An Empirical Framework for Sequential Assignment:The Allocation of Deceased Donor Kidneys

Résumé

A transplant can improve a patient’s life while saving several hundreds of thousandsof dollars in healthcare expenditures. Organs from deceased donors, like many otherscarce public resources (e.g. public housing, child-care, publicly funded long-term care),are rationed via a sequential offer waiting list. The theoretical trade-offs in designingthese mechanisms are not well understood and depend on agent preferences. This paperestablishes an empirical framework for analyzing the trade-offs involved in designingsequential offer waiting lists and applies it to study the allocation of deceased donorkidneys. We model the decision to accept an organ while on the waiting list as anoptimal stopping problem and use it to estimate the value of accepting various kidneys.Our estimates show that while some types of organs are preferable for all patients(e.g. organs from young donors), there is substantial match-specific heterogeneity invalues. We show how to use these estimates to solve for the equilibria of counterfactualmechanisms. These techniques are then used tofind mechanisms that improve on designgoals such as improving the match quality of transplants and reducing organ waste.