Organ Allocation and Transplantation, by Ashlagi and Roth, forthcoming in Annual Review of Economics 2026

 Here's a  forthcoming review paper on organ allocation and transplantation that focuses on the allocation of deceased-donor organs, particularly kidneys, and goes through the whole supply chain, from donor registration and family consent after death, to patient prioritization, and organ allocation. We also discuss the regulatory and political practices and ethical concerns that keep the availability of transplants far short of their need.

Organ Allocation and Transplantation
by Itai Ashlagi and Alvin E. Roth, Annual Review of Economics   
Vol. 18 https://doi.org/10.1146/annurev-economics-092425-123425
Review in Advance first posted online on June 08, 2026. (Changes may still occur before final publication.)
 
Abstract: There is a large shortage of solid organs for transplants. This survey reviews the allocation of organs (particularly kidneys), with an emphasis on how deceased donor organs are obtained and allocated in the United States but with pointers to related issues involving living donors and transplantation around the world. We review some of the key institutional details and theoretical and empirical studies and describe some open questions that we hope will continue to attract attention from researchers interested in the economic and operational aspects of organ allocation. 

 

The paper ends with a set of open questions and research directions, followed by these concluding paragraphs about the future:

 "THE DAY AFTER TOMORROW

"Efforts to quickly improve the availability of transplants include recovering more transplantable organs from deceased donors, successfully transplanting more of those recovered organs, and facilitating more living donor organ transplants of kidneys and livers. In the longer term, efforts are under way to reduce the need for human organ transplants by reducing the need for re-transplantation (after graft failure) and by preventing organ failure or curing it by other means. 

"It is common to hear that xenotransplantation is tomorrow’s cure for organ failure, and always will be. However, recent developments in transplanting organs from genetically modified pigs into primates and humans suggest that the future possibilities are real, even though (as of this writing) no pig organ transplant to a human has yet survived for as much as a year (although there have now been some pig kidney and heart transplants that worked for months; Tector 2025). Another somewhat related approach involves trying to bioengineer an artificial kidney by removing from a pig kidney the pig cells that would be attacked by the human immune system, leaving a scaffold that could be populated with human kidney cells (Lo et al. 2024). Less developed so far is the hope of regrowing kidneys through some kind of stem cell manipulation, although some kidney cell growth in mice has been achieved (Araoka et al. 2025).
 

"Each of these lines of research offers the possibility of reducing or ending the need for, and hence the scarcity of, human organs for transplantation. That scarcity would also be reduced by medical progress in reducing the incidence and progression of kidney disease and its precursors and of other kinds of organ failure that now require transplantation.  Yet it remains likely that almost everyone whose life could be extended by a human organ transplant today will die without one, and so our attention to the shortage of transplants is still needed."