A Simple Incentive Mechanism to Alleviate the Burden of Organ Wastage in Transplantation

Sait Tunç*, Burhaneddin Sandıkçı*, Bekir Tanrıöver*

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Özet

Despite efforts to increase the supply of donated organs for transplantation, organ shortages persist. We study the problem of organ wastage in a queueing-theoretic framework. We establish that self-interested individuals set their utilization levels more conservatively in equilibrium than the socially efficient level. To reduce the resulting gap, we offer an incentive mechanism that recompenses candidates returning to the waitlist for retransplantation, who have accepted a predefined set of organs, for giving up their position in the waitlist and show that it increases the equilibrium utilization of organs while also improving social welfare. Furthermore, the degree of improvement increases monotonically with the level of this nonmonetary compensation provided by the mechanism. In practice, this mechanism can be implemented by preserving some fraction of the waiting time previously accumulated by returning candidates. A detailed numerical study for the U.S. renal transplant system suggests that such an incentive helps significantly reduce the kidney discard rate (baseline: 17.4%). Depending on the strength of the population’s response to the mechanism, the discard rate can be as low as 6.2% (strong response), 12.4% (moderate response), or 15.1% (weak response), which translates to 1,630, 724, or 338 more transplants per year, respectively. Although the average quality of transplanted kidneys deteriorates slightly, the resulting graft survival one-year posttransplant remains stable around 94.8% versus 95.0% for the baseline. We find that the optimal Kidney Donor Profile Index score cutoff, defining the set of incentivized kidneys, is around 85%, which coincides with the generally accepted definition of marginal kidneys in the medical community.

Orijinal dilİngilizce
Sayfa (başlangıç-bitiş)5980-6002
Sayfa sayısı23
DergiManagement Science
Hacim68
Basın numarası8
DOI'lar
Yayın durumuYayınlandı - Ağu 2022

Bibliyografik not

Publisher Copyright:
© 2022 INFORMS.

Finansman

This work was supported in part by Health Resources and Services Administration contract 234-2005-370011C. B. Sandıkçı acknowledges financial support from the University of Chicago Booth School of Business and the Becker–Friedman Institute Health Economics Initiative at the University of Chicago. B. Tanrıöver is partly supported by the University of Texas Southwestern O’Brien Kidney Research Core Center [Grant NIH-P30DK079328]. The authors thank the editor-in-chief, David Simchi-Levi; an anonymous associate editor, and three anonymous referees for their constructive suggestions that helped improve the paper. The authors thank John Birge (Chicago Booth) and Douglas R. Bish (Virginia Tech) for their helpful comments on earlier drafts of the paper. This research used resources from the University of Chicago Research Computing Center. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. Sandıkçı conducted a significant portion of this research while at the University of Chicago. History: Accepted by David Simchi-Levi, stochastic models and simulation. Funding: This work was supported in part by Health Resources and Services Administration contract 234-2005-370011C. B. Sandıkc¸ı acknowledges financial support from the University of Chicago Booth School of Business and the Becker–Friedman Institute Health Economics Initiative at the Uni-versity of Chicago. B. Tanrıöver is partly supported by the University of Texas Southwestern O’Brien Kidney Research Core Center [Grant NIH-P30DK079328]. Supplemental Material: The online appendix is available at https://doi.org/10.1287/mnsc.2021.4203.

FinansörlerFinansör numarası
U.S. Government
University of Texas Southwestern O’Brien Kidney Research Core CenterNIH-P30DK079328
U.S. Department of Health and Human Services
Health Resources and Services Administration234-2005-370011C
University of Chicago
Research Computing Center, University of Chicago

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