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Gaming the Liver Transplant Market

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  • Jason Snyder

Abstract

The liver transplant waiting list is designed to allocate livers to the sickest patients first. Before March 1, 2002, livers were allocated to patients based on objective clinical indicators and subjective factors. In particular, a center placing a prospective transplant recipient in the intensive care unit (ICU) leads to a higher position on the liver transplant waiting list. After March 1, 2002, a policy reform mandated that priority on the liver transplant waiting list no longer be influenced by whether the patient was in the ICU. I show that after the reform, ICU usage declined most precipitously in areas with multiple transplant centers. I find no evidence that pervasive manipulation in the most crowded liver transplant markets distorted the allocation of livers away from the intended prioritization of the sickest patients first. It appears that centers in areas with multiple competitors manipulated the waiting list to ensure that the sickest patients received a liver. The Author 2010. Published by Oxford University Press on behalf of Yale University. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org, Oxford University Press.

Suggested Citation

  • Jason Snyder, 2010. "Gaming the Liver Transplant Market," Journal of Law, Economics, and Organization, Oxford University Press, vol. 26(3), pages 546-568.
    • Handle: RePEc:oup:jleorg:v:26:y::i:3:p:546-568
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    File URL: http://hdl.handle.net/10.1093/jleo/ewq003
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    Cited by:

    1. Lamar Pierce & Jason Snyder, 2015. "Unethical Demand and Employee Turnover," Journal of Business Ethics, Springer, vol. 131(4), pages 853-869, November.
    2. Paarsch, Harry J. & Segre, Alberto M. & Roberts, John P. & Halldorson, Jeffrey B., 2011. "Competition and Post-Transplant Outcomes in Cadaveric Liver Transplantation under the MELD Scoring System," CIS Discussion paper series 522, Center for Intergenerational Studies, Institute of Economic Research, Hitotsubashi University.
    3. Wiltermuth, Scott S. & Bennett, Victor M. & Pierce, Lamar, 2013. "Doing as they would do: How the perceived ethical preferences of third-party beneficiaries impact ethical decision-making," Organizational Behavior and Human Decision Processes, Elsevier, vol. 122(2), pages 280-290.
    4. John, Leslie K. & Loewenstein, George & Rick, Scott I., 2014. "Cheating more for less: Upward social comparisons motivate the poorly compensated to cheat," Organizational Behavior and Human Decision Processes, Elsevier, vol. 123(2), pages 101-109.
    5. Pierce, Lamar & Rogers, Todd & Snyder, Jason A., 2015. "Losing Hurts: The Happiness Impact of Partisan Electoral Loss," Working Paper Series rwp14-051, Harvard University, John F. Kennedy School of Government.
    6. Simon, Daniel H. & Prince, Jeffrey T., 2016. "The effect of competition on toxic pollution releases," Journal of Environmental Economics and Management, Elsevier, vol. 79(C), pages 40-54.
    7. Victor Manuel Bennett & Lamar Pierce & Jason A. Snyder & Michael W. Toffel, 2012. "Competition and Illicit Quality," Harvard Business School Working Papers 12-071, Harvard Business School, revised May 2012.

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