Congested Waiting Lists and Organ Allocation

Information Systems and Operations Management 

Speaker: Itai Ashlagi (Stanford MSE)

Room T025

Abstract:

More than 25% of the kidneys that are recovered from deceased donors in the U.S. and are offered to patients on national waiting list are not utilized. This paper shows that waiting list designs can suffer from a form of congestion that can lead to discarding valuable organs. Congestion arises from the interaction of a physical limit on the number of patients that can sequentially consider an organ before it accrues excess cold ischemic time (i.e., expires) with incentives of patients to try to obtain organs of the highest quality. We develop a parsimonious framework to study equilibria of waiting lists with congestion, and show that congestion provides a strong enough externality to substantively affect welfare and wastage. We further show how delegating decisions to doctors can increase congestion. We also discuss how recent changes to waiting list designs affect congestion, and policies and market designs that can mitigate congestion.