Why--excerpt in Business Insider

Yesterday's Business Insider published a few-paragraph excerpt from Who Gets What and Why:

The 'cash back' you get from your credit card comes from the guy behind you in line

Surrogacy troubles in Thailand

The Guardian has the story, about incomplete contracts and changing laws and social support for surrogacy in Thailand.
Gay parents fight to leave Thailand with surrogate baby daughter

"A same-sex couple is embroiled in a legal battle in Thailand after the surrogate mother who gave birth to their child has refused to allow them to leave the country claiming she was unaware they were gay.

"The surrogate – who is biologically unrelated to the baby – handed over baby Carmen to Gordon Lake, an American, and his Spanish husband, Manuel, in January but later refused to sign documents to allow the infant to get a passport.

Tuesday, August 11, 2015

Conference housing pirates--the (criminal) market for hotel rooms

Here's a scam I hadn't encountered before.

I will be speaking at a transplant conference in February, and last week my phone rang and someone asked me if I had already made my hotel reservations, and offered to make them for me. I declined, and emailed the conference organizer asking if this was how housing was being arranged. In reply I got the following (slightly redacted) email, addressed to all the speakers....

"Dear ... Faculty,

I have received word from two speakers who advised me that they were contacted by a company called Expo Housing. (They can go by other names too) xxx told me she was contacted by a xxx who left an 866 call back number.

This company ...has NOT been contracted to organize, sell or arrange housing for anyone attending or speaking at the [conference] taking place in February 2016 ....

Please DO NOT BOOK housing with anyone. As a speaker you will receive a travel and housing survey from me or another member of the  staff located in the ... National Office. Please contact me immediately if you are contacted by anyone trying to book your housing. 

Our housing website is under construction at this time but again, as a speaker your housing will be arranged by  staff.

Housing pirates or hijackers are illegal entities who "sell" hotel rooms. These rooms can exist or not exist. Often times your money is lost. Typically these people target large meetings like the American Transplant Congress, but no meeting is safe. Any rooms booked through a pirate are not guaranteed by the group nor will they be included in the [conference] block of rooms. "
  

Monday, August 10, 2015

Organjet versus regional transplant lists

Forbes discusses the unequal waiting times for deceased donor organs caused by the fact that transplant waiting lists are organized regionally.

Your New Liver Is Only A Learjet Away: First Of Three Parts

"Tayur’s initial business model for OrganJet was quite simple. OrganJet would charge a modest fee to help clients figure out which transplant programs would be likely to shorten their waiting time for an organ. Clients could then sign up to have access to an on-demand flight, in case one of those transplant programs called up with an available donor. Having a flight at ready disposal is critical because many transplant programs require patients to arrive within six hours after an organ becomes available, or they pass the organ on to the next person on the list. The six hour requirement exists because in organ transplantation, donor organs need to be placed into recipients in a timely manner or the organs accumulate irreversible damage. Thus, if a patient on the transplant waiting list in, say, Pittsburgh cannot make it there in time, the transplant team will call another candidate until it finds one that can make use of the organ.
Excited about his chance to address an important social problem, Tayur began working through the details of his business plan, issues such as how many jet companies he would need to contract with and how much money he would need to charge customers for a given flight. “I envisioned OrganJet as an opportunity to make some money and save some lives at the same time,” Tayur told me, words not that different from what honest medical school applicants would tell interviewers about their career choice. The fees he charged customers for these flights would not only cover the charge of paying for the pilots and the fuel, but would include a surcharge that would be the source of OrganJet’s profits.
Tayur was excited about his idea, but the more people he bounced his business plan off, the more pushback he received. In particular, many people told Tayur his idea would only promote greater unfairness in the transplant system, by further disadvantaging people who lacked the financial resources to pay for OrganJet’s services. Tayur thought he could minimize this problem by convincing health insurance companies to pay for the flights, but his critics pointed out that many low-income patients wouldn’t be able to afford such generous insurance.
Tayur realized his new company needed to become two new companies. He had already incorporated OrganJet as a nonprofit entity in May 2011. So in July of 2012 he started a second company, GuardianWings, a tax-exempt nonprofit that raises funds to cover flight costs for low-income patients. His vision was now clear – he would work to overcome geographic inequities in transplantation one patient at a time, giving everyone a fair shake at life-saving treatments even if they were not wealthy CEOs."
...
"Neither Medicare nor Medicaid currently pays for OrganJet’s services, and it is too early to tell whether private insurers will embrace OrganJet’s prices. Tayur, the CEO of OrganJet, is still negotiating with insurance companies on a case-by-case basis. He is also negotiating with large companies that self-insure their employees, presenting them with results of statistical analyses he has conducted which demonstrate that OrganJet’s services could save them money: “It would get their employees off dialysis sooner, not only improving their quality of life in the process, but also allowing them to return to work sooner, with greater productivity.”"

Sunday, August 9, 2015

SITE workshops on Psych and Econ, and on Experimental Econ, Aug 10-14

Starting tomorrow, a week of behavioral and experimental econ at Stanford...

August 10-12, 2015
The location for this session will be the Arrillaga Alumni Center, 326 Galvez St., Stanford campus
Organized by:
  • Doug Bernheim, Stanford University
  • John Beshears, Harvard University
  • Vincent Crawford, University of Oxford
  • David Laibson, Harvard University
  • Ulrike Malmendier, University of California, Berkeley
This workshop will focus on recent research in behavioral economics. While the standard model of economic decision-making has proven useful in a wide variety of settings, its limitations are also well-documented. The field of behavioral economics seeks to enrich the standard model, thereby improving its descriptive and predictive accuracy, by incorporating insights from psychology and other disciplines, and to examine the implication of those enriched models for a wide variety of important economic issues, such as the effects of policies affecting spending, saving, labor supply, and investment. While considerable progress has been made in this subfield, our theoretical and empirical understanding of economic behavior remains incomplete.


August 13-14, 2015
The location for this session will be the Arrillaga Alumni Center, 326 Galvez St., Stanford campus
Organized by:
  • Katherine Baldiga Coffman, Ohio State University
  • Christine Exley, Harvard Business School
  • Muriel Niederle, Stanford University
  • Alvin Roth, Stanford University
  • Lise Vesterlund, University of Pittsburgh
This session is dedicated to advances in experimental economics combining laboratory and field-experimental methodologies with theoretical and psychological insights on decision-making, strategic interaction, and policy. We invite papers in lab experiments, field experiments, and their combination that test theory, demonstrate the importance of psychological phenomena, and explore social and policy issues.
Presentation theme groupings:
  • Time Inconsistency - Thursday 9-10:30am
  • Social Preferences - Thursday 11am-12:30pm
  • Generosity & Giving - Thursday 2-3:30pm
  • Shorter Papers and Future JM Candidates - Thursday 4-6pm
  • Experimental Techniques - Friday 9-10:30am
  • Incentive Schemes - Friday 11am-12:30pm
  • Theory Experiments - Friday 2-3:30pm
  • Consumption (Positive & Negative) - 4-5:30pm

Saturday, August 8, 2015

Is it time to compensate kidney donors?

Tina Rosenberg in the NY Times thinks it is: It’s Time to Compensate Kidney Donors

"Still, a debate is beginning to emerge. In the United States, some prominent kidney doctors believe we might learn something from Iran. “My journey was from ‘this is all immoral and we shouldn’t think about it’ to the other side,” said Robert Gaston, executive co-director of the Comprehensive Transplant Institute at the University of Alabama at Birmingham, and a recent past president of the American Society of Transplantation, one of two American organizations of transplant doctors. “Iran’s program can’t be termed a universal success. But it is a reasonable approach, a transparent, ethical way to address kidney disease in the population there.”

While no country seems willing to follow Iran into providing monetary incentives for kidney donors, many are starting to remove the financial disincentives that make donating a kidney an activity only for those with disposable income."

Friday, August 7, 2015

You can't say that! Repugnant words

The WSJ has the story on words we think people shouldn't say:
How Dare You Say That! The Evolution of Profanity
From ‘Odsbodikins’ to ‘belly,’ the banned words of our ancestors look as bizarre today as tribal rituals

"In other respects, we’re actually quite a bit like our ancestors. We are hardly beyond taboos; we just observe different ones. Today, what we regard as truly profane isn’t religion or sex but the slandering of groups, especially groups that have historically suffered discrimination or worse. Our profanity consists of the N-word, that C-word once suitable for an anatomy book discussion of women’s bodies, and a word beginning with f referring to gay men (and some would include a word referring to women beginning with b).

"It might seem strained to compare our feelings about the N-word with a bygone era’s appalled shuddering over the utterance of “By God!” But do note that I have to euphemize the N-word here in print just as someone would have once have felt compelled to say, “By Jove!”

Thursday, August 6, 2015

First kidney exchange in South Africa

South Africa's Daily Maverick has the story:
Saving lives: South Africa joins paired kidney exchange revolution, ANDREA TEAGLE  SOUTH AFRICA 06 AUG 2015

"On March 6, 2015, South Africa’s first kidney exchange took place at the Donald Gordon Medical Centre in Johannesburg. After having been kept alive by dialysis for years, 24-year-old Vivek [not his real name] and 60-year-old Allison Stevenson were both given a new lease on life.
...
"This was South Africa’s first paired kidney exchange. And it happened almost by chance.
“This youngster in Port Elizabeth – his mother was so anxious about him, she phoned the transplant centre in Johannesburg … It was like the next week that I phoned up.” Stevenson recalls, “And there, Belinda (a transplant coordinator), had this file on her desk, where the aunt didn’t match the nephew. It just so happened that she matched me, and Sally matched Vivek.”
...
"South Africa relies primarily on deceased kidney donations. Of the 4,300 people on the waiting list for life saving, most are waiting for a kidney. There is only a small hope of getting one: just 0.2% of the population are registered as organ donors. And a host of medical requirements need to be satisfied for a match. The waiting list is like a mile long tightrope to life and many people never make it across.
...
"This is an example of what economists call a mismatched market. And for at least one economist, Stanford Professor Alvin Roth, it posed an exciting challenge. Roth and his colleagues were able to apply a model to the problem they had initially built out of mathematical curiosity. In 2012, this work won him a joint Nobel Prize in Economics.
Roth’s matching program builds little bridges between supply and demand. The simplest case is a two-way exchange like Stevenson’s. By decoupling the donors from their intended (but incompatible) recipients, and recoupling them with compatible ones, long chains of transplants can take place that otherwise would have been impossible.
...
"In South Africa this type of optimised matching is but a dream.
The National Health Act allows for living donors to donate to a blood relative or a spouse. If the donor is not a relative, he or she must apply for special permission from the Department of Health. In South Africa – as in every other country in the world with the exception of Iran – the sale of organs is illegal.
The hesitancy to implement paired matching, although the law does not in fact prohibit it, is likely partly due to fear of abuses through monetary exchange. (It is, however, lawful for the donor to be reimbursed for “reasonable costs” associated with the transplant.)
However, Stevenson’s case shows that paired exchanges can be subjected to the same careful scrutiny as direct donations. Only after establishing that neither donor had been coerced, misled or financially incentivised, did the Department of Health give the go-ahead. Further, the pairs were not allowed to meet or communicate prior to the operation, so Stevenson has never met her actual donor.
...
"The successful matching is an important step towards overcoming what surgeon Francis Delmonico, who was involved in the original matching program in the US, described as “the frustration of a biological obstacle to transplantation”. However, without a registry of living donors, finding a paired match will require hours of effort, and many will not be as lucky as Stevenson."

Wednesday, August 5, 2015