Candidate for the Lee B. Lusted Student Prize Competition
Purpose: Deceased donors constitute the major source of transplanted organs in the U.S., but the current system for cadaveric organ donation and allocation is not effectively converting the public’s high approval of donating organs into satisfactory organ donation rates. One proposed policy change (hereafter referred to as “donor priority rule”) is to endow registered organ donors with the priority of receiving organs when in need for a cadaveric organ. This research aims to investigate the social welfare consequences of the donor priority rule.
Method: We build an analytic model of the current organ donation and allocation system using Queueing and Game Theoretic frameworks. In our model, each candidate’s utility is positively associated with the quality-adjusted life expectancy (QALE), which is determined by life expectancies before and after transplantation, quality-of-life scores before and after transplantation, and probability of receiving of an organ (as opposed to dying while on the waiting list). One significant aspect of our model is that we use rigorous heavy-traffic queueing approach to model candidates’ waiting time when the demand for organs far exceeds the sparse and random supply. This allows us to capture each individual’s decision to register as an organ donor. We characterize the equilibrium before and after adopting the policy.
Result: Different from popular beliefs and extant research findings (cf. Kessler and Roth 2012) about the role of the donor priority rule, we show that if the health status of the population is sufficiently heterogeneous, the social welfare can be reduced as a result of the donor priority rule. The main reason is that individuals with low health status might have a higher incentive to become organ donors, leading to a distorted pool of organ supply.
Conclusion: Our model is among the first to analyze individuals’ decisions to become registered organ donors. We show that although the donor priority rule invariably increases the size of the donor registry, the overall social welfare can be worse off after adopting the donor priority rule if the population is differentially healthy. Nevertheless, the social welfare will be increased when the variance of individual health status is low enough.