Kidney exchange needs to be conducted at scale, in the AER by Agarwal, Ashlagi, Azevedo, Featherstone and Karaduman

Market Failure in Kidney Exchange

• Nikhil Agarwal
• Itai Ashlagi
• Eduardo Azevedo
• Clayton R. Featherstone
• Ömer Karaduman


AMERICAN ECONOMIC REVIEW (FORTHCOMING)


Abstract
We show that kidney exchange markets suffer from market failures whose remedy could increase transplants by 30%–63%. First, we document that the market is fragmented and inefficient: most transplants are arranged by hospitals instead of national platforms. Second, we propose a model to show two sources of inefficiency: hospitals only partly internalize their patients' benefits from exchange, and current platforms suboptimally reward hospitals for submitting patients and donors. Third, we calibrate a production function and show that individual hospitals operate below efficient scale. Eliminating this inefficiency requires either a mandate or a combination of new mechanisms and reimbursement reforms.
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