Why do transplant surgeons turn down organs? A model of the accept/reject decision

Despite the scarcity of transplantable organs, 45% of livers are rejected by the first surgeon to whom they are offered. I present a model in which a surgeon decides to accept or reject an organ for a patient based on the patient's current health level. Using data on transplanted patients, I show that surgeons' behavior is consistent with the solution to an optimal stopping problem in which they reject low quality organs for relatively healthy patients in the hope that they will receive a better organ offer in the future. I discuss trends in organ procurement in light of this finding.