- prioritization of kidneys with longest estimated function to a limited number of candidates expected to benefit the longest
- wider geographic allocation of kidneys with shorter potential function, to increase utilization for candidates facing a significant mortality risk remaining on dialysis long-term
- definition of waiting time expanded to include time a patient spent on dialysis prior to waiting list registration
- a sliding scale of priority for candidates with high PRA, as well as matching of blood subtype A2 and A2B offers for candidates with blood type B, and
- elimination of the kidney payback system and existing kidney allocation variances.
Congrats to our blogger, Al Roth, for his Nobel Prize in economics (alongside Lloyd S. Shapley of UCLA)! Al built on Shapley’s theories about the best ways to match “agents” in markets — for example, students matched with schools or organ donors with patients needing organs — and conducted experiments to further illuminate Shapley’s work. Al presented a really fascinating paper (with his colleague Judd Kessler) at one of last year’s Harvard Health Law Policy workshops on organ allocation policy and the decision to donate, and you can find lots more about his interesting work over at his Market Design blog.
Congrats again, Al! (Probably the best 4AM wake up call a person could get!)
Al Roth has an interesting post up today at his Market Design blog referencing some data on the crowding out effect, i.e., the idea that if you pay people for something that they are currently donating, altruists will be “crowded out” and you’ll end up with less of the thing that you need. It turns out that the data just don’t support that theory. Check it out.
Related to Nikola’s post below on the proposed revisions to the deceased donor kidney allocation policy, Al Roth has posted some interesting commentary from OPTN/UNOS Kidney Transplantation Committee Chair John Friedewald (in response to a query on a list serve):
Sorry for the late notice, but we just learned that Al Roth will be giving a talk with this title TODAY @ 3:30 at Stanford. More info here.
Al has also pointed us to two relevant posts over at his Market Design blog:
Two recent NY Times stories discuss the allocation of deceased donor kidneys:
Following up on his post on Australia, Al Roth notes that American medicine is a market with tightly restricted entry, at all levels. Proposed legislation offers a glimpse: Bill Would Create More Medical-Residency Slots, Potentially Easing Physician Shortage
Legislation introduced in Congress on Monday would expand the number of Medicare-sponsored training slots for new doctors by 15,000, a step that two medical-education groups said would go a long way toward easing a projected shortage of physicians. The bill, the Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act (HR 6352), is sponsored by Rep. Aaron Schock, an Illinois Republican, and Rep. Allyson Schwartz, a Pennsylvania Democrat. Medical schools have been expanding their enrollments and new schools have been opening up as concerns have grown about a shortage that could reach more than 90,000 physicians by 2020, according to the Association of American Medical Colleges. Those worries have intensified with passage of the Affordable Care Act, which will greatly increase the number of people seeking medical care by providing insurance coverage to 32 million more people. But while more students are making their way through the medical-school pipeline, they’re likely to run into bottlenecks because of a cap on the number of Medicare-supported residency training slots that Congress imposed in 1997.
Al Roth has come across a troubling phenomenon in Australia, where medical internships are in short supply.
The Australian Medical Students’ Association estimates almost 500 students will miss out on an internship next year because of insufficient places. Under the internship system students must work for a year under supervision in a hospital before they can work as doctors. … Australian Medical Association president Steve Hambleton points to the curious situation where the nation has a shortage of doctors, yet there are too few internships. … The placement system has fallen apart, he says, because the federal government regulates the number of students universities can enrol while its state counterparts oversee the provision of internships.
[posted on behalf of Al Roth]
Al will be cross-posting here from his Market Design blog, and he’s let us know that he plans to follow-up soon on the circumcision debate around the world. For a preview of what’s to come, check out his related posts from earlier this summer: http://marketdesigner.blogspot.com/search?q=circumcision&max-results=20&by-date=true.