Empirical Analysis of Resource Allocation Problems

Project Outcomes Statement

Kidney transplantation improves the quality and length of life of a patient with kidney failure while saving hundreds of thousands of dollars in expensive dialysis treatment. Unfortunately, we do not have enough kidneys to transplant the approximately 100,000 patients currently on the waiting list.

The grant supported several research projects aimed at improving systems for allocating deceased donor kidneys and for expanding living donor kidney exchange. These areas of research have direct and large public health benefits. Policies aimed at improving the transplant system can result in several thousand more transplants per year as well as improved allocation of the deceased donor organs that are available.

The first set of research papers supported by the grant developed a new statisical and simulation framework for evaluating proposed changes to the kidney waiting list. This framework incorporated surgeon and patient decision-making in response to the incentives generated in the waitlist system. Many organs that are offered from transplantation are declined in the hope that a better offer is soon to come. Previous approaches had assumed that these decisions would not be responsive to the waitlist design. The research supported by the grant made methodological advances that allowed these aspects to be built into the state-of-the art simulation models for kidney allocation.

Using this framework, we designed new approaches for prioritizing patients on the waiting list which promises improvements to patient welfare. The new priority systems aims to decrease organ discard rates and also improve the utilization of available organs while making sure that no group of patients is worse off. It does so by considering the incentives of patients and surgeon to accept specific organs, but not others.

The second set of papers studied kidney exchange markets. Kidney exchange enables transplants for patients who have a willing live-but-incompatible donor, by arranging swaps and chains with other patient-donor pairs. Research supported by the grant documented barriers in the kidney exchange markets that prevent this model of transplantation from reaching its full potential. Issues identified include financial disincentives that limit participation by transplant centers and a design issue in kidney exchange platforms that reduces participation incentives. These issues result in a fragmented market structure that makes it impossible to realize the potential of kidney exchange.

We developed a new design for kidney exchange platforms and policy responses that can reduce fragmentation by aligning participation incentives. Improved coordination in this area could increase transplants through kidney exchange by more than 30%.

In addition to publication at high-profile peer-reviewed academic journals and presentations at conferences, the results were also disseminated through a brief prepared for Congressional aids in Washington D.C., members of the executive branch of the Federal government, and a presentation to a committee of the National Academies of Sciences Engineering and Medicine charged with reviewing the organ allocation system in the U.S.