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

Agarwal, Nikhil; Ashlagi, Itai; Rees, Michael; Somaini, Paulo; Waldinger, Daniel C.

doi:10.3386/w25607

Cited by 13 publications

(8 citation statements)

References 40 publications

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“…Agarwal et al (2018) presented descriptive evidence consistent with dynamic incentives using data from all areas of the United States and find that highly sensitized patients who are immunologically compatible with fewer donors —and who therefore expect to receive fewer offers in the future—are more likely than less sensitized patients to accept similar offers. We replicated this research strategy in the NYRT sample and found qualitatively similar patterns (see Section D.2 in the Supplemental Material (Agarwal, Ashlagi, Rees, Somaini, and Waldinger, 2021)). We refer the reader to this paper for a more detailed discussion of the empirical strategy and potential confounds.…”

Section: Background Data and Descriptive Evidencesupporting

confidence: 56%

Equilibrium Allocations Under Alternative Waitlist Designs: Evidence From Deceased Donor Kidneys

Agarwal¹,

Ashlagi

Rees

et al. 2021

ECTA

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Waitlists are often used to ration scarce resources, but the trade‐offs in designing these mechanisms depend on agents' preferences. We study equilibrium allocations under alternative designs for the deceased donor kidney waitlist. We model the decision to accept an organ or wait for a preferable one as an optimal stopping problem and estimate preferences using administrative data from the New York City area. Our estimates show that while some kidney types are desirable for all patients, there is substantial match‐specific heterogeneity in values. We then develop methods to evaluate alternative mechanisms, comparing their effects on patient welfare to an equivalent change in donor supply. Past reforms to the kidney waitlist primarily resulted in redistribution, with similar welfare and organ discard rates to the benchmark first‐come, first‐served mechanism. These mechanisms and other commonly studied theoretical benchmarks remain far from optimal. We design a mechanism that increases patient welfare by the equivalent of an 18.2% increase in donor supply.

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Section: Background Data and Descriptive Evidencesupporting

confidence: 56%

Equilibrium Allocations Under Alternative Waitlist Designs: Evidence From Deceased Donor Kidneys

Agarwal¹,

Ashlagi

Rees

et al. 2021

ECTA

Self Cite

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“…The acceptance thresholds depend on the agent's position s and the mechanism M because these quantities influence the value of waiting. Agarwal et al (2018) show how to estimate the values of various object attributes in a similar dynamic choice model using data on accept-reject decisions and knowledge of the mechanism. They apply their methods to data on decisions from the deceased donor kidney wait list.…”

Section: A a Model Of Decisions On A Wait Listmentioning

confidence: 99%

“…Surprisingly, less than 0.2 percent of all offers are accepted by patients, but the total number of transplants indicate that the organs from most donors are transplanted. As Agarwal et al (2018) discuss, this low acceptance rate is a result of relatively undesirable organs being offered to several thousand patients. Indeed, the acceptance rate amongst the top 10 offers is 18.1 percent, and still higher at the very top of the list.…”

Section: A Datamentioning

confidence: 99%

Dynamic Incentives in Wait List Mechanisms

Agarwal

Ashlagi

Somaini

et al. 2018

AEA Papers and Proceedings

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Many scarce public resources are allocated through wait lists that use priorities for individual agents. A new priority system for allocating deceased donor kidneys was adopted in 2014. This redesign was guided by simulations that held decision-rules fixed. We synthesize recent theoretical results to show that the welfare effects of a mechanism depend on the interaction between dynamic incentives and heterogeneity in preferences. We show evidence suggesting that patient decisions on the deceased donor kidney wait list respond to dynamic incentives. Therefore, an empirical approach to dynamic mechanism design is an essential complement to mechanism design theory in dynamic environments.

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“…There is a limited but growing body of literature on ESRD patients' preferences. A recent paper by Agarwal et al (2019) establishes an empirical framework to analyse how tradeoffs embedded in waitlist systems map into individual preferences and applies it to the allocation of deceased donor kidneys. The researchers develop a method for estimating patient preferences using administrative data and apply it to the kidney waitlist data from New York to estimate payoffs from various types of transplants.…”

Section: Introductionmentioning

confidence: 99%

The Role of Heterogeneity of Patients’ Preferences in Kidney Transplantation

2019

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We elicit time and risk preferences for kidney transplantation from the entire population of patients of the largest Italian transplant centre using a discrete choice experiment (DCE). We measure patients' willingness-to-wait (WTW), expressed in months, for receiving a kidney with one-year longer expected graft survival, or low risk of complication. Using a mixed logit in WTW-space model, we find heterogeneity in patients' preferences. Our model allows WTW to vary with the patient's age and duration of dialysis. The results suggest that WTW correlates with age and duration of dialysis. The implication for transplant practice is that including individual preferences in kidney allocation protocols that assign "non-ideal" (expanded donor criteria) organs may not only increase the expected survival rates of patients with transplanted organs but also improve patients' satisfaction.

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

Abstract: NBER working papers are circulated for discussion and comment purposes. They have not been peer-reviewed or been subject to the review by the NBER Board of Directors that accompanies official NBER publications.

Cited by 13 publications

References 40 publications

Equilibrium Allocations Under Alternative Waitlist Designs: Evidence From Deceased Donor Kidneys

Equilibrium Allocations Under Alternative Waitlist Designs: Evidence From Deceased Donor Kidneys

Dynamic Incentives in Wait List Mechanisms

The Role of Heterogeneity of Patients’ Preferences in Kidney Transplantation

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