Last year, 43% of kidneys transplanted in the U.S. came from living donors, up from 28% a decade ago.
But a biological barrier often blocks a transplant from a relative. In about a third of all would-be pairs, blood types are incompatible. In others, the sick person has antibodies that can initiate a rejection of the donated organ. It’s heartbreaking “to have the treasure of the live donor and then have that not go forward because of a biological obstacle,” says Massachusetts General Hospital transplant surgeon Francis DelMonico.
Occasionally, transplant centers spot a way out: One New England father with blood type A couldn’t donate a kidney to his daughter with blood type B. So he gave a kidney to a teenager with blood type A, and the teenager’s sister gave a kidney for the man’s daughter.
Such swaps, however, typically occur only when happenstance alerts surgeons to the possibility. Economist Alvin Roth and co-authors have devised an algorithm, however, that computes all the possible swaps and which is incentive-compatible.
…when Dr. Saidman gave the economists details on 45 pairs in which the would-be donor was unable to give a kidney to the intended recipient. Even though each of the 45 had a donor willing to spare a kidney, all were stuck waiting for the right person to die. With swaps involving two kidneys, the economists found, eight transplants were possible. If swaps involving three kidneys were possible, then 11 transplants were possible.
Addendum: Alert readers will note that kidney swaps are quite similar to organ clubs an idea for saving lives that has been implemented by Lifesharers.
Your spouse is dying of kidney disease. You want to give her one of your kidneys but tests show that it is incompatible with her immune system. Utter anguish and frustration. Is there anything that you can do? Today the answer is yes. Transplant centers are now helping to arrange kidney swaps. You give to the spouse of another donor who gives to your spouse. Pareto would be proud. Even a few three-way swaps have been conducted.
But why stop at three? What about an n-way swap? Let’s add in the possibility of an exchange that raises your spouse on the queue for a cadaveric kidney. And let us also recognize that even if your kidney is compatible with your spouse’s there may be a better match. Is there an allocation system that makes all donors and spouses better off (or at least no worse off) and that maximizes the number of beneficial swaps? In an important paper (Warning! Very technical. Requires NBER subscription.) Alvin Roth and co-authors describe just such a mechanism and show that it could save many lives. Who says efficiency is a pedestrian virtue?
See here for more on how to alleviate the shortage of transplant organs.
1. Incarnations: A History of India in Fifty Lives, by Sunil Khilnani. A highly readable introduction to Indian history, structured around the lives of some of its major figures. I passed along my copy to Alex.
2. Haruki Murakami, Absolutely on Music: Conversations with Seiji Ozawa. More for classical music and Ojawa fans than Murakami readers, this is nonetheless an easy to read and stimulating set of interviews for any serious classical music listener. They are most interesting on Mahler.
3. Elsa Morante, History. In America, this is one of the least frequently read and discussed great European novels of the 20th century.
4. Miriam J. Laugesen, Fixing Medical Prices: How Physicians are Paid. Will people still care about these issues for the next four years? I hope so, because this is the best book I know of on Medicare pricing and its influence on pricing throughout the broader U.S. health care system.
My copy of Joel Mokyr, A Culture of Growth: The Origins of the Modern Economy has arrived. It is a very good statement of how political fragmentation and intensified intellectual competition drove modernity and the Industrial Revolution.
I have only perused John H. Kagel and Alvin E. Roth, Handbook of Experimental Economics, volume 2, but it appears to be an extremely impressive contribution.
Marc Levinson’s An Extraordinary Time: The End of the Postwar Boom and the Return of the Ordinary Economy details what made the post World War II era so special in terms of its economics and income distribution and why it will be so hard to recreate.
Chris Hayes’s A Colony in a Nation, due out in March, he argues that racial equality really hasn’t improved much since 1968.
Guillermo A. Calvo, Macroeconomics in Times of Liquidity Crises is a useful book on sudden stops and related ideas.
Arrived in my pile is Yuval Noah Harati, Homo Deus: A Brief History of Tomorrow.