Kidney exchange when hospitals are the players

Itai Ashlagi and I have a new paper, motivated by recent developments in kidney exchange. Now that exchange is often proceeding through multi-hospital clearinghouses, we are going to have to think about how to give hospitals the incentive to participate fully, and enroll all of their patient-donor pairs into the exchange, and not just the ones that are difficult to match.

Ashlagi, Itai and Alvin E. Roth, "Individual rationality and participation in large scale, multi-hospital kidney exchange," working paper, January 2011.


Abstract: As multi-hospital kidney exchange clearinghouses have grown, the set of players has grown from patients and surgeons to include hospitals. Hospitals have the option of enrolling only their hard-to-match patient-donor pairs, while conducting easily arranged exchanges internally. This behavior has already started to be observed.
We show that the cost of making it individually rational for hospitals to participate fully is low in almost every large exchange pool (although the worst-case cost is very high), while the cost of failing to guarantee individually rational allocations could be large, in terms of lost transplants. We also identify an incentive compatible mechanism."