The Faculty Lounge

Book Recommendation: Kidney To Share by Martha Gershun And John D. Lantos

Over the holidays, I finished Kidney To Share, a new book by Martha Gershun And John D. Lantos published by Cornell University Press and highly recommend it! It’s extremely well-done—informative, funny, thought-provoking.

The book alternates between chapters from Martha and John, with Martha taking readers through a personal account of her non-directed kidney donation to a woman she had never met but shared a number of social connections with and whose story she came across in a local media story. John’s chapters place Martha’s personal experience within the larger context of the history and ethics of living kidney donation.

It is a fascinating account. You will read this and marvel at the fact that anyone would complete the expensive, time-consuming, and opaque process to become a living donor for a complete stranger. This is a terrible state of affairs, and not only because the transplant waitlist currently stands at over 100,000 people (the vast majority of them waiting for a kidney) and we need more living donors to address the shortage. But also because, as I was reminded during the ugly “Bad Art Friend” affair, living donors deserve better treatment.

Much of the work on the kidney shortage focuses on risks to donors and (as the book notes) debates over whether financial incentives can safely increase the number of donors. But Martha and John highlight the numerous other hurdles faced by would-be donors, that are almost never discussed. As Martha details in the book, at the time of her decision, she was a recently-retired business executive with a spouse still working. Time and time again problems that should have been solved by Mayo were left to her creativity and research skills to solve, expenses that should have been covered by insurance were personally paid by her or her recipient, and she had to advocate for herself and her donation in ways that no donor should have to. Most would-be donors do not have the time, money, dedication, confidence, and advocacy skills to take on this task. And Martha tells these stories with grace and humor – from a dry ice snafu to the problems caused by a (legal) marijuana encounter, the book’s ultimately happy ending is a long time coming and not at all a guaranteed result.

I highly recommend Kidney to Share. There’s even a (very well read) audible version for folks like me who prefer to multitask.

Taboo Trades on the Private Law Podcast

On the latest episode of The Private Law Podcast I discuss Taboo Markets and Trades with Felipe Jimenez. It was a wonderfully engaging conversation, due to Felipe’s thoughtfulness and knowledge. The topics ranged from sex work and egg and sperm markets to kidney donation and the Bad Art Friend.

You can listen here

or here

 

 

It’s also on Apple, Spotify, and other services.

Recent Contract Disputes In The Transplant World

Readers may be interested in two relatively recent lawsuits involving the National Kidney Registry (NKR) and the University of Colorado Hospital Authority (“UCH,” filed 3/26/21) and the University of Maryland Medical Center (“UMMC”, filed 4/2/2018), respectively. (Citations and links to both lawsuits are at the end of this post)

Both suits involve a particular provision of the Member Center Terms and Conditions that seeks to assess fees on transplant centers who took more kidneys out of the NKR network than they put into it, and seeks to do so in perpetuity, unless and until the kidney deficit is erased:

3. MCs shall not have net chains started (NCS) less than 0. The fee for MCs with a negative NCS shall be billed on a 1:1 ratio according to the MC's NCS. For example, a center with a -2 NCS will be billed $2,000/ month, a center with a -20 NCS will be billed $20,000/ month, etc. This provision and the related monthly fee shall survive the termination of the Service Contract. (emphasis added)

Because UCH had a deficit of 8 unpaired kidney exchanges, NKR billed UCH $8000/month under this provision, which UCH refused to pay. According to the Complaint (paragraph 29):

On or about March 17, 2021, NKR informed Denise Harrington, UCH's Director of Transplant Business that NKR increased the amount of the Center Connectivity fee, which had previously been $275 per month, by the amount of $8,000 per month, to the new amount of $8,275 per month in perpetuity, as result of NKR's unilateral action to apply Section 1.3. against UCH. (emphasis added)

NKR correctly argues in its motion to dismiss that centers can avoid the deficit charges through kidney delivery:

Member Centers may also comply with Section I.3 by putting an equal number of kidneys into the NKR network as they take out. The purpose of Section I.3 is to encourage Member Centers to enter into the system at least as many potential donors as the number of matches received from the system by Member Center recipient patients. If Member Centers have no obligation to contribute to the nationwide network, the network and the ability to make high quality donor matches breaks down, to the detriment of recipients in need of kidneys.

This option to specifically perform is interesting in its own right, and I may say more about it later, but what if a Member Center couldn’t deliver kidneys to the network, say because the UCH kidney transplant program had been closed? Or because they determined that kidney exchange was bad for their patients? In the event that delivering kidneys to NKR is impossible, is a court likely to award NKR these fees into perpetuity – a present value of nearly $5 million? (using an interest rate of 2%, which may understate the amount, given the current low interest rate environment)

Under the penalty doctrine, NKR would have to describe its loss, and why $1000/kidney/month is a reasonable estimate of it, even if it can’t provide a precise amount. Here, the “in perpetuity” aspect may be troubling to courts, even if the present value is not high relative to whatever the alleged loss is, as it seems unlikely that NKR is harmed in perpetuity if a member center backs out.  

Along those lines, NKR’s language quoted above may not help it in this case, because it could suggest that I.3 is designed to ensure performance, rather than estimate damages. In that sense, I was reminded me of the fateful testimony from a witness, noted in Judge Posner’s famous Lake River opinion, though Victor Goldberg thinks that is an unfair interpretation of the witness’s statement.

Because both cases settled, we don’t know how a court would have resolved this issue. In both cases the parties seem to agree that the NKR network was owed kidneys under the contract. Normally, that obligation would be translated into monetary terms that the court would award to the nonbreaching party. But when federal law prohibits the exchange of valuable consideration for a kidney, by definition there is no market price for either the court or the contracting parties to reference. Here, the parties attempted to overcome that problem by specifying a recurring charge, but it’s continuation into perpetuity may raise eyebrows, even if the present value of the charges is otherwise reasonable.

The contract and resulting litigation raise other interesting issues, including specific performance and public policy that aren’t touched on here. The referenced documents are:

Complaint: University of Colorado Hospital Authority v. KidneyLife Foundation, Inc. d/b/a National Kidney Registry, Civil Action No. 21-cv-889 (3/26/21)-- https://kimberlydkrawiec.org/wp-content/uploads/2021/11/Complaint.pdf

Motion to Dismiss (5/7/21)-- https://kimberlydkrawiec.org/wp-content/uploads/2021/11/May-7-motion-to-dismiss.pdf

Member Center Terms and Conditions (Revised 11/20/20)-- https://kimberlydkrawiec.org/wp-content/uploads/2021/11/Member-Terms-and-Conditions.pdf

Complaint: KidneyLife Foundation, Inc. d/b/a National Kidney Registry v. University of Maryland Medical Center, Index No. 606183/2018 (4/2/2018) -- https://kimberlydkrawiec.org/wp-content/uploads/2021/11/1Summons-Complaint.pdf

My thanks to Eric Posner, Bob Scott, George Cohen, and Mitu Gulati for helpful discussions about this contract and litigation

2021 Legal Forum Symposium: The Body

2021 Legal Forum Symposium: The Body

Legal issues surrounding our bodies are both timely and timeless. Because our understanding of the body is constantly evolving, law must continue to redefine how our bodies interact with the world around us. Accordingly, the University of Chicago Legal Forum will convene scholars to discuss how the law directly regulates and responds to the human body—exploring topics such as disability law; autonomy; medicine; gender, sexuality, reproduction; race; the criminal legal system; and exploitation of the body. Where current law governing the body is deficient, we plan to offer remedies.

Please join us. The Symposium is open to the public, but you must register in advance for this meeting:
Registration for the 2021 Legal Forum Symposium

SCHEDULE OF EVENTS
Friday, November 5

9:00 – 9:05 a.m.
WELCOMING REMARKS FROM LEGAL FORUM'S EDITOR-IN-CHIEF 
Lauren Spungen

9:05 – 10:20 a.m.
PANEL A: BODILY IDENTITY AND RIGHTS
Moderator: Jonathan S. Masur, University of Chicago Law School

1. Mimics, Extenders, Procreative Rights and Uterus Transplants
    I. Glenn Cohen, Harvard Law School

2. Managing and Monitoring the Menopausal Body
    Naomi R. Cahn, University of Virginia School of Law
    Bridget J. Crawford, Pace Law School
    Emily Gold Waldman, Pace Law School

3. Involuntary Servitude: Pregnancy, Abortion, and the Thirteenth Amendment
    Michele Goodwin, University of California, Irvine School of Law

4. Genitals that Matter
    Ezra Young, Cornell Law School

10:25 – 11:50 a.m.
PANEL B: EXPLOITING AND TRANSACTING THE BODY
Moderator: Sonja B. Starr, University of Chicago Law School

1. Fear, Desire and Control: Black Male Bodies in the Criminal Legal System
    Paul Butler, Georgetown University Law Center

2. Bring Up the Bodies
    Bennett Capers, Fordham University School of Law

3. Moral Disagreements about Markets and Bodies
    Kimberly D. Krawiec, University of Virginia School of Law

4. Donorsexuality
    Mary Anne Case, University of Chicago Law School

5. The Body of Sports
    Alice M. Miller, Yale Law School

12:15 – 1:20 p.m.
KEYNOTE ADDRESS "On Not Hating the Body" with Martha C. Nussbaum
Introduced by Dean Thomas J. Miles, The University of Chicago Law School

1:20 – 2:00 p.m.
LUNCH BREAK

2:00 - 3:15 p.m.
PANEL C: REGULATION AND POLICY OF THE BODY
Moderator: Joshua C. Macey, University of Chicago Law School

1. The Body Bureaucracy: Feminist Politics at the Food and Drug Administration
    Aziza Ahmed, University of California, Irvine School of Law

2. How the Law (Mis)construes Disabled Bodies (and Minds)
    Leslie Francis, University of Utah College of Law
    Michael Ashley Stein, Harvard Law School

3. Gender as Commons
    Sonia Katyal, University of California, Berkeley School of Law

4. Medical Teleologies of the Body in the Law
    Craig Konnoth, University of Virginia School of Law

3:15 – 3:20 p.m.
CLOSING REMARKS FROM LEGAL FORUM'S SYMPOSIUM EDITOR 
Hannah Fisher, Legal Forum Symposium Editor

Marijuana Legalization with Pat Oglesby on the Taboo Trades Podcast

I've posted a new episode of the Taboo Trades podcast, this one featuring Pat Oglesby of the Center for New Revenue discussing marijuana legalization. From the show summary: "Pat discusses marijuana legalization and disses on the tax academe"

Pat has also done a blog post about the episode, in which he answers a few additional questions about legalization and drug policy posed by my seminar students.

You can listen to this episode (and others!) on spotify or apple, among other services. 

 

 

 

Christian Turner on the Taboo Trades Podcast

You should definitely ease your election anxiety by listening to me and Christian Turner of the University of Georgia School of Law argue about why people have sex in the latest episode of the Taboo Trades podcast: "Market Segregation (& Football!) with Christian Turner." There's even some discussion of football, so there's something to satisfy everyone. (Okay, European football, but whatevs). 

 

You can also listen on apple podcasts and spotify.

Taboo Trades Podcast, featuring Nicola Lacetera and Mario Macis

I’ve uploaded a new and very special episode of the Taboo Trades podcast, featuring Mario Macis and Nicola Lacetera.

Mario Macis is a Professor of Economics at Johns Hopkins Carey Business School. Nico Lacetera is a Professor of Strategic Management at the Rotman School of Management at the University of Toronto.

They joined me this week to discuss their empirical and experimental work on incentives for blood donation, as well as their recent surveys of public attitudes toward a variety of taboo trades, including payments to living kidney donors. It’s a fun and informative episode (thanks to the guests, not the host :-)

You can listen on Apple and spotify, as well as below.

 

 

Consentability with Nancy Kim on the Taboo Trades Podcast

I've uploaded a new episode of the Taboo Trades podcast, this one featuring Nancy Kim. We discuss her book, Consentability; the limits of consent, and whether I should get silicone horns on my head. 

The episode (and prior episodes) is available here: https://www.buzzsprout.com/1227113, as well as on apple podcasts and spotify. 

 

 

 

Speaking of challenge trials

Speaking of challenge trials . . .this panel that I recently moderated for Duke Science & Society is quite informative, I think. It features Marc Lipsitch, who is a professor of epidemiology, immunology and infectious disease at the Harvard TH Chan School of Public Health, and the director of the Center for Communicable Disease Dynamics; Nir Eyal, a professor of bioethics at the Rutgers School of Public Health, and the Director of the Center for Population–Level Bioethics at Rutgers; and Cameron Wolfe, an Associate Professor of Medicine and clinical expert in respiratory and infectious disease at the Duke Medical School and Duke Hospital, where he has been treating COVID-19 patients since they began to be admitted to our hospital system this spring. 

I’m a podcaster!

Yeah, I know everyone has a podcast these days. But theirs aren’t about Taboo Trades and, therefore, are not as good as mine. :-)

As many readers know, I’ve taught a course on Taboo Trades for a number of years now. I’ve always been lucky to have interesting speakers, and this year decided to try to make lemonade out of the lemon that is zoom teaching.  So I’m interviewing some of my favorite folks working in this area for the course and making it available to all of you as well.

You can access the podcast on both apple and spotify.

I’ve uploaded two episodes so far, and should have another posted this week.

I’ve so far interviewed Peter Jaworski about compensating plasma donors and Josh Morrison about paying kidney donors and purposely infecting volunteers with Covid-19 for a challenge trial.

If you’re interested listen to the full episodes on apple and spotify.

Repugnance, Global Kidney Exchange, and Drinking Our Own Spit: An Oral Argument Reunion

Last week I had a great “reunion” with Joe Miller and Christian Turner taping the latest episode of their Oral Argument podcast. I first appeared on Oral Argument (which was also my first podcast ever) back in episode 17 (“Fleshlist”), which Christian and Joe reminded me was WAAAYY back in 2014. Wow, that seems like last year, not five years ago! But congrats to Christian and Joe for their staying power!

As always, Joe and Christian were incredibly thoughtful, entertaining, and imaginative, taking the discussion to places I couldn’t anticipate even if I tried – make sure to listen to the end so that you can catch our discussion about drinking your own spit from a glass (yuck!).

One of the things that occurred to me, as we discussed the research I’ve been doing the last few years, is how lucky I am to have found collaborators who share my interest in taboo trades and who are much smarter than me! So, thank you, academic gods, for the wonderful co-authors you’ve sent my way.

Here’s their description of “Repugnance”, Episode 189:

Kim Krawiec rejoins us to discuss "repugnant" transactions. One common target of this adjective is trade in human body parts. While on the one hand making more matching kidneys available saves lives and prevents large amounts of suffering, on the other hand revulsion and concerns about coercion and distributive fairness arise when kidneys are bought and paid for. In recent years, a number of innovative market designs have allowed strangers to exchange kidneys without engaging in impersonal, commodified market transactions. And now there have been several global examples of such exchanges, transferring not only kidneys but also the resources needed to perform transplants in poor countries. But are these alternative designs still "markets," and what exactly is our problem with markets in kidneys anyway?

As always, the episode notes contain a wealth of information and useful links to books and articles we discussed, but I’ll add a few additional links below, for those interested in really indulging their taste for repugnant transactions and following the debate about Global Kidney Exchange.

On Global Kidney Exchange

Rees MA, Dunn TB, Kuhr CS, Marsh CL, Rogers J, Rees SE, Cicero A, Reece LJ, Roth AE, Ekwenna O, Fumo DE, Krawiec KD, Kopke JE, Jain S, Tan M, & Paloyo SR. Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation. Am J Transplant 2017; 17: 782–790

Krawiec, Kimberly D., and Michael A. Rees. "Reverse transplant tourism." Law & Contemp. Probs. 77 (2014): 145.

Bozek, Danielle N., et al. "Complete Chain of the First Global Kidney Exchange Transplant and 3-yr Follow-up." European urology focus 4.2 (2018): 190-197.

Roth, A. E., Krawiec, K. D., Paloyo, S., Ekwenna, O., Marsh, C. L., Wenig, A. J., ... & Rees, M. A. (2017). People should not be banned from transplantation only because of their country of origin. American Journal of Transplantation, 17(10), 2747-2748.

Rees, M. A., Paloyo, S. R., Roth, A. E., Krawiec, K. D., Ekwenna, O., Marsh, C. L., ... & Dunn, T. B. (2017). Global kidney exchange: Financially incompatible pairs are not transplantable compatible pairs. American Journal of Transplantation, 17(10), 2743-2744.

On Repugnance

Roth, Alvin E. "Repugnance as a Constraint on Markets." Journal of Economic perspectives 21.3 (2007): 37-58.

Roth, Alvin E. Who Gets What—and Why: The New Economics of Matchmaking and Market Design. Houghton Mifflin Harcourt, 2015.

Healy, Kieran, and Kimberly D. Krawiec. "Repugnance Management and Transactions in the Body." American Economic Review 107.5 (2017): 86-90.

Healy, Kieran, and Kimberly D. Krawiec. "Organ Entrepreneurs." (2017).

Krawiec, Kimberly D. "Kidneys without Money." Journal of Institutional and Theoretical Economics JITE (2018).

            Cohen, I. Glenn, On Repugnance, Distribution, and the Global Kidney Exchange: Comment on Kidneys without Money by Kimberly D. Krawiec.” Journal of Institutional and Theoretical Economics JITE (2018).

            Lübbe, Weyma , Understanding (one's own) Repugnances: Comment on “Kidneys without Money” by Kimberly D. Krawiec.” Journal of Institutional and Theoretical Economics JITE (2018).

Repugnance Readings For The New Year

Happy 2019! Why not start out the new year with a set of readings on repugnance . . . you know you want to.  (They’re readings on repugnance, not repugnant readings!)

There is a piece from me, accompanied by excellent commentaries by Harvard law’s Glenn Cohen and the German philosopher, Weyma Lübbe (University of Regensburg). Sadly, all three pieces are behind a paywall.

The abstract for:

Kidneys without Money
by Kimberly D. Krawiec

"Market design and matching have been especially important for markets in which the use of money is viewed as repugnant or distasteful. This article employs the example of kidney exchange, with a particular focus on a new form, global kidney exchange (GKE), to highlight the manner by which repugnance and the law limit exchange and create scarcity. Yet it also opens the door to innovation that, at each stage of market development, prompts new repugnance concerns and initiates a renegotiation of legal rules, social norms, and institutional barriers."

And . . . a taste from the text:

“Repugnance influences which animals are food and which are pets, marks the limits of art and entertainment, and dictates who is eligible to marry. Importantly, repugnance is also associated with a strong resistance to the commercial exchange of certain goods and services. This aversion limits the types of transactions one sees in the marketplace and carries serious consequences for market design and regulation. Yet, as compared to the more well-known causes of market failure, scholars of economics and of law have spent less time addressing the role of repugnance in market design and regulation. Indeed, as noted by Roth (2007) and Healy and Krawiec (2017a), until fairly recently, the standard economic response to repugnance was to treat it as simply an irrational preference to be overcome with rational arguments and evidence.”

And, check out the accompanying excellent commentaries (no abstracts):

I. Glenn Cohen

On Repugnance, Distribution, and the Global Kidney Exchange
DOI: 10.1628/jite-2019-0004

Weyma Lübbe

Understanding (One's Own) Repugnances
DOI: 10.1628/jite-2019-0005

Comments are closed, but come find me on Twitter if you want to discuss! (@KimKrawiec)

 

 

Meet me in Mannheim!

Next week I’ll be giving a keynote lecture and also participating in a panel discussion on “Allocation Problems in health care” at theMaCCI Law & Economics Conference on The Law and Economics of Market Design.  From the conference website:

The conference will provide an international platform for exchange and discussion between academic researchers and practitioners in public authorities, legal counsel, and economic consultancies.

The MaCCI Law and Economics Conference is organized for the eighth time since the inaugural edition in 2011. It is our ambition to stimulate and disseminate research in the field of market design, competition, regulation, and innovation policy.

We gratefully acknowledge financial support from White & Case and the EPoS Collaborative Research Center for this year’s annual law and economics conference.

This year the topic is “The Law and Economics of Market Design”. The conference will consist of 4 panel discussions, two keynote lectures and will cover the following topics.

• Design of digital platforms
• Managing private and public procurement
• Designing infrastructure markets (telecom, traffic, energy)
• Allocation problems in health care (organ exchange)

Keynote Speakers

Professor Kimberly D. Krawiec

Duke Law School, Durham

Professor Dr. Peter Cramton

University of Cologne and University of Maryland

For the keynote address, I’ll discuss repugnant transactions, or "taboo trades" (something I also recently discussed on Brian Frye’s Ipse Dixit podcast) and how the law responds to such transactions. I’ll focus on egg, sperm, and organ “donation” and, if I have time, briefly discuss blood, plasma, and bone marrow donation. (I’ve put “donation” in quotes because, consistent with common practice, I’m using the word donation to refer to transfers without regard to whether the donor was compensated).

For the health care allocation panel, I’ll discuss Global Kidney Exchange (prior blog posts on Global Kidney Exchange are collected here).

The full conference program is here.

Me with Brian Frye on Ipse Dixit

I just did a short and fun podcast with Brian Frye (University of Kentucky College of Law) about repugnant markets ranging from kidneys to football, boxing, sex, and blood.  You can listen below.  Brian was a wonderful and generous host, and I’m so grateful for the opportunity to discuss my work with him (and with you!)

Comments are closed, but if you want to argue with me on Twitter (why not, everyone else does) I'm @KimKrawiec 

 

Links to some of the papers discussed in the podcast:

If We Allow Football Players and Boxers to be Paid for Entertaining the Public, Why Don't We Allow Kidney Donors to be Paid for Saving Lives?(with Philip Cook)

Repugnance Management and Transactions in the Body(with Kieran Healy)

Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation(with Michael A. Rees et. Al)

Lessons from Law About Incomplete Commodification in the Egg Market

Details of the first Global Kidney Exchange Live and (temporarily) ungated

The final version of the paper that I blogged about last week, Complete Chain of the First Global Kidney Exchange Transplant and 3-yr Follow-up, is now available online.

The publisher has created a Share Link providing 50 days' free access to the article. Anyone clicking on this link before October 27, 2018 will be taken directly to the final version of the article on ScienceDirect, which they are welcome to read or download.

After that, the paper will be behind a paywall, so enjoy!

Share Link:
https://authors.elsevier.com/c/1XhNI8Yy0L8qol

 

Details of the First GKE (Global Kidney Exchange) Chain

My co-authors and I recently published a paperthat provides more detail on the first Global Kidney Exchange (GKE), including a 3-year follow-up report on the Filipino pair that participated. We wrote this, in part, to respond to GKE critics who argued that the Filipino pair had been exploited or coerced into participating, or who argued that the pair had been disadvantaged in the swap or not received adequate follow-up care. Al Roth has more discussionover at his market design blog. 

From the abstract:

Background

Global Kidney Exchange (GKE) offers an opportunity to expand living renal transplantation internationally to patients without financial means. These international pairs are entered into a US kidney exchange program that provides long-term financial support in an effort to identify opportunities for suitable exchanges for both these international pairs and US citizens.

Objective

While the promise of GKE is significant, it has been met with ethical criticism since its inception in 2015. This paper aims to demonstrate the selection process and provide >3 yr of follow-up on the first GKE donor and recipient from the Philippines.

Design, setting, and participants

The first GKE transplant occurred with a young Filipino husband and wife who were immunologically compatible, but lacked the financial means to continue hemodialysis or undergo a kidney transplant in their home country. The pair was enrolled in the Alliance for Paired Donation matching system, several alternative kidney exchanges were identified, and the pair subsequently underwent renal transplantation and donation in the USA financed by philanthropy. The resulting nonsimultaneous extended altruistic chain provided transplantation for the Filipino husband and 11 US patients.

. . .

Conclusions

While criticisms of GKE highlight concerns for possible exploitation of financially disadvantaged groups, these results demonstrate that these concerns did not come to fruition, and the outcome experienced by the GKE donor and recipient (and other US participants) was successful.

Patient summary

The first Filipino Global Kidney Exchange (GKE) donor-recipient pair continues to be followed by both US and Filipino transplant centers. Both are in good health, support the GKE program, and advocate for its expansion.

Related posts:

GKE Debate in The Latest Issue of the American Journal of Transplantation

GKE Debate in Current Issue of The American Journal of Transplantation

Global Kidney Exchange (GKE) to Overcome Financial Barriers to Kidney Transplantation

Reverse Transplant Tourism

Reverse Transplant Tourism (cont.)

RTT Conclusion

Reverse Transplant Tourism Goes Live!!

More News Coverage Of Reverse Transplant Tourism

Kidney Donor Stories

Over at Market Design Blog, Al Roth posts part of an incredibly moving email conversation with a donor who became part of a kidney paired exchange after hearing what I think is one of the best Freakonomics episodes of all time. As the donor describes it:

Then I heard a follow up episode that united a donor with his recipient.  Stephen Dubner was crying... I was crying... I called Mayo Clinic the next morning and signed up for testing.

You should definitely read the entire exchange here. And if you have not yet listened to the pair of Freakonomics podcasts that led to the donation, you should do so, but only if you’re in a setting where it’s okay to cry. The second podcast is the one the donor is referring to, in which a donor is reunited with his recipient.

Freakonomics podcast: Make Me a Match (Rebroadcast)

Freakonomics podcast: Ask Not What Your Podcast Can Do For You

I found this part of the exchange particularly interesting:

"The rest is a long story and I know you are a busy man so I'll skip most of it.  I ended up being part of a pair, instead of an altruistic donor.  There was a man who worked with my wife that needed a kidney.  He once saved her life with the Heimlich maneuver so it was pretty poetic that I could save his.  He received his kidney from a bridge donor and I gave mine to someone on the diseased donor list.  So I got to save two lives!  I'm doing great.  I went back to work a couple of weeks ago.  I have no regrets and I hope I can inspire others to do something selfless and extraordinary in their lifetime. (emphasis added)

This ability to help more people, through a chain or paired exchange, rather than a single recipient, as through a donation to the waitlist, seems to be something that (understandably, I think) provides kidney donors with a lot of satisfaction. More generally, it's important to hear these personal stories from kidney donors. 

I’ve blogged a few times about kidney exchange, for example:

Custom, Contract, and Kidney Exchange

Global Kidney Exchange (GKE) to Overcome Financial Barriers to Kidney Transplantation

GKE Debate in Current Issue of The American Journal of Transplantation

Reverse Transplant Tourism

Our Day of Market Design

 

New Volume: Altruism, Community, and Markets

The latest Law & Contemporary Problems volume -- Altruism, Community, and Markets -- is now available! The entire volume is free online here. From the Foreword: 

That human motivations can be complicated and that the concerns of individuals for both self and others shape communities—local, national, and global—are simple observations. It is much harder to grasp the complexities of a rapidly changing world in which human beings with their varying commitments continually interact. Our desire to better understand how and in what ways the forces of self-interest and altruism intersect—and at times collide—in the early twenty-first century inspired us to organize a symposium on “Altruism, Community, and Markets.” The proceedings of that conclave are published in this issue. Held in Washington, D.C. in October 2017 and sponsored by the American Enterprise Institute, Duke Law School, and the University of Virginia School of Law, the symposium brought together scholars in law, public policy, economics, medicine, and related fields to examine the institutions5 that promote and restrict market and nonmarket interactions. The group also explored how the powers of altruism and self-interest are (and have the potential to be) harnessed to create and distribute goods and services.

The articles produced for the symposium cover a wide range of subjects and are of exceptional depth and intellectual ambition. All address topics of current importance while situating their analyses in the broader context of the symposium’s theme. Taken together, the articles contained in this issue provide a snapshot of a world grappling with the challenges of “institutionalizing”6 human cooperation in the face of evolving social attitudes and technological advances.

As they say, download it while it's hot!

Super Bowl Week OpEd

As the Super Bowl approaches, Phil Cook and I have an OpEd running in the Raleigh News & Observer and other venues. Below is a taste, but you can read the whole thing here. Our paper on this topic, forthcoming in Law & Contemporary Problems, is available here. 

Why ban payment to kidney donors but not football players?

BY PHILIP J. COOK AND KIMBERLY D. KRAWIEC 

February 01, 2018 01:06 PM

Super Bowl week rivets national attention on America’s most popular and lucrative sport, professional football. If stories of concussion and permanent injury to players make some fans uneasy, there is always the reassuring fact that the players volunteer for the job and are well compensated – so well compensated that there are untold thousands of young men who would gladly take their place.

Football is so ingrained in our culture that we generally accept this situation without much scrutiny. However, our research got us thinking about the stark contrast with another risky but valuable activity – kidney donation.

About 6,000 people per year donate one of their two kidneys. This selfless act has some risk to the donor, both from the surgery and years later when there is a chance the remaining kidney will fail. In return, kidney donors are rewarded with the knowledge they helped save the life of a loved one. They receive nothing tangible. Indeed, federal law bans compensation for kidney donors, as do the laws of all other countries except Iran (really).

So, why do we pay football players to entertain the public, but are unwilling to pay kidney donors to save lives?

The stakes in both cases are high, but much higher in kidney donation. The total value of NFL teams is about $60 billion. If, in some unlikely future, the risk of serious permanent injury to players led to a ban on professional play, that value would be destroyed.

Meanwhile, the ban on compensation for living kidney donation currently costs thousands of lives and billions of dollars in taxpayer money every year. The waiting list for a kidney now includes 100,000 patients, who for the most part are kept alive by renal dialysis at federal government expense. If they survive long enough, typically more than five years, in this debilitated state, they may hope to rise to the top of the list and receive a kidney from a deceased donor.

. . . 

Millions of Americans, not just NFL players, work in occupations that have a substantial risk of serious injury. Loggers, fishermen and others accept these risks in exchange for compensation. Extending that list to include kidney donors is just common sense.

PHILIP COOK IS TERRY SANFORD PROFESSOR EMERITUS OF PUBLIC POLICY AND PROFESSOR OF ECONOMICS AND SOCIOLOGY AT DUKE UNIVERSITY’S SANFORD SCHOOL OF PUBLIC POLICY. KIMBERLY KRAWIEC IS THE KATHRINE ROBINSON EVERETT PROFESSOR OF LAW AT DUKE LAW SCHOOL.

Paying for Canadian Plasma

I’m a signatory (along with a number of economists and ethicists) to this letter to the Expert Panel on Immune Globulin Product Supply and Related Impacts in Canada. The letter argues that Canada, which imports most of its plasma from the United States (which, in turn, collects plasma from paid donors), should not ban compensation to plasma donors.

The genesis of the letter is that the Provinces of Québec, Ontario, and Alberta prohibit compensation for plasma donations for purposes of further processing into plasma-derived medicinal products (PDMPs). Currently, Nova Scotia and British Columbia are contemplating similar bans. The detailed letter, for which Peter Jaworski deserves primary credit, addresses, among other issues, wrongful exploitation, commodification, and crowding out.  But the most interesting issue, in my view, is the purported safety rationale behind the ban.

Many opponents of compensating Canadian plasma donors raise safety issues. This really makes no sense to me (or the other signatories) for a number of reasons.  First, some opponents conflate blood donors for transfusion purposes with plasma donors for PDMPs. As we explain in the letter, these are two very separate issues. Second, the scientific consensus is that compensating donors does not compromise the safety of PDMPs. As stated by Dr. Graham Sher, the CEO of Canadian Blood Services:

“It is categorically untrue to say, in 2015 or 2016, that plasma-protein products from paid donors are less safe or unsafe. They are not. They are as safe as the products that are manufactured from our unremunerated or unpaid donors.”

Finally, and perhaps most importantly, Canada imports PDMPs from the United States, where donors are compensated. There is no reason to believe that PDMPs made from compensated Canadian donors would be any less safe than PDMPs made from compensated United States donors. Instead, the opponents’ position seems to reflect a type of NIMBYism that fellow letter signatories Nico Lacetera (Rotman School of Management, University of Toronto) and Mario Macis (Johns Hopkins, Carey Business School) discuss in an article forthcoming in a Law & Contemporary Problems volume, Altruism, Community, and Markets, edited by me, Julia Mahoney (UVA), and Sally Satel (AEI). A draft doesn’t appear to be available online yet, but I’ll blog more about it when it is.

Fellow signatories Al Roth and Alex Tabarrok also blog about the letter here and here, respectively. The letter is very informative and can be read in full here.