Kidney Allocation and Patient Behavior

This study examines how kidney allocation policy shapes both transplant behavior and survival outcomes. Using a fuzzy regression discontinuity design based on the CPRA 80 threshold—a cutoff indicating patients incompatible with most donors, I show that a 10 percentage point increase in deceased donor access reduces reliance on living donor transplants by about 2 percentage points. It also lowers both waitlist and overall mortality. Importantly, these effects are heterogeneous. Substitution is more limited among African American, blood type O, and less-educated candidates, yet their survival outcomes diverge. African American and blood type O patients experience substantial mortality gains, while less-educated candidates exhibit smaller improvements. By jointly analyzing behavioral and survival responses, this study highlights how allocation policy interacts with biological and structural constraints. These findings underscore the need to design kidney allocation systems that promote both equity and effectiveness.