Friday, June 23, 2017

Kidney transplant in June 1950

I'm accustomed to calling Murray's 1954 surgery the first successful kidney transplant, and indeed the first successful organ transplant.
(see my post  A transplant makes history--Joseph Murray’s 1954 kidney operation ushered in a new medical era.)

But there were earlier attempts, and there's room to disagree on what constitutes a success. Here's a recent anniversary article about an earlier kidney transplant, from a deceased donor (and also before immunosuppression--Murray's surgery involved a live donation from one identical twin to another...)

This Day In Science June 17, 1950 – First successful kidney transplant operation was performed

"On June 17th 1950 Dr. Richard Lawler performed the first successful kidney transplant. The recipient was Ruth Tucker, a 44-year-old woman who had polycystic kidney disease (PKD).
...
"A transplant was risky but the only real option for survival for Tucker, as dialysis was not yet widely available. The donor kidney was removed from a patient who had died of cirrhosis of the liver.

“Not the most ideal patient, but the best we could find,” said Dr. Lawler after the surgery. The transplant surgery was quick, and 45 minutes after removal of the kidney from the donor the operation was complete. Tucker was released from the hospital a month later.
"The kidney functioned for at least 53 days, but it was removed 10 months after the surgery as it had been rejected. This transplant was conducted well before the development of immunosuppressant drugs and tissue typing which would have helped prevent organ rejection.

"Ruth Tucker had PKD in both of her kidneys, leaving one non-functioning and the other functioning at 10%. The donor kidney gave her body the chance to resume normal kidney function, therefore when the donor kidney was removed, Ruth was able to live another 5 years with her one remaining kidney. She died in 1955 from coronary artery disease which was unrelated to PKD and her organ transplant.

"Dr. Richard Lawler never performed another transplant, saying that he “just wanted to get it started”.
***********

Here's some more detail on the website of the Little Hospital of Mary in Chicago, where the surgery was performed.

First Successful Organ Transplant, Little Company of Mary, 1950

"The surgery was extremely courageous, given that it was done without anti-infection drugs, tissue typing and other advances that are now standard. A Newsweek article a week after the surgery was headlined, “Borrowed from the Dead”. The article stated, “Successful transplants have been made of bones, skin, nerves, tendons and eye corneas. But up to last week, no vital human organ had ever been moved from one person to another. Then, in a daring surgical feat, Dr. Richard M. Lawler of the Little Company of Mary Hospital, Chicago, removed a diseased kidney from Mrs. Ruth Tucker…The patient was ‘willing to gamble rather than lie back and wait for death,’ Dr. Lawler said.” A month later, Tucker was released from the hospital, a medical miracle. She lived five years before dying from a coronary occlusion following pneumonia."

Thursday, June 22, 2017

Ben Edelman calls out Uber

Ben has been following Uber for some time, and he's calling them out for their law-breaking business model:

Uber Can’t Be Fixed — It’s Time for Regulators to Shut It Down
From many passengers' perspective, Uber is a godsend — lower fares than taxis, clean vehicles, courteous drivers, easy electronic payments. Yet the company’s mounting scandals reveal something seriously amiss, culminating in last week’s stern report from former U.S. Attorney General Eric Holder.
Some people attribute the company’s missteps to the personal failings of founder-CEO Travis Kalanick. These have certainly contributed to the company’s problems, and his resignation is probably appropriate. Kalanick and other top executives signal by example what is and is not acceptable behavior, and they are clearly responsible for the company’s ethically and legally questionable decisions and practices.
But I suggest that the problem at Uber goes beyond a culture created by toxic leadership. The company’s cultural dysfunction, it seems to me, stems from the very nature of the company’s competitive advantage: Uber’s business model is predicated on lawbreaking. And having grown through intentional illegality, Uber can’t easily pivot toward following the rules.

Repugnance to Science: Brecht's "Life of Galileo" at the Young Vic

I had the great pleasure of seeing a timely production of Brecht's Life of Galileo at the Young Vic.
Before his troubles with the Church, Galileo has a Silicon Valley vibe:
"When a young man in Siena, I saw how a couple of builders, after five minutes argument, replaced a thousand-year-old system for moving graniteblocks by a new and more practical arrangement of the tackle. Then andthere I knew-the old age is past and a new age is here."

Later in the play, the Cardinal Inquisitor explains to the Pope why the Church should regard science with repugnance:

" A terrible unrest has come, into the world. It is this unrest in their own minds which these men would impose on the motionless earth. They cry: the figures compel us. But whence come their figures? They come from doubt, as
everyone knows. These men doubt everything. Are we to establish human
society on doubt and no longer on faith? ‘You are my master, but I doubt if
that is a good thing.’ That is your house and your wife, but I doubt whether
they should not be mine.’ "
***********

Climate change anyone?



Wednesday, June 21, 2017

Travel while on dialysis

One of the burdens of kidney failure is that, while waiting for the chance of a transplant, patients often have to spend several hours several times a week on dialysis.  This means most patients can't travel without arranging dialysis sessions at their destination.

After my Morishima Lecture in London, Silvina Lindner pointed out to me that there is an emerging marketplace for dialysis travel.

Here's the website of Connectus Medical, which offers to help arrange dialysis in more than 150 countries.

(In another approach, see my post on efforts towards portable dialysis.)

Tuesday, June 20, 2017

Needed: International responsibility sharing for refugees

The Scalabrinians, a Catholic organization concerned with refugees, has issued a report:

International Migration Policy Report:
Responsibility Sharing for Large Movements of Refugees and  Migrants in Need of Protection
A report of the Scalabrini migration study centers June 2017
It's table of contents reminds us that the problem is not limited to any one region of the world. Here are the chapter headings...

  1. Introduction
  2. Rohingyas: The People for Whom No One is Responsible
  3. South Sudan: A Young Country Divided by Civil War
  4. Politics and Responsibility Sharing in Facing the Migration Crisis in Europe
  5. The Challenges of Migration Trends and Shared Responsibility in Latin America and the Caribbean 
  6. Knocking on the Door: Vulnerable Populations at the US-Mexico Border
  7. Conclusion
Here is the Conclusion:

"The five papers in the 2017 International Migration Policy Report of the Scalabrini migration study centers demonstrate that the global community is at a crossroads with regard to the protection of large movements of refugees and migrants. Common to each analysis is the absence of adequate responsibility-sharing mechanisms to ensure that all nations contribute to the protection of persons on the move.

"In Europe, nations continue to point the finger and not accept responsibility collectively, with front-line nations, such as Greece and Italy, bearing the brunt of protection responsibilities. In Africa, regional cooperation, while noble, is insufficient to the need, leading to protracted refugee situations with little options for improvement.

"The Rohingya ethnic group of Myanmar is stateless, with few nations in the region willing to accept them permanently, as their villages are being burned and their population being killed by the Myanmar military. Latin America and the Caribbean are largely immigrant-producing countries, with the majority of their migrant populations attempting to reach the United States and Canada, but with many settling in nations within the region. In North America, the United States, the wealthiest nation on earth, is using deterrence tactics to prevent unaccompanied children and women and children in families from arriving at the US border.

"The policy recommendations in these papers point to the need for a uniform global model for responsibility sharing in the context of large movements of persons. Such a model would apply to the entire international community and would help relieve the burden on front-line states, many of which do not have the capacity to deal with large populations.

"As such, it is vital that the processes leading to a Global Compact on Responsibility Sharing for Refugees and the Global Compact on Safe, Orderly, and Regular Migration continue and lead to binding agreements by 2018. The Scalabrini migration study centers will continue to inform and participate in these processes and will raise concerns and solutions, based on its expertise and experience serving refugees and migrants around the world.

"As Pope Francis has stated, the world must move beyond a “globalization of indifference” to migrants to international solidarity: “It is important that nations in the forefront of meeting this present emergency not be left alone, and it is also essential to initiate a frank and respectful dialogue among all the countries involved in the problem — countries of origin, transit, or reception — so that, with greater boldness and creativity, new and sustainable solutions can be sought.”1

1  Pope Francis in an address to the Vatican diplomatic corps on January 11, 2016.799

Monday, June 19, 2017

Listen to my Morishima Lecture: Marketplaces and Market Design (audio only)

Below you can listen to a podcast of my lecture in honor of Michio Morishima at the LSE last Thursday. (Update: I've also added links to video below.)

I showed slides in my lecture, but I think you can actually follow the talk without them.  The introduction is by Professor Nava Ashraf.  My talk ends at minute 60, and then you can hear a half hour of questions and answers, many raised by my discussion of repugnant transactions.
******************

Update:
Here are two videos of the event; the first mostly follows me and not the slides, the second is audio plus slides.

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

Sunday, June 18, 2017

Mail order opiods, paid for by bitcoin, ordered over the dark net

The NY Times has the story:
Opioid Dealers Embrace the Dark Web to Send Deadly Drugs by Mail

"In a growing number of arrests and overdoses, law enforcement officials say, the drugs are being bought online. Internet sales have allowed powerful synthetic opioids such as fentanyl — the fastest-growing cause of overdoses nationwide — to reach living rooms in nearly every region of the country, as they arrive in small packages in the mail.

The authorities have been frustrated in their efforts to crack down on the trade because these sites generally exist on the so-called dark web, where buyers can visit anonymously using special browsers and make purchases with virtual currencies like Bitcoin.

The problem of dark web sales appeared to have been stamped out in 2013, when the authorities took down the most famous online marketplace for drugs, known as Silk Road. But since then, countless successors have popped up, making the drugs readily available to tens of thousands of customers who would not otherwise have had access to them."
**************

For an earlier post on the Silk Road marketplace and its demise, see

Monday, June 1, 2015

Saturday, June 17, 2017

A long transplant chain in Nebraska

An 18 person chain (9 donors and 9 transplants) is celebrated in Nebraska:
After transplant chain, donors meet those whose lives they saved
By Julie Anderson / World-Herald staff writer  Jun 9, 2017

"On Thursday, 18 people — nine living donors and nine recipients from across Nebraska and one other state — gathered at the Nebraska Medical Center to learn how a chain begun by an Omaha mother of seven had come together and how it is making a difference in the lives of the recipients, one as young as 5.

Until then, none had known how many were involved in what now ranks as the largest single-hospital living-donor kidney transplant chain in Nebraska history and one of the largest chains at a single hospital in the United States. Previously the medical center’s largest transplant exchange was a three-way exchange in July 2016."