“The Discard Problem in Deceased Donor Organ Transplantation”
by Burhaneddin Sandıkçı
İstanbul Technical University
Organ transplantation is life-saving, but demand for organs far exceeds the supply. Despite efforts to increase the supply of donated organs for transplantation, organ shortages persist. On the flip side, about 15% of organs recovered for transplantation in the U.S. are discarded. Using a queueing-theoretic framework, we argue that self-interested individuals set their utilization levels more conservatively in equilibrium than the socially efficient level, resulting in the observed discard problem. 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. We also present detailed simulation results calibrated with real life transplant data, quantifying the magnitude of impact of this incentive mechanism for the U.S. kidney transplant system.