Tuesday, August 23, 2016

More on starting kidney exchange chains with deceased donor kidneys

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

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

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


Here's a post about that earlier article:

Using deceased donor kidneys to start living donor kidney exchange chains


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

Monday, August 22, 2016

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

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

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

Background

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

Study Design

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

Results

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

Conclusions

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

Sunday, August 21, 2016

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

Deutscher Wirtschaftsbuchpreis 2016: Die Shortlist

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

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

Saturday, August 20, 2016

Differential privacy at Apple

The MIT Technology Review has an article about Apple's use of differential privacy, that caught my eye for several reasons: Apple’s New Privacy Technology May Pressure Competitors to Better Protect Our Data: The technology is almost a decade-old idea that’s finally coming to fruition.

"On a quarterly investor call last week, Apple CEO Tim Cook boasted that the technology would let his company “deliver the kinds of services we dream of without compromising on individual privacy.” Apple will initially use the technique to track trends in what people type and tap on their phones to improve its predictive keyboard and Spotlight search tool, without learning what exactly any individual typed or clicked.
...
“It’s exciting that things we knew how to do in principle are being embraced and widely deployed,” says Aaron Roth, an associate professor at University of Pennsylvania who has written a textbook on differential privacy. “Apple seems to be betting that by including privacy protections, and advertising that fact, they will make their product more attractive.”
In the version of differential privacy Apple is using, known as the local model, software on a person’s device adds noise to data before it is transmitted to Apple. The company never gets hold of the raw data. Its data scientists can still examine trends in how people use their phones by accounting for the noise, but are unable to tell anything about the specific activity of any one individual.
Apple is not the first technology giant to implement differential privacy. In 2014 Google released code for a system called RAPPOR that it uses to collect data from the Chrome Web browser using the local model of differential privacy. But Google has not promoted its use of the technology as aggressively as Apple, which has this year made a new effort to highlight its attention to privacy (see “Apple Rolls Out Privacy-Sensitive Artificial Intelligence”)."

Friday, August 19, 2016

Interview with a kidney buyer and seller in Syria

Here's an interview with a displaced person in Syria (an internal refugee) and the Syrian woman to whom he sold his kidney:
The woman in need of a kidney and the man willing to sell one to her: ‘I’m at the end of the line’

Here's the prolog:
"Regime forces burst into a village in the east Homs countryside last November to drive the Islamic State out. Fadi a-Salamah, 36, fled Mahin with his family and headed 160 km south to Damascus.

When he arrived in the capital, a-Salamah began working the graveyard shift in a fast food restaurant. After four months, he was stopped and interrogated one night at a checkpoint.

Fearing for his life, a-Salamah quit his job.

Unable to find work, he exhausted his SP400,000 savings (about $2,000). His landlord threatened to kick him, his wife and his three young children out of their house.

Desperate to keep his family off the streets, a-Salamah turned to what he considers all he has left to sell—his kidney, for $4,000.

A-Salamah went to a nearby hospital where he conducted a kidney screening and tissue-type test. He left his number with the doctor in the event a patient with compatible blood and tissue types needed a kidney.

On June 20, a-Salamah received a call from a 50-year-old Damascene woman with failing kidneys. The woman is the aunt of Syria Direct’s Bahira al-Zarier, and asked that her name not be published.

After 20 years of kidney disease, the woman says her doctor told her that weekly dialysis treatments were no longer effective.

When the doctor told her that her and a-Salameh’s tissue were 100 percent compatible, “I almost couldn’t contain my joy.”

“At the same time, I feel guilty because I’m taking advantage of someone’s financial need.”

At the time of the interview, a-Salamah and the woman were waiting for the doctor to set an appointment for the operation."

HT: Jonathan Spencer

Thursday, August 18, 2016

Transplant surgeons meet in Hong Kong amid questions about China's continued use of organs from executed prisoners

The NY Times has the story: Debate Flares on China’s Use of Prisoners’ Organs as Experts Meet in Hong Kong

It discusses a recent article in the American Journal of Transplantation:
Transplant Medicine in China: Need for Transparency and International Scrutiny Remains by T. Trey, A. Sharif, A. Schwarz, M. Fiatarone Singh, and J. Lavee

Here's the abstract of the article:
"Previous publications have described unethical organ procurement procedures in the People's Republic of China. International awareness and condemnation contributed to the announcement abolishing the procurement of organs from executed prisoners starting from January 2015. Eighteen months after the announcement, and aligned with the upcoming International Congress of the Transplantation Society in Hong Kong, this paper revisits the topic and discusses whether the declared reform has indeed been implemented. It is noticeable that China has neither addressed nor included in the reform a pledge to end the procurement of organs from prisoners of conscience, nor have they initiated any legislative amendments. Recent reports have discussed an implausible discrepancy of officially reported steady annual transplant numbers and a steep expansion of the transplant infrastructure in China. This paper expresses the viewpoint that, in the current context, it is not possible to verify the veracity of the announced changes and it thus remains premature to include China as an ethical partner in the international transplant community. Until we have independent and objective evidence of a complete cessation of unethical organ procurement from prisoners, the medical community has a professional responsibility to maintain the academic embargo on Chinese transplant professionals."
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The NY Times story includes this:
"In an interview conducted on the messaging app WeChat, Huang Jiefu, a senior Chinese transplant official and a former deputy minister of health, appeared to defend the changes but simultaneously acknowledge they were far from perfect.

“We have finished walking the first step of a long march of 10,000 li, the task is heavy and the road far, but we are walking on a path of light,” he wrote. "

Wednesday, August 17, 2016

Salary negotiation: some Massachusetts market design

The NY Times has the story: Massachusetts Bans Employers From Asking Applicants About Previous Pay

"In a groundbreaking effort to close the wage gap between men and women, Massachusetts has become the first state to bar employers from asking about applicants’ salaries before making them job offers.

"The new law will require hiring managers to offer a compensation figure upfront — based on what the applicant’s worth is to the company, rather than on what he or she made at a previous position.
...
"No longer will job seekers be compelled to disclose their salary or wages at their current or previous jobs — which often leaves applicants with the nagging suspicion that they might have been offered more money if the earlier figure had been higher. Job candidates will still be allowed to volunteer their salary information.

"The Massachusetts law, which will take effect in July 2018, takes aim at the subtle factors that often play into compensation decisions. Companies will not be allowed to prohibit their workers from telling others how much they are paid, a move that advocates say can increase salary transparency and help employees uncover disparities."
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It will be interesting to see how this plays out. The intention is to free people from being forever constrained by their salary history. Employers will be worried about the winner's curse...