Tuesday, March 19, 2024

The Impact of prioritization on kidney and liver allocation in Israel

   Israel's  Organ Transplantation Law grants some priority on waiting lists for transplants to candidates who are first-degree relatives of deceased organ donors (i.e. whose family has given permission for someone's deceased organ donation) or who previously registered as organ donors themselves. (There's also a tiny priority for relatives of people who signed organ donor cards...)  Here are two papers that looks at the effect of those priorities on kidney and liver transplants, and how they interact with other priorities on waiting lists for Israeli organs.  

The first paper, on kidneys, concludes that the priorities are effective in reducing waiting time to transplant, and suggests that perhaps these priorities should not be so large compared to other existing priorities (e.g. for time on dialysis), or for priorities that could be established, e.g. for highly sensitized patients (who get high priority in the U.S., for example.)

Mor, Eytan, Meitar Bloom, Ronen Ghinea, Roi Anteby, Ronit Pasvolsky-Gutman, Ron Loewenthal, Ido Nachmani, and Tammy Hod. "The Impact of the Donor Card Holder Prioritization Program on Kidney Allocation in Israel." Transplantation (2024): 10-1097.

Abstract

Background: Since 2014, as part of a priority program within the Israeli Transplant Law, additional points were given to waitlisted candidates with donor cards. We assessed the impact on deceased donor kidney allocation.

Methods: This study enrolled all patients older than 18 y who underwent deceased donor kidney transplantation (January 2016–December 2019). Data were obtained from the National HLA Tissue Laboratory registry at the Sheba Medical Center. Patients were grouped by donor card status (ADI group) (not signed, 0 points; relative signed, 0.1 points; patient signed, 2 points; and relative donated, 9 points). The primary outcome was waiting time until kidney transplantation with and without the additional score.

Results: Four hundred forty-four patients underwent kidney transplantation during the study period: 281 (63%) were donor card holders (DCH) and 163 (37%) were not DCH. DCH with extra points waited 68.0 (±47.0) mo on average, compared with 94.6 (±47.3) mo for not DCH (P < 0.001). Donor card signers had a shorter time until transplant in a multivariable model. Without extra points, 145 recipients (32.6%) would have missed organs allocated to higher-scored candidates. Allocation changes occurred in 1 patient because of an additional 0.1 points, in 103 candidates because of an additional 2 points, and in 41 candidates because of an additional 9 points.

Conclusions: Additional DCH scores improved allocation and reduced waiting time for donor card signers and those with donating relatives. To enhance fairness, consideration should be given to reducing the score weight of this social criterion and raising scores for other factors, especially dialysis duration.

##########

There are many fewer liver transplants than kidney transplants, and the effect of priority is less clear:

Ashkenazi, Tamar, Avraham Stoler, and Eytan Mor. "The effect of priority given to donor card holders on the allocation of livers for transplant—evidence from 7 years of the Israeli priority program." Transplantation 106, no. 2 (2022): 299-307.

Abstract

Background. The Israeli Transplant Law grants priority in organ allocation to patients signing a donor card. Liver transplant candidates get additional 2 points on their Model for End Stage Liver Disease score for signing a donor card, 0.1 points for a relative holding a card, and 5 points if a relative donated an organ. We studied the effect of the priority program on waiting list mortality and allocation changes due to priority.

Methods. Using Israeli Transplant data of 531 adult liver transplant candidates with chronic liver disease listed between 2012 and 2018 we compared waitlist mortality and transplant rate of candidates with and without priority. Then we analyzed liver allocations resulting from additional priority points and followed outcome of patients who were skipped in line.

Results. Of the 519 candidates, 294 did not sign a donor card, 82 signed, 140 had a relative sign, and for 3, a relative donated an organ. The rates of waitlist mortality in these 4 groups were 22.4%, 0%, 21.4%, and 0%, respectively, and the transplant rates were 50%, 59.8%, 49.3%, and 100%, respectively. Of the 30 patients who were skipped because of priority, 24 subsequently underwent transplant, 2 are on the waiting list, and 4 died within 0.75, 1.75, 7, and 17 mo.

Conclusions. The 2 points added to the Model for End Stage Liver Disease score were associated with lower waitlist mortality and higher transplant rate for candidates signing a donor card without significantly affecting access to transplant during allocation. Further research and consideration of optimal policy when granting priority for candidates signing a donor card should continue.

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Earlier:

Stoler, Avraham,  Judd B. Kessler, Tamar Ashkenazi, Alvin E. Roth, Jacob Lavee, “Incentivizing Authorization for Deceased Organ Donation with Organ Allocation Priority: the First Five Years,” American Journal of Transplantation, Volume 16, Issue 9, September 2016,  2639–2645.

 Stoler, Avraham, Judd B. Kessler, Tamar Ashkenazi, Alvin E. Roth, Jacob Lavee, “Incentivizing Organ Donor Registrations with Organ Allocation Priority,”, Health Economics, April 2016 Volume: 26   Issue: 4   Pages: 500-510   APR 2017


Monday, March 18, 2024

Eyal Winter's historical novel "Anna's Children"

 Eyal Winter, the eminent Israeli economist (who was a postdoc of mine a lifetime ago, in Pittsburgh), has published a novel called Anna's Children, about his aunt, who tried to rescue 22 orphans after Kristallnacht. It's discussed in this interview in Haaretz (and there is another link to the article here if the one below doesn't work).

'The Idea That Who You Are Is Only Genetics Is the Essence of Evil' A new book by Prof. Eyal Winter, an economist and games theory researcher, tells the story of his aunt, a woman of high society in pre-Nazi Germany, who tried to rescue 22 orphans from the Holocaust.  by Gili Izikovich

"Winter, 64, is no stranger to writing, but "Anna's Children" is his first novel. He was born and raised in Jerusalem and now lives in a bright, beautiful stone house in the suburb of Mevasseret Zion.

...

"Is this a good time to publish a book about the Holocaust?

"I pondered a lot about the link between the Holocaust and what happened in October," says Winter. "I considered delaying the book. It's a difficult story with a bad ending, but it also has elements of comfort given what is happening with us. It's possible to understand our reactions to the contemporary situation and maybe make it easier somehow."

#######

Here's his related post on Linkedin: Eyal Winter’s Post



Sunday, March 17, 2024

Privacy while driving

 Internet connected cars collect lots of data on driving behavior, which can be sold to insurance companies and used to change drivers' insurance rates.

The NYT has the story:

Automakers Are Sharing Consumers’ Driving Behavior With Insurance Companies . LexisNexis, which generates consumer risk profiles for the insurers, knew about every trip G.M. drivers had taken in their cars, including when they sped, braked too hard or accelerated rapidly.   By Kashmir Hill

"LexisNexis is a New York-based global data broker with a “Risk Solutions” division that caters to the auto insurance industry and has traditionally kept tabs on car accidents and tickets. 

...

"In recent years, insurance companies have offered incentives to people who install dongles in their cars or download smartphone apps that monitor their driving, including how much they drive, how fast they take corners, how hard they hit the brakes and whether they speed. But “drivers are historically reluctant to participate in these programs,” as Ford Motor put it in a patent application that describes what is happening instead: Car companies are collecting information directly from internet-connected vehicles for use by the insurance industry.

"Sometimes this is happening with a driver’s awareness and consent. Car companies have established relationships with insurance companies, so that if drivers want to sign up for what’s called usage-based insurance — where rates are set based on monitoring of their driving habits — it’s easy to collect that data wirelessly from their cars.

But in other instances, something much sneakier has happened. Modern cars are internet-enabled, allowing access to services like navigation, roadside assistance and car apps that drivers can connect to their vehicles to locate them or unlock them remotely. In recent years, automakers, including G.M., Honda, Kia and Hyundai, have started offering optional features in their connected-car apps that rate people’s driving. Some drivers may not realize that, if they turn on these features, the car companies then give information about how they drive to data brokers like LexisNexis.

"Automakers and data brokers that have partnered to collect detailed driving data from millions of Americans say they have drivers’ permission to do so. But the existence of these partnerships is nearly invisible to drivers, whose consent is obtained in fine print and murky privacy policies that few read.

"Especially troubling is that some drivers with vehicles made by G.M. say they were tracked even when they did not turn on the feature — called OnStar Smart Driver — and that their insurance rates went up as a result."

Saturday, March 16, 2024

Match Day for new doctors

 The 2024 Match for new American doctors was announced yesterday by the NRMP, the National Resident Matching Program. Congratulations to all!

Here are some links:

Advance Data Tables
Match By the Numbers
Press Release




Friday, March 15, 2024

Plasma in Canada: payments and protests

 The local newspaper in Niagara on the Lake, a town in Ontario, Canada, covers the proposed opening next year of plasma collection centers that will pay for plasma.

Pay-for-plasma centre draws criticism from Health Coalition. The centre, which will pay residents to donate their blood plasma, is scheduled to open on Hespeler Road by early 2025, by Matt Betts

"The chair of the Waterloo Region Health Coalition is raising concerns about a pay-for-plasma centre slated to open on Hespeler Road in Cambridge by early 2025.

"Just as it sounds, residents can be compensated for donating their blood plasma.

"It's all part of an agreement between Spanish global healthcare company, Grifols, and the Canadian Blood Services.

"In September 2022, Canadian Blood Services announced our action plan in response to a global shortage of medications called immunoglobulins and plasma needed to make them," CBS said in an email to CambridgeToday.

"With funding from governments, Canadian Blood Services is opening 11 plasma donor centres in Canada and collecting more plasma ourselves. Our agreement with Grifols, a global healthcare company and leader in producing plasma medicines, is another part of that plan."

...

"paying for donations is banned in Ontario, Quebec and British Columbia. 

"However, CBS said its been in close discussions with the government and has an exemption.

...

"The agreement also complies with Ontario’s Voluntary Blood Donations Act, which has always contained an exemption for Canadian Blood Services, with implicit consideration of our agents, given our role as the national blood operator and supplier of blood products in Canada. Through our agreement, Grifols will operate under the Act as an agent of Canadian Blood Services."

"Per the agreement, Grifols must use plasma they collect in Canada to make immunoglobulins exclusively for patients in Canada, which reduces reliance on the global market, CBS said.

"But the whole operation doesn't sit right with Waterloo Region Health Coalition chair, Jim Stewart.

"It's a repugnant example of profit driven healthcare," Stewart said, questioning who's profiting in the end.

"What's next, paying people for their organs or embryos? This is just another example of Premier Doug Ford’s drive to privatize our healthcare system."

...

""These pay-for-donations centres really impact the homeless, people with low incomes and those with high levels of unemployment. This is going to dismantle the voluntary donor base and the sustainability of blood supply could be in jeopardy."

...

"While not confirmed by Grifols, Canadian Blood Resources and giveplasma.ca states qualified donors can earn up to $70 per donation and can donate twice in a seven day period."

#####

HT: Frank McCormick


Earlier:

Sunday, September 18, 2022

Thursday, March 14, 2024

New Zealand repeals anti-smoking law that would have prevented tobacco sales to anyone born after 2008

 In an earlier blog post, I wrote about a New Zealand anti-smoking law, saying "And now there's a law that cuts nicotine content of cigarettes, and (get this) "bans the next generation of New Zealanders — anyone born after 2008 or currently 14 years old or younger — from ever buying cigarettes in the country. " (That's going to be a complicated age restriction to administer in, say, 10 years from now...)  

Well, people born in 2008 are turning 16 this year, and New Zealand just repealed that law, for reasons that New Zealand's prime minister Christopher Luxon says include concerns about black markets.

Here's an article from Medpage today, reporting on the change in the law. However the article takes the point of view that black markets are just a smokescreen thrown up by tobacco companies.

Up in Smoke: What Happened to New Zealand's Tobacco Ban Plan?— It appears the new government is making an embarrassing attempt to fend off a budget shortfall. by Eric Trump, March 6, 2024

"As part of the newly elected coalition government's rush to tick 49 "actions"  off its 100-day list by March 8, it has repealed  the Smokefree Environments and Regulated Products Amendment Act of 2022. This act, passed by the previous Labour government, would have banned selling tobacco products to those born on or after January 1, 2009, reduced the nicotine in tobacco products to non-addictive levels, and slashed the number of outlets allowed to sell tobacco by 90%, from 6,000 to 600. Overall tobacco use was predicted to drop from the current 8% to lower than 5% by 2025, and the act was expected to create a tobacco-free generation.

...

"Why would New Zealand's new coalition government, an alliance opens in a new tab or window

of the conservative National Party along with the libertarian ACT and populist New Zealand First parties, repeal data-driven and life- and money-saving legislation? Without a shred of evidence, Prime Minister Christopher Luxon and his coalition partners have repeatedly claimed restricting tobacco and reducing nicotine levels is experimental (as though that were a bad thing), leading to black marketsopens in a new tab or window and a proliferation of crimeopens in a new tab or window. ACT's health spokesperson Todd Stephenson, for example, said thatopens in a new tab or window the "radical prohibitionism" of creating a smoke-free generation would "push smokers into the arms of gang members."

"This rhetoric uncannily echoes the tobacco lobby. Public health experts at the University of Otago recently released a damning reportopens in a new tab or window showing that the coalition government's arguments in favor of a repeal closely mirror the tobacco industry's own narratives on this subject.

"So suspicious are the similarities between the flimsy remarks of coalition partners and tobacco companies' talking points that the report's authors are calling on all members of parliament to declare any past associations with tobacco companies.

######

 

Here's the story about the Prime Minister's concerns, from Radio New Zealand (RNZ):

Smokefree legislation would have driven cigarette black market - Christopher Luxon


Wednesday, March 13, 2024

SITE 2024 Conference: Call For Papers for Summer 2024

 Now is the time to be thinking of submitting papers for the summer sessions at Stanford. (Some deadlines are in April.)

Here's the call for papers:

SITE 2024 Conference: Call For Papers

Stanford Economics is proud to host its annual Stanford Institute for Theoretical Economics (SITE) Conference from July 1 to September 11 2024. SITE sponsors sessions that encompass both economic theory and empirical work and cover a broad range of topics. It brings together established and emerging scholars to present leading-edge economic research, to educate, and to collaborate.

These sessions are scheduled:

  1. Gender  Monday, July 1, 2024, 8:00am - Tuesday, July 2, 2024, 5:00pm
  2. Empirical Implementation of Theoretical Models of Strategic Interaction and Dynamic Behavior  Thursday, July 11, 2024, 8:00am - Friday, July 12, 2024, 5:00pm
  3. Trade and Finance  Thursday, July 25, 2024, 8:00am - Friday, July 26, 2024, 5:00pm
  4. Fiscal Sustainability  Thursday, August 1, 2024, 8:00am - Friday, August 2, 2024, 5:00pm
  5. Dynamic Games, Contracts, and Markets  Monday, August 5, 2024, 8:00am - Wednesday, August 7, 2024, 5:00pm
  6. The Micro and Macro of Labor Markets  Tuesday, August 6, 2024, 8:00am - Wednesday, August 7, 2024, 5:00pm
  7. Political Economic Theory  Thursday, August 8, 2024, 8:00am - Friday, August 9, 2024, 5:00pm
  8. Market Design  Thursday, August 8, 2024, 8:00am - Friday, August 9, 2024, 5:00pm
  9. Market Failures and Public Policy  Wednesday, August 14, 2024, 8:00am - Thursday, August 15, 2024, 5:00pm
  10. Empirical Market Design  Thursday, August 15, 2024, 8:00am - Friday, August 16, 2024, 5:00pm
  11. Climate Finance and Banking  Monday, August 19, 2024, 8:00am - Tuesday, August 20, 2024, 8:00am
  12. Frontiers of Macroeconomic Research Wednesday, August 21, 2024, 8:00am - Friday, August 23, 2024, 5:00pm
  13. Experimental Economics  Thursday, August 22, 2024, 8:00am - Friday, August 23, 2024, 5:00pm
  14. Psychology and Economics Monday, August 26, 2024, 8:00am - Tuesday, August 27, 2024, 9:00pm
  15. The Labor Market Experience of Vulnerable Populations of Workers  Monday, August 26, 2024, 8:00am - 5:00pm
  16. Housing and Urban Economics  Wednesday, August 28, 2024, 8:00am - Friday, August 30, 2024, 5:00pm
  17. The Macroeconomics of Uncertainty and Volatility  Wednesday, September 4, 2024, 8:00am - Friday, September 6, 2024, 5:00pm
  18. New Research in Asset Pricing  Wednesday, September 4, 2024, 8:00am - Friday, September 6, 2024, 5:00pm
  19. The Economics of Transparency  Thursday, September 5, 2024, 8:00am - Friday, September 6, 2024, 5:00pm
  20. Financial Regulation  Monday, September 9, 2024, 8:00am - Wednesday, September 11, 2024, 5:00pm