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Biological, Behavioural and Spurious Selection on the Kidney Transplant Waitlist

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  • Kastoryano, Stephen

    (University of Reading)

Abstract

The kidney allocation system aims to distribute kidneys from deceased donors in an equitable and potential-life optimising manner. This is a difficult task, not least because intrinsic biological differences, such as a person's ABO blood type, influence the allocation. This paper begins by presenting a curious and undocumented empirical fact: candidates on the kidney transplant waitlist with blood types implying they will more rapidly be offered a kidney display lower pre-transplant survival. The paper investigates whether this difference in pre-transplant survival is due to biological, behavioural, or spurious selection. To that end, we promote a two-in-one randomization design which allows us to credibly fit our empirical setting within a dynamic potential outcomes framework. Using this framework, drawing from economic theory, and noting problematic financial and legal market incentives, the paper systematically evaluates different explanations for pre-transplant survival patterns. Our analysis establishes a small set of behavioural explanations which directly inform debates about how to reduce the excessive discard of viable kidneys in the US transplant market.

Suggested Citation

  • Kastoryano, Stephen, 2024. "Biological, Behavioural and Spurious Selection on the Kidney Transplant Waitlist," IZA Discussion Papers 16995, Institute of Labor Economics (IZA).
    • Handle: RePEc:iza:izadps:dp16995
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    More about this item

    Keywords

    kidney transplant; expectation effects; dynamic treatment effects; survival models;
    All these keywords.

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • C22 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Time-Series Models; Dynamic Quantile Regressions; Dynamic Treatment Effect Models; Diffusion Processes
    • C41 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods: Special Topics - - - Duration Analysis; Optimal Timing Strategies

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