An Achievable-Region-Based Approach for Kidney Allocation Policy Design with Endogenous Patient Choice

44 Pages Posted: 14 Jun 2017 Last revised: 16 Aug 2018

See all articles by Baris Ata

Baris Ata

University of Chicago - Booth School of Business

Yichuan Ding

Desautels Faculty of Management, McGill University

Stefanos A. Zenios

Stanford Graduate School of Business

Date Written: August 10, 2018

Abstract

The deceased-donor kidney transplant candidates in the US are ranked according to characteristics of both the donor and the recipient. We seek the ranking policy that optimizes the efficiency-equity tradeoff among all such policies, taking into account patients' strategic choices. Our approach considers a broad class of ranking policies, which provides approximations to the previously and currently used policies in practice. It also subsumes other policies proposed in the literature previously. As such it facilitates a unified way of characterizing good policies. We use a fluid model to approximate the transplant waitlist. Modeling patients as rational decision makers, we compute the resulting equilibria under a broad class of ranking policies, namely the achievable region. We then develop an algorithm that optimizes the system performance over the achievable region. We show analytically that it suffices to restrict attention to priority scores that are affine in the patient's waiting time. We also show through a numerical study that the total QALYs can be increased substantially by allowing patient rankings to depend on the kidney quality. Lastly, we observe that there is almost no improvement if only the healthier patients are prioritized for certain kidney types. Our results verify that ranking patients differently for kidneys of different quality can reduce the survival mismatch and the kidney wastage significantly. Consequently, the policy change in 2014, that implemented prioritizing the healthiest patients when allocating the highest 20% quality organs, is a step in the right direction. For further improvement, one may consider revising the current policy by also prioritizing the least healthy patients on the waitlist for the lowest-quality organs.

Keywords: Kidney Allocation, Fluid Model, Multiclass Queue, Nash Equilibrium, Achievable Region, Nonlinear Complementarity Problem, Efficiency and Equity

Suggested Citation

Ata, Baris and Ding, Yichuan and Zenios, Stefanos A., An Achievable-Region-Based Approach for Kidney Allocation Policy Design with Endogenous Patient Choice (August 10, 2018). Stanford University Graduate School of Business Research Paper No. 17-48, Available at SSRN: https://ssrn.com/abstract=2978263 or http://dx.doi.org/10.2139/ssrn.2978263

Baris Ata

University of Chicago - Booth School of Business ( email )

5807 S. Woodlawn Avenue
Chicago, IL 60637
United States

Yichuan Ding (Contact Author)

Desautels Faculty of Management, McGill University ( email )

1001 Sherbrook St W
Montreal, Quebec H3A 1G5
Canada
5143982482 (Phone)

HOME PAGE: http://https://www.mcgill.ca/desautels/yichuan-daniel-ding

Stefanos A. Zenios

Stanford Graduate School of Business ( email )

655 Knight Way
Stanford, CA 94305-5015
United States

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