Organ Allocation Policy and Organ Donation Decisions

The "priority rule," which grants priority on organ waiting lists to those who have previously registered as organ donors, can significantly raise the number of potential donors.

In Organ Allocation Policy and the Decision to Donate (NBER Working Paper No. 17324), Judd Kessler and Alvin Roth find that an organ allocation policy known as the "priority rule," which grants priority on organ waiting lists to those who have previously registered as organ donors, can significantly raise the number of potential donors. Their results suggest that the priority rule, which is currently used in Singapore and which is being introduced in Israel, is a potentially powerful policy tool for encouraging donor registration.

The researchers devise an experimental game which captures some of the key features of the organ donation problem and collect data when students play this game. Each player begins the experiment with "kidneys" that may, with some probability, "fail" during the game. Players receive monetary compensation for each round of the game in which they remain alive. A player may "die" from "kidney failure" if he cannot obtain donated organs. He may also "die" during the game for other reasons - that creates a potential supply of donors whose "kidneys" may be assigned to still-living players who face organ failure. A player gives up some money if he registers to donate his "kidneys" in the event of death -- this captures what the authors view as the psychic cost of registering as an organ donor. A larger pool of potential donors conveys benefits for all players, because it raises the likelihood that if a player experiences "kidney failure" a replacement organ will be available.

The authors compare the effect of reducing this cost of donation, which in their game is a monetary cost, with the effect of adopting a priority rule. Both approaches increase the number of registered donors, but the "priority rule" performs at least as well as, and sometimes better than, an equivalent decrease in the cost of donation. The authors try introducing the priority rule after subjects have made donation decisions a number of times, as well as at the start of the game. In the latter case, the increased performance of the priority rule is even greater. With regard to actual policy design, Kessler and Roth point out that one advantage of the priority rule over strategies for compensating registered donors, and thereby reducing their costs of registering, is that the priority rule seems feasible and can be implemented without any additional costs to the system.

--Matt Nesvisky