Influencing Policy and Transforming Institutions: Lessons from Kidney/Liver Exchange

Kidney exchange emerged as a pioneering application in the early stages of market design. Unlike most other successful applications in the field, where design
economists primarily serve as consultants to decision-makers, in the context of kidney exchange, they assumed the role of outsider critics, ultimately succeeding in shaping real-life practices and institutions. This paper explores the strategies that facilitated this influential role. Drawing on our two decades of involvement in shaping kidney and liver exchange clearinghouses in the United States and Turkey, we provide insights into factors pivotal for the effectiveness of market design research in shaping policy. Building upon these experiences and incorporating lessons from school choice reforms in the 2000s, Sönmez (2023) introduces “minimalist market design” as a novel institutional design paradigm. Recent years have witnessed tangible outcomes from holistic research and policy efforts using this framework, notably contributing to the 2021 reform of the US Army’s cadet branching system and the establishment of reserve systems during the COVID-19 pandemic for vaccine and therapy allocation across multiple states.