Enhancing Kidney Supply Through Geographic Sharing in the United States

The deceased‐donor kidney allocation system suffers from a severe shortage of available organs. We illustrate a mechanism which can increase the supply of cadaveric kidneys in the United States. This supply increase exploits the fact that under the current organ allocation policy, some kidneys remain unprocured in some procurement areas but would be highly sought in other areas. The current kidney allocation policy procures within a donor service area (DSA) and offers these kidneys first to patients in the DSA; if these offers are not accepted, the kidney will be offered within the region (a cluster of DSAs); if these offers are not accepted, the kidney will be offered nationally. A deceased‐donor organ is procured if there is the belief that the offered organ will be transplanted (known as “intent”). We conduct an empirical analysis of the donor and recipient data (at the DSA level) which reveals that the intent increases significantly with organ quality, the median waiting time for a transplant, and higher competition. In particular, it shows that lower quality organs are likely to be procured at a higher rate in DSAs with longer waiting times. Motivated by a new kidney allocation system, we conduct a counterfactual study which shows that geographically broader sharing the bottom 15% quality kidneys leads to stronger intent for the organ, thus increasing the supply of procured organs available for transplantation. The expected increase in procured organs ranges from 58 (an increase of 0.4% of all procured kidneys) to 174 (an increase of 1.2%), depending on regional or national sharing.