Sure, markets generally work well. But for some transactions — like school admissions and organ transplants — money alone can't solve the problem. That's when you need a market-design wizard like Al Roth.
This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
If you'd like to listen to free economic radio without ads the place to do that is sticker premium five dollars a month and you can get a free month trial by going to stick your premium dot com and use a promo code freak. You also get access to all our bonus. Episodes and you'll be supporting our show to that sticker premium, dot, com, promo code, freak thanks,
they're stupid double the holidays are upon us. So we are taking the opportunity to replay. What's turned out to be when the most influential episodes we ve ever made, it actually helped save lives. Now we can claim credit. We were just spreading the word on the good work done by people like Al Roth, whom you'll meet in a minute, and then people who heard the episode acted on their own to perform random acts of kindness, encourage. I won't tell you what they did. You'll see that out as you listen. Suffice it to say that during the season of gratitude, we are grateful to have played a tiny role in this most excellent display of human ingenuity and generosity. The economics radio team
really busy this year, producing dozens of new episode that are sent out to you each week free of charge. That's the way. It should be. Why we're here is quite possible that if you are a regular listener, you spent in total more than one all day with economics, radio during two thousand seventeen feel safe to say that we ve earned spot in your life. I mean you're here now right Well, you can help us bring you more for economics, radio in the new year, when you do it by December. Thirty. First you'll set yourself up for a nice little charitable deduction and your tax return. So what are you waiting for support for economics? Radio become a member today with your donation. Get your two thousand seventeen tax deduction before it's too late, just go to free economics, dot com, slash donate or you can text the word
freak the seven o one or one? Thank you so much. hey, I'm a loss and Professor of economics, at Stanford. For many years, Roth had taught economics and harbour, but he and his wife, who was a human factors engineer had relocated. We had just moved into a new apartment. We had moved to Stanford in September, two thousand and twelve shortly thereafter on October 15th, something memorable happened and my wife woke up around two in the morning and said the phone's ringing and I woke up and it wasn't bringing any more. We only had one phone at that point. It was in her office which
upstairs. So I said to her: it's not ringing a hundred back to sleep and she went down and got the phone and it started ringing again. It turns out it's a good thing: they they call you back, they don't put down their list and it was the the Nobel Committee, Roth half asleep, was informed that he long with Lloyd, shabbily had won the Bank of Sweden Prize and Economic Sciences in memory of Alfred Nobel, also known as the Nobel Prize in Economics, Did you think you had a chance that you're too hard to answer that humbly, so I knew that I was on the big list of people who, if I want to Nobel Prize it wouldn't cause the Nobel to be embarrassed, newspapers, the next day would not say craziness into them, but but there are many many people in that category, so indeed we had. We were,
sleep. We were not waiting for a call and it's an interesting called because one of the things they are concerned about they have a lot of experience with. This is convincing you that it's not a prank, so the person who first spoke to me said in relation to Burma, Nobel Prize and many said, and I'm here with six of my colleagues and two of them know you and they're gonna talk to you now to persuade Then this is for me I'll write you a letter of very elaborate prank exactly, but but they call you up, and I say so in half an hour, this is gonna happen, get ready and can I took shower and got dressed, which was a good thing, because it wasn't an opportune Do that again holiday and both the rest the day like then well so at at five minutes. To from calls you back and again, this till I guess concerned that you shouldn't appear confused on the phone. So what would she said? It should point your brain to the to the Nobel site, and you will see your name being announced and then
We will come on the line and have a fresh conflict by telephone. So by the time It happened. I remember. Stanford press office fortunately descended on our house at four a m and started feeling calls from journalists did they take pressure off this ready now? Are you ready and I get the phone and I get five questions from someone, and I would speak to many many people in parallel I mostly answered them very, very seriously, but I told a joke or to that I haven't intended to tell that people would say to me I heard you on in pure. You said something a little odd, but and then there was a press conference and then at eleven I had a class, so people seemed a little supplies, but that's how he entered the press conference note that this was a surprise and It was a monday- and I worry german word- had travelled your students by then I assume it had. There was tramp pain in the very nice room. So what kind of worked it out?
due to land the Nobel Prize in Economics. Well, it's not the kind of work that typically wits about. He has helped people who need a kidney transplant find a donor he's up. New doctors find their first jobs. He's up high school students in New York City find the right Highschool. Even the Roth himself I grew up in New York City dropped out of high school. I was, as you know, were ungrateful student. Isn't it rigid what my teachers were trying to do? You should tell your listeners ancient completely. I'm happy
from W and Y see studios. This is for economics, radio broadcasts that explores the hidden side of everything. Here's your house, Stephen Dogma I recently visited Palo Alto, California, home to Stanford University and a few other things to talk with AL rough. He was, as you have heard, I school dropout. Don't worry, he did go to college many. Many years of college, not finishing high school is not the only odd thing about Al Roth as a Nobel laureate consider this, even though he won the price.
In economics, and even though he's a professor of economics, he is not technically and economists, my degrees or an engineering and did I would pay for once the manifesto of Market Zine called the economist has engineer. Aha, he also, I think, of myself as something like an engineer. I'd like to be an engineer. A manifesto of market design Roth calls it. The Nobel Committee citation noted his fury of stable allocations and the practice of market design what is market design, and why can it when you, a Nobel Prize market design, is an ancient human activity in a win win? When you look at the distribution of stone tools around the Middle EAST in Europe, you find that long before the mention of agriculture. Stone tools were moving thousands of miles from where they were quite and made an that's a sign,
They were markets for stone tools, they were ways to meet and trade things, and we don't really know much about those market, but the stone tools which are very durable are are evident. That markets are older than agriculture, but the stone age men who traded those stone tools and weapons had to make markets on how they had to make them safe. They had to feel confident that they could bring the things they would trade for these stone tools and not be robbed by by guys with stone axis who would take their stuff and that's been a big part of market designed for a long time is, is making market safe. Today we we think about fraud and identity theft and check your credit card, but there was a time when kings thought about securing the
who's against highwaymen, so you wouldn't be waylaid on your way to and from the market. So if, if I were the king of England that I wanted have markets in England, I had to make sure that that the roads were safe to get to the market. Al Ross, never written a book really wonderful book. I should say it's called who gets what and why the new economics of matchmaking and market design if market design is, as Roth, says, an ancient human activity. Why does someone like him need to get involved? after all, were told that markets generally organise themselves right there, sellers and buyers supply me. Demand with price being the glue that holds it altogether in this regard, the the invention of money was a big breakthrough. Border is very hard because Unita double Coincidental wants. You need to find someone who has would you want and who want
do you have right? You happen to have saw. I happen to have woollen, we want what the other wants, or we find a third party right. Well, so finding the third party starts getting you involved over things on. Of course, money is a great market divine invention for helping you find third parties, because you can sell what you have for money and then go look for what you want. But there are some transactions in time realms of transactions. Really were money cannot do what it does in a typical market were, for whatever reason supply
is not allowed to naturally meet demand with price as the arbiter, and that is where someone like our off comes in handy the economist as engineer, because these atypical markets have to be set up differently. Left me helped along. This is sometimes called a matching market matching market or markets where money prices don't do all the work and some of the market's I've studied we dont let prices do any of the work and I like to think of matching market as markets where you can't just choose what you want, even if you can afford it also have to be chosen. So job markets are like that. Getting into colleges like that those things cost money, but money doesn't decide who get into Stanford. Stanford doesn't raise the tool, and until supply equals demand and just enough freshmen wanna come to to fill the seat. Stanford is expensive, but it it's cheap enough that a lot of people would like to come to Stanford
I'm so Stanford has this whole other set of market institutions, applications and admissions, and then you can just come to Stanford. You have to be admitted or think about this problem, which Al Ross has worked on directly what is the best way for hospitals to hire newly minted doctors and for those doctors to find the most appropriate hospital for them to work in the current system is called the national resident matching programme too. I got involved in helping it during a crisis in the ninety ninety, but you have to go back to nineteen hundred understand how doctors get jobs and the night Hundreds- is around the time when the medical degrees, as we know them, the MD degree, became the dominant medical degree in about one thousand nine hundred the that's when internships began so instead of graduating from medical school on a meaty beginning,
practice medicine. As we say a word that always bothered me. Yes, you should be good at it by now. The first job, the standard first job for medical graduate, became what was called an internship and is today called a residency I met a job where you work in a hospital and CARE of patients under the sun, vision of a more experienced attending physician and it's a giant part of that professional education of doctors, so very important doctors where they get their turn trip and residency, and it's very important hospitals, because the entrance and residents are a very important part of the Labour force of hospital. As Roth tells it, there was an arm.
Race between hospitals for the best future doctors. They begin grabbing medical students earlier in earlier, sometimes two years before graduation and when you try hiring people two years in advance. It's hard to tell who the good doctors will be. It also hard for the doctors to tell what kind of jobs they want. So the medical schools intervened in nineteen fifty two, they created the national resident matching programme. They developed a marketplace that has a form that has survived till today. Although my colleagues I have helped modify, it seemed to them and what that form was you go on to views and you find out the of salary and the working conditions and of the various jobs that that you might be offered? a man instead of working the phones. Maybe getting an offer that says you have to take it yes or no right now, on the phone
Would you do? Is you you consider in advance which jobs you would like a new submit a rank order preference? This would be my first choice of the jobs I interviewed at here's. My second choice is my third and the jobs do the same thing: the hospital residency programmes to the same thing a matches made in a centralized clearing house by the nineteen nineties. This system was showing strain. Some people thought the hospitals had too much less. Moreover, the residence also by now there's a lot more female medical students, some of whom had a significant other, who is also a medical student, and such a couple typically wanted to get a residency in the same hospital or at least in the same region, but the matching programme couldn't handle that kind of request, so those candidates might opt out in ninety. Ninety five Al Roth was asked. help right an algorithm. The could fix these problems. The algorithm worked well and it now matches more than twenty thousand applicants. Each year
it sounds as though this works pretty well according to most people involved. Yes, most people involved in this scenario pretty happy with how it works correct will labour market are stressful reference? I think your overstating how happy people are with out of the lake market well, but I think it works, but I mean in the medical residency matching particularly well airily says an improvement over what what was before. It is a vast improvement. Ok, here's my question really for you is this is broader labour markets. If, if we consider the medical residency matching programme relatively successful to what preceded it. At least, why not used more widely in the labour markets, while the the medical market is an easier one to coordinate them. Many markets, because just about
but everyone becomes available. At the same time, we may graduate from medical school and they all start their jobs, therefore about the same time in July. So it's a market that can easily move people all at the same time, whereas many markets think about the market for journalists they might be hired a different moments and jobs might become available and need to be filled. and then not be able to wait for you to consider many. Are you and your colleagues are pretty brilliant? You have mathematical backgrounds. I would think you could deal with rolling admissions. Is it right? I mean for all the talk about how Our labour markets have so many mismatches in them, so many people doing jobs are they don't really want to be doing so? Many corporations with all these theoretically qualified people out there not being able to find the people too too fill them without going through a lot of going to a lot of trouble. I mean hiring practice become more and more complicated, it see
This is one way to address the matching problem, but it seems as though you were complicated. Mathematical foundation might provide ironically, a simpler way to address that problem. So I'm not sure, that's true again, the one of especial things about resolute positions is, although they are very different in different This is their sort of similar to each other. If you are thinking about, should you be a journalist or an airplane pilot or a chef you're dealing with very different jobs, with very different employers and one of the things that we do in the medical matches we make the jobs available at the same time that allows you to consider them tat preferences over them. That's hard to do if you're thinking about being a chef or an auto mechanic, sure I'm
there is to know what's a market or scenario that you ve looked at before that he thought boy. I would love to help fix that one, but either haven't had a shot or may be tried and failed. Well, though, the markets for new lawyers might fall into that category and certainly the best the most the fanciest job that that top graduates of elite law, schools get his alot like a medical residency. It took clerkship with an appellate judge that market is presently in the kind of situation that the doctor market was around. One thousand nine hundred and forty, where jobs are, are being contracted far before law school graduate and probably a dozen times in the last thirty years. The lawyers have tried to fix this with things like setting dates before which you shouldn't tyre and things like that, but it turned out it's hard to make rules.
The judges have to follow. Nudges judges are a law unto themselves em down and they break the rules. They cheat. If you know who's in law school now who want a click ship there, probably gonna, get an offer some time in their second year. You know so the middle of their second, your ear and a half and bore they are ready to go and what would it take for you to have the authority to get in there? and we do that market where the the question is do does- is their desire for judges to coordinate in a way that would control the market, and so far there hasn't been. So you can win on the Nobel prizes you on there's a limit, your power. Nonetheless, there is as complicated as it may seem to match future lawyers or doctors with their employers, consider and even more complicated match a person who will die unless they can get a kidney transplant. You can't fire
didn t you can't pay for some college education to get a kidney. You can't buy my car, that's illegal in the United States to train a kidney through any kind of valuable consideration that is reformed women the programme manager for the kidney pair donation programme at the United Network for organ sharing, the United Network for organ sharing, your universe, maintains the registry, all the people in the? U S, who need an organ transplant. According to the National Kidney Foundation, out of the roughly one hundred and twenty three thousand people awaiting an organ transplant, more than a hundred thousand of them, roughly eighty percent need a kidney we don't have enough supply of kidneys available, and so the list is ever growing, but the number of kidneys available for transplant is pretty stagnant. Its estimated the twelve p
we'll die each day in the? U S while waiting for lifesaving kidney transplant and that's because, as Liegemen says, the demand for kidneys keeps rising, but the supply has risen to meet it. Now. Why is that consider where most donated organs come from? They primarily come from cadavers from people have died, but who died under just the right circumstances, from a brain trauma, for instance, to allow their still functioning organs to be,
arrested for transplant only about one percent of the population who die are actually able to donate their organs. So if you need a heart transplants saying, you are waiting for a cadaver organ but kidneys different from her wise up, because humans are born with two kidneys and yet we really need only one which means that in a country like the? U S with a few hundred million people, there are potentially a few hundred million spare kidneys out there. When someone has kidney failure, typically, both their kidneys fail, so their left with zero healthy kidneys, whereas the typical healthy person has a perfectly good spare. So while it might seem that there is a massive demand for donated kidneys, remember there more than a hundred thousand people on the list
The fact is that the potential supply is really massive. Here's Al Roth again pure healthy enough. You can remain healthy with just one, and that means if someone you love is dying of kidney disease. You could give me kidney and save his life if you happen to be a match, if you happen to be a match and that's where kidney exchange comes in a kidney exchange because remember, unlike some markets were price is allowed to. Let demand meet supply. Organ donation is a market that doesn't allow money as a society we ve decided it isn't right to reimburse people in any way for donating an organ, although I should say some economists have argued that we should rethink that, but for now at least kidney donation is reliant on altruism, which, judging by the backlog of kidney patients waiting for an organ,
working so well. That's why our off got involved. People often ask me how I got involved in guinea transplantation and I think that the romantic thing that their hoping I'll say is that I knew someone who is ill or or that I was ill. But that is not the case at all. I entered through the mathematics coming up on economic region how Al Wroth and his comrades used mathematics to save lives. We invest six hundred Kinney per donation transport the year right now in the United States thousand. We had to end our Roth's greatest hope for his new book, who gets what and why. My hope is that this book will help you to see markets in new ways. So may I take you to dinner to celebrate the completion of this book. That's coming up, but first a quick reminder that you can do something amazing that will deliver good stuff for many other people right now. This is it,
of year when we remind you that for economics, radio is made possible in no small part by the dollar's given by our listeners. That means you You can help us bring you more for economics radio in New year, when you do it by December. Thirty. First, it will deliver a charitable deduction on your next tax return become a man today with your donation, get your two thousand seventeen tax deduction before it's too late, just go to for economics, dot, com, slash, donate or text. The word freak to seven o one o one. Thank you. So much outlawed high school dropout Nobel Laureate author of the book, who gets what and why began working on organ donation within forty years ago as it turned out so nineteen seventy.
Torreon volume. One number one of the journal of mathematical economics herb, scarf and Lloyd sharply, with whom I eventually shared a Nobel Prize, wrote an article about how to trade indivisible goods you couldn't whose money- and this was a theoretical argument- was entirely entirely theoretical and sort of whimsically. They. Let's call the object, houses and, let suppose everyone has a house and people have preferences over houses and they can trade houses, but they can't use money. All you can, all you can do is bar. You can say I'll trade, my house for yours or you could do it among three people, get I'll give you my house, and you give someone your house, and he gives me his house. That's all you can do. How would trade work, so they rode a paper about that and I had just got my phd in nineteen. Seventy four when this article came out- and I read the article and I thought what an interesting
problem to think about how to trade without money. So I wrote some articles about that too. With Andy postal Weight and still theoretical, or did you entirely theoretical talking about how to trade houses and, of course, no one trained houses? I can tell you I've just bought it in California and money played away, but but but it's you know the way economist learn about things. The way mathematical Comest one about things is a little bit the way children learn about things, you, U fine, toys to play with, and then by playing with the toys. You gain experiences that might help me without thinks. So this is a toy, this toy model that allows you to think about the question of how to trade When you can't, whose money- and when you camped divide the good you can't say you have a big house and I have a little house so just get me half of your house for my house, you, you say: houses are indivisible, have to trade
in nineteen. Eighty two Roth took a teaching job at the University of Pittsburgh, which happened to have an excellent medical center with a prominent organ transplant programme Roth began thinking about kidneys. From the perspective of supply and demand again there's a seemingly huge demand for donated kidneys, but in fact a much much larger supply of potential kidneys for donation since people have to but only need one. So, let's say that your spouse or sibling or parent needs a kidney transplant. You could voluntarily undergoes surgery to give up one of yours, if that is you happen to be a biological match. If you aren't a batch than than your healthy enough to give some.
kidney, but you can't give the person you love a kidney, so there they are with an indivisible object than we had been calling houses, but now call it a kidney- and here are these incompatible patient donor pears and they have an indivisible object and it's against the law to buy and sell kidneys for transplantation, so all of a sudden this toy model that we ve been playing with that didn't make a lot of sense for houses, because we use money for houses made sense for kidneys, because our late, moment for you, where you saw that the kidney was the you no concrete version of what had been discussed in this model and again I'd like to say that there was, but there was another. Are we looking for something to plug into that model? I was use, I was looking for a teaching tool, I was teaching the model and my students would would say,
This is interesting model, but isn't it a little silly wing we use here in Pittsburgh? We use money for housing. Professor should I'd say yes, but this is a toy model that you should study it, but they were in Pittsburgh and we had all these transplant going on. I set up so supposing its kidneys, so we talked about kidney exchange. Without my ever thinking it would become a difficult thing. I was not seeking to design conviction, but in ninety ninety eight I moved to worm to Boston, to teach at Harvard and in two thousand, First, kidney exchange in the United States was done in New England. That's an exchange between incompatible patient donor pairs as our off calls them to couples. Let's say with the healthy member
of each couple agreeing to give a kidney to the needy. Member of the other couple, the first kidney paired exchange ever took place in South Korea and ninety ninety one, the first? U S, exchange that Roth mentioned happened at Rhode, island hospital improvidence. Then it was covered in the press. It was an unusual thing. Unfair I was, I had notes about, can be exchanged so with a former student find from Pittsburgh. Who who is visiting at the at Harvard could go on, but I said to him: look at this: there's can exchange. Let's give a class, I would teach you to market design class, let's give a class on how we would do kidney exchange and meaning this one. It happened without your help. Yes, and you looked at this and thought hey. If this is happening on a small scale, we can maybe we can help organize and we we, we have play
these years would tie models. We know how to organise, on a large scale, trade among people dealing with indivisible goods when you can't whose money we know a lot about this. Several other economists began thinking about the problem and dumb. Eventually, we wrote a paper about how to organise kidney exchange if you weren't to word about logistical problems, so we haven't talked to doctors, Vienna, coffee surgeons, although like where the kidney needs to be at what read, write and just behind the preparation is for surgery and zone and how hard it is to do big exchanges compared to little exchanges and so
we said the paper to all the surgeons wicked think of, and only one answered me frank, don't matter, and he was a good one to have answered than an absolute right. Absolutely he was. He was the director of the New England, Organ Bank, many came to luncheon, and he- and I have been colleagues- can exchange on other things, fur for more than a decade now, but we helped him build. The New England Programme for Kidney exchange one person that Delmonico hired at the New England Programme for Kidney Exchange or Nevsky was Ruth Englishman, who help set up their kidney paired donation programme. Remember the Rhode Island transplant had already happened. in two thousand, but that was just done manually looking at the blood types of the donors and the candidates and then into that Before we started working with Alan, in his optimization programme.
the behind, using our rots algorithm, was to make it so transplant centres could simply enter the medical and demographic data on potential organ donors and recipients type in a few keystrokes, and then, while it would produce a match, really be impossible to do this by hand because of the number of antibodies that we're Talkin bout in the number of people that we're talking about. We really need a computer to look at it. Not just stood do any kind of matching, but really to optimize. The matching matching of potential kidney donor is harder than it sounds. Not only does any given person have one of four major blood type, but we also each have our own stew. Antibodies and antigens were born with a certain amount of inherited antigens. But when our bodies encounter foreign antigens, we develop antibodies the battle them. This can happen during a blood transfusion friends, since that was the case. With a Minnesota woman named Julie Park,
What really happened was I broke my leg about five eight years ago. and dumb unbeknownst to me. They gave me a blood transfusion during it and just changed a bunch of antigens and Anna bodies and Enough they re no longer was gonna, be a match. For me, Ray is Julie's husband, re book. They ve been married for twenty, for years. The Julian I went to high school together didn't know each other had one day We were a freshman at the university Minnesota. I told her I get back to her in it are, When you, your class reunion, I got backdoor Julian Ray One daughter, three grandchildren Julie, has been a type one diabetic since she was eight years old and it basically, you know, has caused all my medical issues. Over the years. Julie got her first kidney transplant when she was thirty five, it came from
a deceased donor and it lasted me quite a while that was great. Like twenty six plus year and then that one, for whatever reason, was failing. So all of a sudden, needed. Another one raise blood type is oh, which means he's a universal donor or your kind of going down that road thinking he'd be able to donate to me some day, but after that blood transfusion Julie was told by her doctors. That re was no longer a match in Julie's body raise kidney would have failed. Ruth ambition is familiar with Julius case. She had a lie. antibodies. Ninety four percent was her aunt.
I level, which means basically, she only matches with about six percent of the population. So if Julie went the rule that got her first donated kidney, it likely would have taken a long time to get another one. Given her particulars, one doktor told her. She could wait five years or more years which, as Lee men describes are hard on anyone with kidney failure. Then then, there waiting on dialysis and in three days a week they go into a dialysis unit to have their blood cleared of this toxins that the kidney usually removes
or their at home at night, doing home, parity, Neil Diagnosis, and so that's a nightly with ritual for people, and it makes it difficult to work. It makes people tired. It makes people sicker. So when they do get a transplant, they may not be in the best health anymore. So it's it's challenging, but Julie had the good fortune to be enrolled in a kidney exchange programme and her chances were greatly increased because her husband re was offering to donate one of his kidneys to someone anyone since he wasn't a match with Julie. This is what is known as being appeared donor, meaning that re was offering his kidney under the condition that his wife would receive a kidney donated by someone who was a match with her. I wanted to help my wife in any. That I could so I went out and got tested all
information went into the computer, we just put it out there into the network and God there's a network like that, and the algorithm obviously worked and it worked fat you know I went on Dialysis November first. They call me around Christmas time and who you know told me well looks like we ve got something in all on the schedule here, but you know you ve got a heel. This wound you ve got on your foot, so I spent the month of January in
bad. So anyway that was January, and then we had the transplant February Fifth, so you know it wasn't. Certainly wasn't five years or more, the kidney exchange landscape has changed. Their been consolidations. Nevsky, for instance, has been dissolved under push secreted national programme and the numbers have grown last year, for instance, there were just over seventeen thousand kidney transplant in the. U s about one third of those came from living donors, not all kidney paired donation, but still there what is our off point so in one respect its even more than that sounds so what that means is in the United States. We now have more living donors than we have deceased donors, because deceased donors give two kidneys and living
only give one. So there are more living donors than deceased donors, but more deceased donor transplants, the living donor transport, but the growth possibilities would be in living donor transplantation because everyone has to kidneys. The growth possibilities are substantial, not only because the matching algorithm is successful, but perhaps because it so successful it has allowed for another kind of kidney donor to enter the programme re book. You'll remember it was apparent donor, but is also room for, what's called a non directed, don't Ruth Englishmen. Again somebody who comes into the computer program without a recipient. They don't know anybody who needs a kidney transplant. They just want to donate to somebody and help somebody will they come into the programme, and they match with of recipient whose don't matches with another recipient whose Dona matches with another. At the end, and this can go on and on and so, instead of
non directed donor. Helping just one person receive a transplant, they can help to three five. Ten thirty sixty people receive a transfer as we go down the line in the chain, it was one of these incredibly generous people. A non directed donor who wound up giving Julie Park Avenue kidney. This chain started with a woman named Jody hello. My name is Jody shakily right, Jody shakily rate is forty two years old. At the time she was libyan, Charlotte North Carolina in May two thousand twelve. I was working as a telephonic health coach for company in Dallas, Texas and I work from home and in Charlotte
I had a client who needed to lose twenty pounds so that he could donate a kidney to his sister and I knew nothing about organ donation at the time and at first I wanted to do some internet research to determine how his lifestyle might change after the surgery, as well as what he could expect to do. Pray up in order to prepare for the procedure. In my research I came across something called kidney pair donation doesn't really familiar with that at first, but I have also seen around the same time an episode of grace Anatomy. It's actually season five episode, five, if you're interested in checking that out of it it's about pair donation,
at. First, when I had seen laundries anatomy, I wasn't really serve if it was a Hollywood thing or if it really existed so did more research and sure enough. It was a real thing and I wasn't looking to donate but kind of, sat back and thought you know I'm at a place in my life, where I think that I'm healthy enough, I work out of my house and financially stable, and this is something that I could do should begin working with the transplant centre at Piedmont Hospital in She went through a long series of physical and psychological tests. They wanted to know. If I had considered all the factors lie, I should talk not donate. First and foremost, I was asked to make a few minor lifestyle changes, or at least I felt that they were minor, but things like they didn't want me to do any death defying sleigh, ride, motorcycles or jump out airplanes.
I had already jumped out of an airplane. So that was ok, but with one kidney eve, you kind of have to take a little bit more care. Basically, you know they wanted to make sure that I was sure about donating one of my kidneys, because I really only have you no one to donate. I need the other one to survive and you know they really want you to think about things like. Are you going to be okay with the decisions that your recipient makes, meaning that once you give this kidney up its? It is not mine to to direct how it's used anymore, and I was really okay with that. That's the recipients call I'm giving a gift. After passing, your test, Sheakley Rights information, was entered into the computer program used by the kidney and the algorithm went to work on her data. It quickly found a match Julie Park,
good Minnesota. Listen. Two months later, it was surgery day. My surgery was in Atlanta first thing in the morning and once they remove my kid needs its put in of styrofoam container and its put on a commercial flights and was flung too many apple us for kids is actually put on a plane and flown to Minnesota where it is transplanted into Julie. I think I went in about four in the afternoon, something like that. Julie's husband, the same day, is having his kid D. covered in a hospital in Minnesota. It was a very national time, I told my kidney go and do a good job and take care of somebody, and I shed some tears, sir.
is kidney at the same time that my kidney was flying from Atlanta Minneapolis. His was flying from Minneapolis to Atlanta for the second recipient in the chain to receive her kidney. So re book donated his kidney as appeared donor, so that his wife Julie Park could get a kid me from a stranger than non directed donor. Jody shakily. And who got raise kidney did we did find out? It was a woman that got my kidney so and she was in the next room. Next to the woman, was donating to Julie. Now recovery, room in Atlanta was next door to raise recipients recovery room ends, I had the risk, enough not to bargain there and introduce myself. Although I have to be honest, I really wanted to all
you know about her. Is that she's doing well? That recipient had also come into the kidney exchange with some unwilling to give her a kidney, but she wasn't a match so this person in Georgia who received raise kidney, her on the same day went to operating room and donated her kidney. And that kidney stayed right there in the same hospital and went to Somebody on that? She's gonna wait list who didn't have a living donor available to them. So this one act of kindness by Jody shakily right donated out of the goodness of her heart. She didn't even have anyway, she was donating for this. One act had a multiplier effect, would Jody did by entering the programme without a recipient
attached to her ass. She was able to unlock matches that otherwise wouldn't have been possible. It also would have been possible without the algorithm created by Roth and his colleagues, the saving a lives. It's out. We have six hundred Kenny Pair donation transplants the year. right now in the United States. In two thousand we had two we would have stayed doing two or four six a year without the algorithm. The entire process is incredible How's that much knowledge about algorithms, it's been a little while since high school in college, so I'd have to revisit some of my mouth skills, but I You know that it's
easing lay complex and just to match blood types and Anna bodies, and especially knowing that at this time there almost one hundred twenty four thousand people in need of an organ, so how somebody begins to sift through all that is beyond me, but thankfully, not beyond everyone, L Rauf again, this is about exchange and other things moving Sweden called kidney exchanges, is real exchange going on. So when I started talking to surgeons, they didn't automatically think of economists as fellow members of the helping profession, but when I about a nowadays, I say, exchange you that's what anonymous study of course learn a subject for fur for economists, but but initially many people found it odd that that economists we're getting involved in organizing surgeries, you rate in the book, or maybe hint in the book that all this work that you and others have done to.
Try to solve this problem will hopefully be obviated one day, not too long from now when there's either medical treatment or perhaps artificial organs. Yeah I mean I hope, so. I think that your grandchildren and maybe mine, will will just be appalled, they'll, they'll, say to you in grandpas. It tell me again: you used to cut the organ out of it dead person and so it into a sick person and met with modern medicine and and we'll have to save them year. Yet we proud and lucky to be able to do that. It saved lots to lie in even more entered. The libyan, perhaps, would be the notion that you'd have had to create this complicated way to get a living donor to match with the right. I don't he s right, so my hope is that stem cell research
our genes will allow you to go and look at me the way you go, the ones you have a regionally but were far from that now and while that may eventually happen, everyone who has an stage wino disease today will be dead by that time. So, and so our responsibility is to try to take care of the people who are sick. Today, No, they will be better ways to take care of them in the future. What's it feel like to have played a role in helping redesign enough, you called to market it is. It is a market. I called a market. I mean it's, not a market where who plays a role but but its exchange and end you wanna, get efficient exchange. Wanna get is as many in his good quality transplants, as you can. Also. Absolutely so they're a bunch of people out there who are alive, who wouldn't have been alive head, not you and others working with you done what you ve done. What I feel like Roman others. It feels good. But
but economics in general does good things for people, so I think that it is. Maybe an allusion to say here we are saving lives as my great and it it is great, but Imagine all the other good things that market do you know that the economy has been immensely productive? We all live much much longer than people like us lived even a hundred years ago, and this has to do with the the rapidly increasing prosperity that that the world experiences because of the way market work. So the
the big job of economists, is market designers is to help that process along its been going along for many many centuries without the help of economists. But it goes by trial and error, and maybe we can reduce some of the errors and then make some of the trials go more quickly and more fruitfully year. The last chapter in your book called free markets and market design have another copy with you. I don't, but I remember from thirty two I do have a copy I'd like you to. Red. Then, if I may pass you the book, the first to the first two paragraphs, their think, about the design of markets gives us a new way of looking at them, noticing them and understanding them. My hope is that this book will help you to see markets in new ways. So, may I take you to dinner to celebrate the completion of this book. Ok,
it's great so out- you interested in continuing this conversation orbit of dinner. Then that sounds like a great idea. Oh, you have any ideas her where we can go grab them well, we could go to California Avenue this her thick market for restaurants, there. We didn't really get it. That's what you mean by thick market, lots of restaurants and lots of people who like to eat it in thickness is good in a market, because why? Well, if we didn't, have a reservation, which I know the dude debate I did I did I someone in your office made a reservation, but but if we didn't have a reservation, the advantage of a thick markets, we can just walk down Caliph one avenue and open doors and say: do you have room for two guys at this hour and we'd eventually get to one? We went to a nice place in Palo Alto on California, Avenue called Spalding northern italian our interest in something to drink.
We could also food as well have the same Chicken Marseilles. Thank you very much, Sir Simon. Here somebody had left him ever this. Thank you. Thank you. You wrote about something that was so fascinated me. Who is just a tiny little aside. I just want to ask you not about per se, but about
What it's like to do the kind of work you do in the things that you learn about these fields where you're coming from outside. So is it when you're ready that organ transplantation, you wrote that if, let's say a husband and wife, if a spouse needs a kidney and the other one is to donate and they might be physiologically blood. Take tissue type there might be compatible, but that They have had children. There might be a higher chance of rejection because proteins intermingle or something during so it turns out it made up to me, but I believe you can hear you know a Nobel laureates. So one of the things that could stop you from taking my guess is that you might have antibodies reformed antibodies against some of my party. So if you have antibodies against my proteins than your,
the system is waiting ready to attack my proteins efficient show up. I can aid granted, but mostly you shouldn't, have antibodies against human burdens that, but you don't. You have to be exposed to those pertains to develop antibiotic, so the chance that I didn't know my blood type, the chance that you could take my kidneys somewhat over fifty percent My wife can take my is only about thirty percent and the reason is we're parents and, in the course of childbirth, not pregnancy and childbirth. My wife might my wife's immune system might have been exposed to some of the proteins. Then our boys inherent. From me and if so, how immune system might have developed anti might now be prepared to attack. My kid me, a bit should appear so soon
husbands dominating the wives is harder than an icy measures. One of many strange, interesting, passing things you learn in your work about rounds knew nothing coming in market design. Is an outward facing pardon of economics, which means we always learning new thing to economics is about almost everything that people do, which means the nice. for being an economist is, it means we can learn things from almost anyone and, of course, Learn a lot about me surgery to be able to help surgeons, organise surgeries. You have to learn a lot about medical in education, in order to help organise labour markets with doctors a lot about nursery schools to be able to help. I schools do their admissions project,
in that learning is a chain of its own, like the kidney donor chain, the owl, Roth and others help create in which is saving lives and is Al Wroth and people like him continue to learn. They pass at knowledge along to people like you and me, making all of us a bit wiser it more curious. better off every ten years, thanks for listening. Please remember. It is a great time to make a donation to keep more for economics radio coming in the new year and to claim your tax deduction just go to for economics, dot, com, slash, donate or text. The word freak to seven o one o one. Thank you so much coming up next time on economics, radio,
talk about one of the most important and, unfortunately elusive components of a healthy, happy society. Social trust Social trust is extraordinarily interesting variable and doesn't get anywhere near the attention it deserves, but the bicycle There is turned on some. What is it the kind of the fabric of society that makes economies? Do you just people get along in general sites? We got long weeks, but it does mean that governments have done very much about it until very recently how to create more social trust, that's next time and for economic theory. Almost radio is produced by w in my C studios and W productions. This episode was produced by Gregg results. Are staff also includes Alison Hockenberry merit Jacob step. The term Harry, Huggins and brand Gutierrez you can subscribe to for economics, radio on Apple podcast or wherever you get your podcast. You should also check out our archive at free economic.
that com you can stream or download every episode we ve ever made. You can also read the transcripts and find links to the underlying research. We can also be found on Twitter, Facebook or the email at radio at for economics. That thanks.
Transcript generated on 2021-01-22.