Equilibrium Allocations under Alternative Waitlist Designs: Evidence from Deceased Donor Kidneys Kidneys

Area of Science:

• Health Economics
• Operations Research
• Transplantation Science

Background:

• Waitlists are crucial for allocating scarce resources like deceased donor kidneys.
• Mechanism design for waitlists must consider patient preferences and trade-offs.

Purpose of the Study:

• To analyze equilibrium allocations under different deceased donor kidney waitlist designs.
• To estimate patient preferences for kidney transplants and evaluate mechanism efficiency.

Main Methods:

• Modeling organ acceptance as an optimal stopping problem.
• Estimating patient preferences using administrative data from the New York City area.
• Developing methods to evaluate and compare alternative waitlist mechanisms.

Main Results:

• Significant match-specific heterogeneity exists in patient values for different kidney types.
• Past waitlist reforms resulted mainly in redistribution, with welfare comparable to first-come, first-served.
• Current and commonly studied mechanisms are far from optimal in maximizing patient welfare.

Conclusions:

• A newly designed mechanism can increase patient welfare by an amount equivalent to an 18.2% increase in donor supply.
• Optimizing waitlist mechanisms offers substantial potential for improving patient outcomes in kidney transplantation.
• Addressing preference heterogeneity is key to enhancing the efficiency of organ allocation systems.