Showing posts with label Germany. Show all posts
Showing posts with label Germany. Show all posts

Sunday, June 4, 2023

Organ donation day in Germany

 Yesterday was organ donation day in Germany. Here's a post from the German Health Economics Association (DGGÖ): Day of Organ Donation on June 3, 2023

"In Germany, there are about 8,500 people waiting for an organ donation (www.Bundesärztekammer.de). On the Day of Organ Donation, the German Society for Health Economics (dggö) wants to emphasize the urgency of increasing organ donation rates to improve the lives of these individuals. This applies equally to deceased organ donation and living donation. An international comparison also shows that there is room for improvement in Germany: Both in terms of living and deceased donations per million population, Germany lags behind in the EU (see Figure 1).

Organ donation rates

...

"On Wednesday, May 31, 2023, Nobel laureate in economics and professor at Stanford University, Alvin Roth, spoke to a broad audience in the 6th virtual dggö Talk (see https://www.dggoe.de/aktuelles for details) about the possibilities of kidney exchange between compatible but previously unknown pairs and the implementation of cross-over donations and exchange chains in the US.

"Unlike in the US, in Germany, living donation outside of close family is only possible if a close relationship between the donor and recipient has been officially confirmed. Alvin Roth noted in the case of cross-over kidney donations, that it was very complicated for German hospitals to build up and prove a close relationship between two pairs of donors in front of a commission. This should be simplified, especially considering the overall strong support for kidney exchange among the German population. As Figure 2 from a survey conducted by Roth and Wang (2020) illustrates, 79% even agree to kidney exchange across borders and outside of family and friends, although such an exchange is currently not legally possible in Germany.

population supporting legalization of global kidney exchange


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Earlier: 

Tuesday, May 30, 2023


Tuesday, May 30, 2023

Kidney exchange, around the world and in Germany? German Health Economics Association (DGGÖ) webinar tomorrow

Tomorrow  I'll be giving a talk in Germany (8am California time, 17:00 in Germany), hosted by the German Health Economics Association (DGGÖ).  (Bob Slonim will be giving a talk in this series in the summer.)

My title will be Kidney Exchange to increase transplantation: around the world, and in Germany?
(One big issue is that kidney exchange isn't yet supported in Germany.) 

There is a webinar address at the above link for those who might like to listen.

Wednesday, May 3, 2023

Market Design at the Max Planck Institute: Axel Ockenfels will become a Director, of ‘Economic Design & Behavior’

 Here's the announcement from the Max Planck Institutes:

Axel Ockenfels Appointed New Director at the Max Planck Institute for Research on Collective Goods in Bonn

"University of Cologne economist and expert in market design will establish the research department ‘Economic Design & Behavior’ at the MPI in addition to his work at the University of Cologne

"Axel Ockenfels, professor at the University of Cologne, will become a new director at the Max Planck Institute for Research on Collective Goods in Bonn in August 2023. He will establish a new department there, to be called ‘Economic Design & Behavior’. Its aim will be to design market, incentive, and decision architectures, based on modern behavioral research. Professor Dr. Ockenfels will thus complement the departments of Professor Dr. Matthias Sutter and Professor Dr. Christoph Engel at the institute, which focus on behavioral research from an economic and legal perspective. He will continue to teach and conduct research at the University of Cologne.

"As a faculty member of the University of Cologne, Professor Ockenfels heads the Cologne Laboratory for Economic Research and coordinates both the ‘Center for Social and Economic Behavior’ and the research division ‘Market Design & Behavior’ of the Cologne-Bonn Cluster of Excellence, ECONtribute. His appointment to the MPI in Bonn will further intensify the cooperation between the Faculty of Management, Economics and Social Sciences at the University of Cologne and the MPI in Bonn, a cooperation that has already contributed to the creation of a prestigious research center for economic behavior and design research in recent years.

...

"The new department at the Bonn MPI will also investigate ethical aspects of institutions and behavior as well as the opportunities and risks of modern computer technology for new markets. Most recently, Ockenfels has contributed to crisis management, for example with proposals for a market design to secure the supply of vaccines, to avoid supply disruptions in the energy sector, and to reduce energy consumption.

...

"Brief CV Axel Ockenfels

"Axel Ockenfels studied economics at the University of Bonn until 1994. He received his doctorate and habilitation from the University of Magdeburg, with periods abroad at Penn State University and Harvard University. Subsequently, he was Emmy-Noether Junior Research Group Leader at the Max Planck Institute for Economics in Jena. In 2003, he became Professor of Economics at the University of Cologne. Research periods have taken him to Stanford University and, currently, to the University of California in San Diego, among other places.

"In 2005, Ockenfels became the first economist in 17 years to be awarded the Gottfried Wilhelm Leibniz Prize of the German Research Foundation (DFG). He is a member of the National Academy of Sciences Leopoldina, the Berlin-Brandenburg Academy of Sciences and Humanities, the North Rhine-Westphalian Academy of Sciences and Arts, and the National Academy of Science and Engineering (acatech). He also sits at the Economists’ Round Table in the Federal Chancellery and on the Scientific Advisory Board at the Federal Ministry of Economics and Climate Protection (BMWK)."

Monday, November 21, 2022

Surrogacy guidelines: necessity, not convenience

 As surrogacy becomes increasingly well established in the U.S., it is regulated not only by state laws, but  also via voluntary standards put forward by trade organizations as conditions of membership.

One is  the SOCIETY FOR ETHICS IN EGG DONATION AND SURROGACY (SEEDS), which calls itself "a nonprofit organization founded by a group of egg donation and surrogacy agencies, whose purpose is to define and promote ethical behavior by all parties involved in third party reproduction." 

They have a set of guidelines published this year which member organizations are supposed to subscribe to.  One of those guidelines seems to say that surrogacy agencies should only work with intended parents who can't have children on their own. That is, they want to facilitate surrogacies that they regard as necessary rather than those that might be merely convenient.

SOCIETY FOR ETHICS IN EGG DONATION AND SURROGACY, STANDARDS of ETHICAL CONDUCT for SEEDS MEMBER AGENCIES

"24.Agency Screening of Intended Parents

"a. An Agency shall not provide service to Intended Parents unless they demonstrate a need for surrogacy associated with a disease, condition or status characterized by:

"i. the failure to establish a pregnancy or to carry a pregnancy to live birth after regular, unprotected sexual intercourse;

"ii. a person’s inability to reproduce either as a single individual or with their partner without medical intervention; or

"iii. a licensed physician’s or mental health professional’s findings based on a patient’s medical, psychological, sexual, and reproductive history, age, physical findings and/or diagnostic testing. 

*******

The legal blog Above the Law has a post about this:

Should 'Social Surrogacy' Be Permitted? by Ellen Trachman

It says in part:

"What does the law say? States like Louisiana and Illinois specifically require documented medical need of intended parents in a surrogacy arrangement to comply with the state surrogacy law. Louisiana requires that a doctor “who has medically treated the intended mother … submits a signed affidavit certifying that in utero embryo transfer with a gestational carrier is medically necessary to assist in reproduction.”

"Utah previously required “medical evidence … show[ing] that the intended mother is unable to bear a child or is unable to do so without unreasonable risk.” But that provision was struck down by the State Supreme Court after determining it was unconstitutional as applied to a same-sex male couple and could not be read a in gender-neutral way. (The SEEDS standard is, by contrast, gender neutral.)

"Other states with surrogacy-specific statutes — like California, Washington, Colorado, New Jersey, and New York — are silent on medical need and, therefore, implicitly permit social surrogacy arrangements. And then those states with no surrogacy law, much of the country, permit social surrogacy by default.

"The SEEDS standard, of course, only applies to member agencies and does not prevent nonmember agencies from supporting social surrogacy arrangements or for those arrangements to occur independent of agencies."

***********

Stephanie Wang and I anticipated to some extent that this could be an issue in our paper

Roth, Alvin E. and Stephanie W. Wang, “Popular Repugnance Contrasts with Legal Bans on Controversial Markets,” Proceedings of the National Academy of Sciences (PNAS),  August 18, 2020 117 (33) 19792-19798.

We surveyed populations in the U.S. and several other countries on transactions that were legal in some of them and illegal in others. We presented vignettes, and asked if they should be legal.  Because we wanted to give surrogacy a good chance of being perceived as repugnant, we made clear in the surrogacy vignette that there was no medical necessity, it was sought for convenience:

"James and Erica are a married couple in [home country]. They want to have a child, but Erica does not want to become pregnant due to the demands of her career as a model. Maria is a married mother in the Philippines. Maria’s husband is out of work, and Maria has decided to become a surrogate mother to earn additional income. James and Erica hire Maria to carry and give birth to a child from James and Erica’s sperm and egg. James and Erica pay Maria a year’s average income in the Philippines, and everyone signs a contract making it clear that James and Erica are the child’s biological parents and will have custody after the child is born."

You can see in the paper (or in this 2020 blog post) that (even) under these circumstances, clear majorities favored making this kind of voluntary surrogacy legal, not only in the U.S. and Philippines where surrogacy is legal, but also in Spain and Germany where surrogacy is illegal.

Tuesday, January 25, 2022

Multiple offer mechanisms in school choice, when information gathering is costly

 When it's costly to gather information needed to inform yourself about your own preferences, having a guaranteed offer in hand may justify the effort to gather necessary information.  Here's a paper that considers that as a first order issue:

The Case for Dynamic Multi-offer Mechanisms, by Julien Grenet YingHua He Dorothea Kübler

January 2022, (Forthcoming: The Journal of Political Economy)

Abstract: We document quasi-experimental evidence against the common assumption in the matching literature that agents have full information on their own preferences. In Germany’s university admissions, the first stages of the Gale-Shapley algorithm are implemented in real time, allowing for multiple offers per student. We demonstrate that non-exploding early offers are accepted more often than later offers, despite not being more desirable. These results, together with survey evidence and a theoretical model, are consistent with students’ costly discovery of preferences. A novel dynamic multi-offer mechanism that batches early offers improves matching efficiency by informing students of offer availability before preference discovery.

**********

Update: the paper appears as

Grenet, Julien, YingHua He, and Dorothea Kübler. "Preference Discovery in University Admissions: The Case for Dynamic Multi-offer Mechanisms." Journal of Political Economy, volume 130, number 6, June 2022, 1427-1476,  https://www.journals.uchicago.edu/doi/epdf/10.1086/718983


Saturday, November 6, 2021

A step towards kidney exchange in Germany

 Here's an announcement of the German Medical Association's endorsement of kidney exchange, in the Deutsches Ärzteblatt.

Ärztetag spricht sich für Cross-over-Lebend­spende aus Mittwoch, 3. November 2021

Google translate: Doctors' day advocates cross-over living donation

"Berlin - The 125th German Medical Association (DÄT) has spoken out in favor of expanding the number of living organ donors. From the point of view of the medical parliament, a cross-over living donation - as it is already allowed in other countries - should also be made possible in Germany in the future.

"New legal regulations are required for this. Specifically, paragraph 8, approach 1 of the Transplantation Act (TPG) would have to be expanded, a donor-recipient pair can agree with a suitable second pair that two living organ donations are carried out crosswise (i.e. donor A / recipient B and vice versa).

"Living organ donation must be reorganized and rethought based on the current state of science," said Günther Matheis, President of the Rhineland-Palatinate Medical Association ( LÄKRLP ), at yesterday's debate.

T"he TPG currently limits the donor-recipient group for living organ donation to first- or second-degree relatives, spouses, fiancés or other persons who are obviously particularly close to the donor. The DÄT believes that a similar fate can bind people who have not been known to one another just as closely as people who are close to one another.

"In view of over 9,000 patients on the waiting lists who are urgently waiting for a life-sustaining transplant and the still far too low number of available donor organs, possible changes to the regulations on living organ donation have long been discussed in Germany."


HT: Axel Ockenfels

Earlier posts: https://marketdesigner.blogspot.com/search?q=Germany+AND+kidney&max-results=20&by-date=true

Thursday, August 5, 2021

Course allocation at the Technical University of Munich, by Martin Bichler and Soeren Merting

 Here's a paper describing a recently designed and implemented course assignment system at the Technical University of Munich:

Randomized Scheduling Mechanisms: Assigning Course Seats in a Fair and Efficient Way  by Martin Bichler and Soeren Merting

Abstract: Course assignment is a very widespread problem in education and beyond. Typically, students have preferences for bundles of course seats or course schedules over the week, but courses have limited capacity. This is an interesting and frequent application of distributed scheduling, where payments cannot be used to implement the efficient allocation. First-Come First-Served (FCFS) is simple and the most widely used assignment rule in practice, but it leads to inefficient outcomes and envy in the allocation. It was recently shown that randomized economic mechanisms that do not require monetary transfers can have attractive economic and computational properties, which were considered incompatible for deterministic alternatives. We use a mixed-methods design including field and laboratory experiments, a survey, and simulations to analyze such randomized mechanisms empirically. Implementing randomized scheduling in the field also required us to develop a solution to a new preference elicitation problem that is central to these mechanisms. The results of our empirical work shed light on the advantages that randomized scheduling mechanisms have over FCFS in the field, but also on the challenges. The resulting course assignment system was adopted permanently and is now used to solve course assignment problems with more than 1700 students every year.



Wednesday, August 4, 2021

Course allocation at Eötvös Loránd University, by Attila Rusznák, Péter Biró, and Rita Fleiner)

At Eötvös Loránd University in Hungary, there's a course allocation system that gives rise to intense course exchange after its official conclusion (some of which may be planned in advance). Here's a description and analysis:

Seat transfers in the course allocation mechanism of Eötvös Loránd University  by A. Rusznák, P. Biró and R. Fleiner, 2021 IEEE 15th International Symposium on Applied Computational Intelligence and Informatics (SACI), 2021, pp. 503-508, doi: 10.1109/SACI51354.2021.9465548.

"Abstract: We initiate the study of the course allocation mechanism of the largest Hungarian university, ELTE, based on a real data provided for three semesters in 2018-2019. Besides introducing their priority based mechanism and the structure of their course registration data provided, we analyse a special issue coming from a students’ survey related to seat transfer. We identify the seat transfer actions in the last stage of the mechanism from the data that we describe in a transfer graph, and we analyse this network observing interesting patterns."


"In Hungary the course allocations are conducted at every major university by the same administrative system, called Neptun, and most universities use a simple first-come-first-served method. However, the largest university in Hungary, ELTE, uses a three-phase priority-based method [12]. In the first phase the students can submit their most preferred bundles, and the university admission may adjust the quotas of the courses based on these initial inputs. The second phase is the most important, where the students are ranked at each course based on a scoring system and lottery for breaking ties. They have a week to select their best bundles, but the mechanism is dynamic, the students can be unsure whether they will really get admission to a course. After finalising the assignment based on priorities and quotas, in the third phase of the mechanism a simple first-come-first-served method is used to allocate the remaining open slots. This final round also facilitates the informal seat transfers and swaps, a topic that we focus on in this paper. We conducted an online survey at ELTE sent to all registered students, and we received more than 3000 replies in total, so we could identify the main practices and issues for this priority based mechanism. We also received the complete course allocation record from their Neptun system for three recent semesters in 2018-2019. We will use this rich data to check the issues and strategies reported in the students’ survey, starting with the analysis of the seat transfers and swaps in the last stage of the mechanism.

...

"One of most critical comments was concerned with the rejection of the students even from their main courses that fits in their ideal curriculum. Some students mentioned that they could only get admission to some of their important courses by getting a favour from another student, who had higher priority at that course, so could take it in the second stage, and then transfer the course to them in the third stage. The transfer can be observed in the data as the withdrawal of a student and an almost immediate registration by another student. In this paper we initiate the study of this issue by studying the course allocation record of ELTE for the years of 2018-2019, that we describe in the next section."


Wednesday, May 12, 2021

A glimmer of hope for German kidney transplants: a discussion of kidney exchange

 Axel Ockenfels (who, along with Dorothea Kubler has been at the forefront of advocating for kidney exchange in Germany) forwards me this announcement (translated from German):

"the German Federal Ministry of Health is organizing a digital symposium on Tuesday, June 29, 2021, from 09:30 to approx. 15:30 on the topic of "Expanding the donor pool for living organ donation - a perspective for Germany?", to which we cordially invite you. Please feel free to forward the invitation to interested parties from your industry.

"An organ transplant is often the only way to save the lives of seriously ill people or to restore their quality of life. In view of long waiting times for a post-mortem organ donation, the question of living donation sometimes arises. Living organ donation has been permitted in Germany since 1997 within narrow limits and under special conditions. The donor and recipient must be "manifestly close in a special personal bond." However, living donation may be excluded in such cases for medical reasons. In order to increase the chances of organ transplantation for patients who are affected by this, some countries have established so-called kidney exchange programs.

"The symposium will take a look at various possibilities for extending organ donation: What are the opportunities and risks associated with cross over donation, pooled donation and so-called non-directed living donation? What procedures are necessary to protect donors? These and other questions will be discussed from a medical, legal and ethical perspective with an interdisciplinary audience. 

"We would be delighted if you could contribute your expertise to the discussion and if we could welcome you at the event on

"Tuesday, June 29, 2021, 09:30 - approx. 15:30 hrs.

...

"welcome to the event. The invitation is explicitly transferable. 

"If you would like to attend the event, please register by June 28, 2021 at the following link: Event Management Tool link.

Yours sincerely

"Joachim Becker

"Head of the Department of Medical and Professional Law, Prevention

Translated with www.DeepL.com/Translator (free version)"

****************

This seems like a potentially very positive first step, despite (or maybe because) of the fact that it seems to be signed by the Ministry of Health's department of prevention... (Leiter der Abteilung Medizin- und Berufsrecht, Prävention)

A previous post observed that kidney exchange receives popular support in Germany:

Thursday, March 4, 2021

Vaccine supply and delivery in Germany: I'm interviewed in Zeit

 Here's an interview in the German newspaper Zeit, in which I was asked in early February about the vaccine rollout here and there. (Google translate is pretty readable, although some of the Q&A is a bit garbled by the translation from English to German and re-translation back into English...)

"Die Welt kann es sich leisten, einiges zu bezahlen" Alvin Roth weiß, wie man begehrte Güter effizient verteilt. Er hat den Nobelpreis dafür bekommen. Ein Gespräch über knappen Impfstoff und wie er vermehrt werden kann.  Interview: Lisa Nienhaus

Google Translate: "The world can afford to pay a lot" Alvin Roth knows how to efficiently distribute desirable goods. He got the Nobel Prize for it. A conversation about scarce vaccine and how it can be propagated. Interview: Lisa Nienhaus February 15, 2021,

The interview starts off talking about congestion, and line jumping, and the tradeoffs between speed and fairness (and how it's really costly to allow some vaccine to expire unused in the name of fairness).  It then turns to shortages of vaccine in the near term:

ZEIT ONLINE: Attempts are being made to build new production facilities. But in Germany we are - to be honest - pretty late.

Roth: But now is not the time to give up. Everything we build now may help us in August. Even if Germany is running late, there is still time to expand production facilities. Especially since these systems would certainly not have to be destroyed after Covid. Being able to produce mRNA vaccines oneself is also a good thing in the future. Vaccine production is not that complicated. You can build production facilities anywhere. And you should too.

ZEIT ONLINE: It's not happening on a large scale yet. What to do?

Roth: Laws are really useful for that. Pfizer / BioNTech and Moderna could be forced to license the production technology to other German pharmaceutical companies.

ZEIT ONLINE: That sounds radical.

Roth: I only think it's logical. If you had a pharmaceutical company, you'd think, "I'm paid by the dose. I've got enough capacity to ship to the whole world in the next year and a half. Why should I hurry?" There is no need to set up production facilities just to supply the world in six months instead of 18. It doesn't make any difference from a business perspective. But for the German or American government, these two options are by no means equivalent. It is important that we vaccinate quickly. We need a lot more production capacity than the pharmaceutical companies think it makes sense.

ZEIT ONLINE: Economists rarely suggest such a strong market intervention. And that also applies to companies that we must first be grateful to because they show us a way out of lockdown.

Roth: It's a global pandemic. It is economically necessary to think about how to avert the damage to the economy. But of course you have to pay the manufacturers. Many forget that.

ZEIT ONLINE: How fair the companies think that probably depends on how much you pay them.

Roth: Yes. But the world can afford to pay a lot. Because the world economy is currently largely at a standstill. We have a multi-trillion dollar economy. Paying a billion to save a trillion is good business.

ZEIT ONLINE: Why is that not happening so far?

Roth: The pharmaceutical companies themselves don't think that way at the moment. But we need the vaccine now. And it's very expensive for the world to shut down its economy like that. If you lose a few percentage points of GDP growth in Germany, that's a huge number. And there is almost no amount to pay to license the vaccine that is not worth it.

Thursday, July 30, 2020

Surrogacy and global kidney exchange receive popular support even where banned, in PNAS by Roth and Wang


Popular repugnance contrasts with legal bans on controversial markets
Alvin E. Roth and  Stephanie W. Wang
PNAS first published July 29, 2020 https://doi.org/10.1073/pnas.2005828117
reviewed by Nicola Lacetera and Mario Macis

Abstract: We study popular attitudes in Germany, Spain, the Philippines, and the United States toward three controversial markets—prostitution, surrogacy, and global kidney exchange (GKE). Of those markets, only prostitution is banned in the United States and the Philippines, and only prostitution is allowed in Germany and Spain. Unlike prostitution, majorities support legalization of surrogacy and GKE in all four countries. So, there is not a simple relation between public support for markets, or bans, and their legal and regulatory status. Because both markets and bans on markets require social support to work well, this sheds light on the prospects for effective regulation of controversial markets.


"Our main result is that (unlike prostitution) the laws banning surrogacy and GKE do not seem to reflect popular demand. Neither do these bans reflect that opponents of legalization feel more strongly than supporters.
...
"All three transactions are the subject of current debate in at least one of the countries we surveyed.¶¶ Based on the results of our surveys, we do not see entrenched popular resistance to either surrogacy or GKE (or simple kidney exchange) where it is presently illegal, and thus, we anticipate that efforts to lift or circumvent current restrictions are likely to be increasingly successful, while efforts to legalize or decriminalize prostitution where it is presently illegal may face greater opposition from the general public.

"Understanding these issues is important, not just for the hundreds of Spanish couples stranded outside of Spain while they look for a way to bring their surrogate children home and not just for the people in need of kidney exchange but for whom it is out of reach in Germany or in the Philippines. These issues are also of importance to social scientists in general and economists in particular. When markets enjoy social support, when they are banned, and when, in turn, bans are socially supported are questions that touch upon many transactions, particularly as social and economic interactions are increasingly globalized.

"Our findings suggest that the answer to these questions may not be found in general public sentiment in countries that ban markets or legalize them. Rather, we may have to look to the functioning of particular interested groups, perhaps with professional or even religious interests, that are able to influence legislation in the absence of strong views (or even interest) among the general public about the markets in question."
************

Here's the published citation:
Roth, Alvin E. and Stephanie W. Wang, “Popular Repugnance Contrasts with Legal Bans on Controversial Markets,” Proceedings of the National Academy of Sciences (PNAS),  August 18, 2020 117 (33) 19792-19798; https://doi.org/10.1073/pnas.2005828117 

Friday, March 27, 2020

Death with dignity, in Germany

Medically assisted suicide, controversial everywhere, has come to Germany.

The Lancet reports:
Germany overturns ban on assisted suicide
Rob Hyde
Published:March 07, 2020DOI:https://doi.org/10.1016/S0140-6736(20)30533-X

"Germany's supreme court has lifted a ban on professionally assisted suicide in a landmark ruling. ...

"Following a campaign by doctors and terminally ill patients, Germany's supreme court has lifted a law which outlawed the provision of assisted-suicide services. These services could range from signing a prescription for a lethal overdose of sedatives, to providing consultation to terminally ill patients on how they could travel outside of Germany to end their lives legally.

"Speaking from Germany's Federal Constitutional Court in Karlsruhe, Judge Andreas Voßkuhle said the 2015 law—paragraph 217 of the German Criminal Code—did not allow a person either “the right to a self-determined death” or “the freedom to take one's life and seek help doing so”. This law, he said, therefore violated the German constitution, and was now void.

"The association Sterbehilfe Deutschland e.V. (Assisted Suicide Germany) was among those campaigning against paragraph 217. Roger Kusch, head of the organisation and Hamburg's former senator for justice, said that the ruling by the supreme court marked “…a wonderful day for our association, for the association members and also for all interested citizens.” He said the ruling meant that no-one now has to suffer the pressure “…from churches and from other people, who believe they have to influence the entire population and the whole of society.”

"Others, however, are less jubilant. Frank Ulrich Montgomery is president of the Standing Committee of European Doctors, which represents national medical associations across Europe. He fears that the supreme court's ruling will mean the principle of doctors preserving life could be rendered obsolete.
...
"“Euthanasia” comes from the Greek word euthanatos (which means easy death), and means taking steps to end an individual's life to relieve suffering. In a medical context, euthanasia refers to a doctor using painless means to end a person's life, providing the patient and the patient's family agree. Assisted suicide, by contrast, refers to when a person is helped to kill themselves. Switzerland has eight right-to-die clinics and is the European country most often associated with euthanasia. However, euthanasia and assisted suicide are legal not only in Switzerland, but also in Belgium, Luxembourg, and the Netherlands, although each country varies on how it defines both terms. In Germany, the issue of the state legalising euthanasia is highly sensitive, especially given that the Nazis used the same term to describe the murder of hundreds of thousands of disabled people."

Wednesday, March 18, 2020

Essential and inessential services under corona virus lockdown (guess before reading--coffee, cannabis, etc?)

We're under "shelter in place" orders in Santa Clara County, with everyone hunkering down, except for essential services:

Bay Area orders ‘shelter in place,’ only essential businesses open in 6 counties

"Six Bay Area counties announced “shelter in place” orders for all residents on Monday — the strictest measure of its kind yet in the continental United States — directing everyone to stay inside their homes and away from others as much as possible for the next three weeks in a desperate move to curb the rapid spread of coronavirus across the region.

"The directive was set to begin at 12:01 a.m. Tuesday and involves San Francisco, Santa Clara, San Mateo, Marin, Contra Costa and Alameda counties — a combined population of more than 6.7 million. It is to stay in place until at least April 7.
...
"Businesses that do not provide “essential” services must send workers home. Among those remaining open are grocery stores, pharmacies, restaurants for delivery only and hardware stores. "
*************

So I was glad to get this email from our local Stanford campus coffeehouse (which I agree is an essential service):

These Coupa Locations are still Open For Take-Out, Curbside-Pickup & Delivery
Today 9:00am - 3:00pm
 Green Library
571 Escondido Mall in Stanford
(nevertheless, our Wednesday morning market design coffee will meet by Zoom, while we shelter in place...)
************
Schools are closed (I guess they might be both essential and sources of contagion).  This being California, there are other essential services:
San Francisco: Cannabis deemed as an essential medicine, dispensaries to remain open
"The San Francisco Department of Public Health released a statement on Tuesday letting San Francisco residents know dispensaries will remain open despite having a shelter in place order.

"The Department states cannabis is an essential medicine."

*************
Nevada is different:  Nevada Brothels Requiring Customers To Wear Masks

Germany (where prostitution is also legal) is different in a different way, Stephanie Wang forwarded this shelter in place announcement from Germany:
https://www.land.nrw/de/pressemitteilung/landesregierung-beschliesst-weitere-massnahmen-zur-eindaemmung-der-corona-virus
via Google translate, a list of what is inessential:
"Already on Sunday, the Ministry of Labor, Health and Social Affairs decrees that almost all leisure, sport, entertainment and educational offers in the country will be discontinued. As of Monday, all so-called "entertainment companies" such as bars, clubs, discotheques, arcades, theaters, cinemas and museums have to close. The same regulation applies to prostitution companies."

Friday, January 17, 2020

Germany sticks with opt-in donation for deceased donor organs for transplants

Axel Ockenfels points me to this story, in English, in Deutsche Welle:

German parliament: Explicit consent still necessary from organ donors
Germany's parliament has rejected a health ministry proposal for a new organ donation system. With low donor numbers, the health minister wanted a presumed-consent system, with the onus on people to refuse to donate.
Date 16.01.2020  Author Mark Hallam, Astrid Prange

"Germany's organ donation rules will remain largely unchanged after an emotional debate in the Bundestag on Thursday morning. The country will stick with a system of informed consent, whereby only people who voluntarily register as organ donors are eligible. Most, but not all, EU members have moved to an opt-out system that presumes a willingness to donate.
Presumed vs. informed consent
"Health Minister Jens Spahn, a Christian Democrat, had led the push to reform the system along with a Social Democrat, Karl Lauterbach. They had proposed a system of presumed consent, albeit also adding the chance for relatives to object to organ donations after the person's death. The motion failed by 292 votes to 397.
"A rival proposal, put forward by a group led by Green party lawmaker Annalene Baerbock, passed by 432 votes to 200, with 37 abstentions, in the decisive final vote. It advocated keeping the existing system of informed consent. However, in a bid to shorten Germany's transplant waiting lists, people will be asked when renewing their national identity cards if they'd like to donate organs. "

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Recent, somewhat related post:

Monday, November 11, 2019

Monday, November 11, 2019

Debate on kidney exchange in Germany

On Friday in Berlin I found myself in a debate with the chairman of the Research Committee of the Bundestag, the German Parliament, about legalizing kidney exchange in Germany. I proposed that a minimal amendment of the law, which now only allows close relatives to donate, would be to also allow them to be the intended donors of their close relatives in kidney exchange.  However it doesn't seem as if this is going to happen anytime soon (it looks like only the Free Democratic Party in inclined to support it...)

The medical newspaper ärztezeitung has the story
Transplantation
Lebendspende breiter aufstellen
Beim Thema Organspende rücken die Lebendspenden zunehmend in den Fokus. Ein Nobelpreisträger befeuert die aufkommende Debatte.
[Widen living donation
With regard to organ donation, living donations are increasingly coming into focus. A Nobel Prize winner fuels the emerging debate.]

"Nobel laureate Professor Alvin Roth submitted on Friday morning a proposal on how the living donation of kidneys in Germany could be broadened. Instead of considering only first and second degree relatives, spouses, registered partners and close friends as potential donors in the transplantation law, the pair organ exchange of living donors should also be possible, he said at the Nobel Prize Dialogue of the Leopoldina in Berlin. The aim of this model is to increase the chances of being able to mediate compatible organs to dialysis-dependent patients.

"The chairman of the Research Committee of the Bundestag, Ernst Dieter Rossmann (SPD) advised in his reply to not overburden the population in Germany. First, the contradiction solution must be introduced and its effect on the donor numbers to be waited, he warned.

"At the end of October, the Greens warned against commercialization and organ trade if the so-called cross-donation was introduced. At the FDP, the considerations have fallen on fertile ground."

Friday, November 8, 2019

Nobel Prize Dialogue Berlin 2019 Towards Health: Equality, Responsibility and Research, Friday Nov. 8

I'll be speaking in Berlin again today:

Below is one announcement, with the agenda (and a list of speakers and panelists is here):
BERLIN 2019
TOWARDS HEALTH
Equality, Responsibility and Research

10:00 A.M. – 12:30 P.M.
Opening Remarks
Jörg Hacker, Laura Sprechmann

What Does ‘Health’ Mean to You?
Peter Agre, Tolu Oni, Ursula Staudinger
Moderator: Adam Smith

Funding Research for a Healthier Future: How Should We Set Priorities?
Tomas Lindahl, Ernst Dieter Rossmann, Eleftheria Zeggini
Moderator: Juleen Zierath

Kidney Exchange
Alvin Roth

How Can We Increase Organ Donation and Transplantation?
Ernst Dieter Rossmann, Alvin Roth, Christiane Woopen
Moderator: Adam Smith

Musical Intermezzo: Berliner Cellharmoniker
How Climate Change Is Affecting Our Health
Kristie Ebi

What Can We Do About the Health Risks of Climate Change?
Kristie Ebi, Sabine Gabrysch, Sylvia Hartmann
Moderator: Gustav Källstrand



Health Inequalities Throughout The Life Course
Michael Marmot

How Can We Reduce Health Inequalities?
Nicola Bedlington, Kathryn Dewey, Michael Marmot
Moderator: Peter Tinnemann

LUNCH BREAK 12:30 P.M. – 1:45 P.M.
LUNCHTIME CONVERSATIONS 12:30 P.M. – 1:45 P.M.
The Microbiome: a New Dimension in Health
Suzanne Devkota
Moderator: Adam Smith

Behind the Scenes of the Nobel Prize
Gustav Källstrand und Juleen Zierath
Moderator: Katja Patzwaldt

PARALLEL SESSIONS 1:45 P.M. – 3:15 P.M.
Lichthof
Vaccine Hesitancy
Michel Goldman, Tikki Pang, Harald zur Hausen
Moderator: Juleen Zierath

You are Entitled to Your Own Opinion, But Not to Your Own Facts
Tikki Pang

Health Challenges in Low- and Middle-Income Countries
Peter Agre, Tolu Oni, Tikki Pang
Moderator: Peter Tinnemann

Atrium
Mental Health and Longer Lives: Positive Plasticity of Cognitive Aging
Ursula Staudinger

Mental Health, Cognition and Ageing
Edvard Moser, Ursula Staudinger
Moderator: Adam Smith

The Future of Drug Development and Precision Medicine
Nicola Bedlington, Michel Goldman, Tomas Lindahl, Eleftheria Zeggini
Moderator: Adam Smith

COFFEE BREAK 3:15 P.M. – 3:45 P.M.
ATRIUM 3:45 P.M. – 4:45 P.M.
The Role of Diet
Suzanne Devkota, Kathryn Dewey, Harald zur Hausen
Moderator: Juleen Zierath

What Level of Healthcare Can Society Afford?
Michel Goldman, Heyo Kroemer, Alvin Roth, Christiane Woopen
Moderator: Peter Tinnemann

Who Is Responsible For Our Health?
Nicola Bedlington, Kristie Ebi, Heyo Kroemer, Michael Marmot, Edvard Moser, Tikki Pang
Moderator: Adam Smith

Closing Remarks
Laura Sprechmann

Friday, June 28, 2019

Legal brothels and sex trafficking in Germany

Apparently it's hard to staff a really high volume brothel entirely with voluntary sex workers.  The Guardian has the story:

Trouble in Paradise: the rise and fall of Germany's 'brothel king'
Jürgen Rudloff’s chain of ‘wellness spas’ sold sex as a health service for men. But his business model was fatally flawed – as his trial for aiding and abetting trafficking revealed

"Until his dramatic fall from grace, Jürgen Rudloff was the self-proclaimed “brothel king” of Germany. Owner of a chain of clubs he boasted was the “the largest marketplace for sex in Europe”, he was every inch the well-dressed entrepreneur, a regular face on reality TV and chat shows.

"Rudloff is now serving a five-year sentence for aiding and abetting trafficking. His trial laid bare the misery and abuse of women working as prostitutes at his club who, according to court documents, were treated like animals and beaten if they didn’t make enough money. His imprisonment has dismantled the idea of Germany’s “clean prostitution” industry and raised troubling questions about what lies behind the legalised, booming sex trade.

"Prostitution – legalised in Germany in 2002 – is worth an annual €15bn (£13.4bn), and more than a million men visit prostitutes every day. The change in the law led to a rise in “super brothels”, attracting tourists from countries where such establishments are illegal.
...
"The Paradise business model is the same as the hundreds of other “sauna clubs” across Germany – brothel owners provide the premises, and the women are self-employed. Yet Rudloff’s high-volume, low-cost model only works if the supply of women is enough to satisfy demand and bring enough customers through the doors.

"According to court documents, this became a problem for Paradise almost immediately. There weren’t enough women to fill the clubs. So Rudloff’s friends in the industry offered to help him out.

"In 2008, as Rudloff was growing his business, investigators in Augsburg, Bavaria – a hundred miles from Stuttgart – received a tip-off that gangs from the city were trafficking women from eastern Europe, and sending them to work in Paradise. (While prostitution is legal in Germany, pimping and sex trafficking are not.)
...
"Peter Holzwarth, the chief prosecutor at the trial, argued that the owner and management at the clubs were guilty of Organisationsdelikt – aiding and abetting an organisation involved in criminality. “He knew – in the cases brought to court – that the women working at his club were being exploited by pimps,” says Holzwarth. “And he knew the women were trafficked, or rather, he thought that they might be and [still let them work], and that is sufficient for a conviction.”

"The court agreed. Sentencing Rudloff in late February this year, the judge remarked: “A clean brothel of this size is hard to imagine.” He said he hoped the convictions would serve as a warning to the sex industry.
...
"For prosecutors like Holzwarth, Rudloff’s conviction is a warning to those cashing in on Germany’s insatiable demand for commercial sex. “Rudloff’s case was not an isolated incident,” he says. “In my opinion, cooperation between brothel owners and pimps is risky but profitable for both sides. A win-win situation … but the case has had an impact already. I think brothel owners will be more careful about dealing with pimps.”

Friday, May 24, 2019

Matching early when information is costly, by Grenet, He, and Kübler

Here's a new paper on school matching that takes preference formation seriously:

Decentralizing Centralized Matching Markets:
Implications from Early Offers in University Admissions
by Julien Grenet, Yinghua He, and Dorothea Kübler
May 2019

Abstract
 The matching literature commonly rules out that market design itself shapes agent preferences. Underlying this premise is the assumption that agents know their own preferences at the outset and that preferences do not change throughout the matching process. This assumption implies that a centralized market where agents receive at most one offer can dominate a decentralized market where multiple offers to agents are possible. Using a quasi-experiment in Germany’s university admissions, we provide evidence against this assumption. We study a centralized clearinghouse that implements the early stages of the university-proposing Gale-Shapley deferred-acceptance mechanism in real time, resembling a decentralized market with continuous offers, rejections, and acceptances. With data on the exact timing of every decision, we show that early offers are more likely to be accepted than (potential) later offers, despite early offers not being made by more desirable universities. Furthermore, early offers are only accepted after some time rather than immediately. These results and direct survey evidence are consistent with a model of information acquisition: it is costly for students to learn about universities and accepting a university that turns out to be inferior causes regret. We discuss and rule out some alternative hypotheses. Our findings motivate a hybrid mechanism that balances centralization and decentralization. By allowing sequential learning, it improves welfare, especially in markets with substantial learning costs.

Wednesday, January 30, 2019

Kidney exchange in Germany? It will need an amendment to the Transplantation Act

Axel Ockenfels points out that the Frankfurter Allgemeine Sonntagszeitung has a recent piece on "Tauschen wir die Nieren?" ("Do we exchange kidneys?"). I can't find it online, but here's a picture:

Google translate renders the opening paragraphs as follows:

"Patients wait a long time for donor organs. That can be changed - with a proposal that has received the Nobel Prize.
Organ donation is literally a matter of life and death. Anyone who receives the urgently needed organ in good time lives on. In Germany, however, many are waiting for the necessary transplantation - often for years. At the same time, the number of organ donations is falling. So how can the number of donated organs be increased so that affected people can live? That's a tricky question, because too many answers tend to limit the voluntary nature of the donation. On Wednesday, the topic is on the agenda of German politics, when the Health Committee of the Bundestag deals with the amendment of the Transplantation Act.
The economists Dorothea Kübler and Axel Ockenfels advise the politicians to take a look at living donations. Kidneys or parts of the liver can also be donated by living people - and this is much less common in Germany than in other countries. The proposal goes in the direction of the FDP parliamentary group around the chairman Christian Lindner, who are pushing for more living donations. In a motion for the health committee on Wednesday, the FDP is proposing to allow the cross-donation of two couples and an anonymous live donation to an organ pool. "

Wednesday, January 16, 2019

Organ donation in Germany

Spiegel.de has the story:
Nach langem Abwärtstrend, Zahl der Organspender deutlich gestiegen
(GT: After a long downward trend, the number of organ donors has increased significantly)

"Last year, 955 people left organs for other critically ill patients after their death, as the German Foundation for Organ Transplantation (DSO) announced. That was an increase of nearly 20 percent compared to 2017 with 797 donors and the first major increase since 2010.
...
"a discussion on new organ donation rules has started in parliament across parliamentary boundaries. So far, withdrawals are only allowed with expressly agreed consent, but many postpone the occupation with this topic again and again.

"Spahn is therefore campaigning for a "double contradiction solution" ["doppelte Widerspruchslösung"]. Accordingly, everyone is automatically considered a donor. One should be able to say no to this, otherwise - as a double barrier - relatives would have to be asked. In an open debate in the Bundestag at the end of November broad reservations against such a new regulation became clear.

"Instead, a group led by Greens leader Annalena Baerbock and left-leaning boss Katja Kipping suggests a mandatory recurring query, such as collecting new passports or identity cards - with the option of not yet deciding."
**********

HT: Rosemarie Nagel