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Recipient Choice Can Address the Efficiency-Equity Trade-off in Kidney Transplantation: A Mechanism Design Model


  • Xuanming Su

    () (Haas School of Business, University of California, Berkeley, California 94720)

  • Stefanos A. Zenios

    () (Graduate School of Business, Stanford University, Stanford, California 94305)


In kidney allocation, transplant candidates may have private information about their propensity to enjoy good outcomes after transplantation or about their relative expected improvement in quality of life after transplantation. This paper develops a mechanism design model to investigate the effect of such information asymmetry on the kidney allocation system. In this model, there are n transplant queues corresponding to n candidate types. Candidate types are only observed by the candidates, and each candidate chooses the queue to join by reporting a type. Kidneys have heterogeneous types, and each kidney will be assigned to one of the queues depending on its type. Candidates report their type strategically to join the queue that maximizes their utility. Candidate utility depends on the type of kidney received and the expected waiting time, which is calculated using fluid approximations. We consider two alternative social welfare functions: aggregate utility (emphasizing efficiency) and minimum utility across all candidates (emphasizing equity). The kidney allocation problem is to divide the organ supply among the different queues so that social welfare is maximized, and this problem is solved explicitly under both objective functions. There are three findings: (1) The allocation mechanism induces truth telling by ensuring that candidates who wait longer receive better kidneys; (2) Information rents are earned by high-risk candidates under the efficiency objective and by low-risk candidates under the equity objective; (3) a choice-based kidney allocation system in which candidates choose the type of queue to join leads to outcomes in the middle of the efficiency-equity spectrum.

Suggested Citation

  • Xuanming Su & Stefanos A. Zenios, 2006. "Recipient Choice Can Address the Efficiency-Equity Trade-off in Kidney Transplantation: A Mechanism Design Model," Management Science, INFORMS, vol. 52(11), pages 1647-1660, November.
  • Handle: RePEc:inm:ormnsc:v:52:y:2006:i:11:p:1647-1660

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    References listed on IDEAS

    1. Israel David & Uri Yechiali, 1985. "A Time-dependent Stopping Problem with Application to Live Organ Transplants," Operations Research, INFORMS, vol. 33(3), pages 491-504, June.
    2. Howard, David H., 2002. "Why do transplant surgeons turn down organs?: A model of the accept/reject decision," Journal of Health Economics, Elsevier, vol. 21(6), pages 957-969, November.
    3. Jean-Charles Rochet & Philippe Chone, 1998. "Ironing, Sweeping, and Multidimensional Screening," Econometrica, Econometric Society, vol. 66(4), pages 783-826, July.
    4. Eric Maskin & John Riley, 1984. "Monopoly with Incomplete Information," RAND Journal of Economics, The RAND Corporation, vol. 15(2), pages 171-196, Summer.
    5. Jae-Hyeon Ahn & John C. Hornberger, 1996. "Involving Patients in the Cadaveric Kidney Transplant Allocation Process: A Decision-Theoretic Perspective," Management Science, INFORMS, vol. 42(5), pages 629-641, May.
    6. Oliver D. Hart, 1983. "Optimal Labour Contracts under Asymmetric Information: An Introduction," Review of Economic Studies, Oxford University Press, vol. 50(1), pages 3-35.
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    Cited by:

    1. Houyuan Jiang & Zhan Pang & Sergei Savin, 2012. "Performance-Based Contracts for Outpatient Medical Services," Manufacturing & Service Operations Management, INFORMS, vol. 14(4), pages 654-669, October.
    2. Monali Malvankar-Mehta & Bin Xie, 2012. "Optimal incentives for allocating HIV/AIDS prevention resources among multiple populations," Health Care Management Science, Springer, vol. 15(4), pages 327-338, December.
    3. Caulkins, Jonathan P., 2010. "Might randomization in queue discipline be useful when waiting cost is a concave function of waiting time?," Socio-Economic Planning Sciences, Elsevier, vol. 44(1), pages 19-24, March.
    4. Bendersky, Michael & David, Israel, 2016. "Deciding kidney-offer admissibility dependent on patients’ lifetime failure rate," European Journal of Operational Research, Elsevier, vol. 251(2), pages 686-693.
    5. Sang-Hyun Kim & Morris A. Cohen & Serguei Netessine, 2007. "Performance Contracting in After-Sales Service Supply Chains," Management Science, INFORMS, vol. 53(12), pages 1843-1858, December.
    6. Dimitris Bertsimas & Vivek F. Farias & Nikolaos Trichakis, 2012. "On the Efficiency-Fairness Trade-off," Management Science, INFORMS, vol. 58(12), pages 2234-2250, December.
    7. Nicoló, Antonio & Rodríguez-Álvarez, Carmelo, 2012. "Transplant quality and patientsʼ preferences in paired kidney exchange," Games and Economic Behavior, Elsevier, vol. 74(1), pages 299-310.


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