Alternative kidney waitlist designs, by Agarwal, Ashlagi, Rees, Somaini, and Waldinger in Econometrica

 Here's a paper that seeks to take into account that patients waiting for a deceased organ transplant are forward looking, and make decisions based not just on their place in the current waitlist and the option being offered to them, but on what offers are likely coming, in equilibrium.

Equilibrium Allocations Under Alternative Waitlist Designs: Evidence From Deceased Donor Kidneys, by Nikhil Agarwal, Itai Ashlagi, Michael A. Rees, Paulo Somaini, Daniel Waldinger, Econometrica, Volume89, Issue1, January 2021, Pages 37-76

Abstract: Waitlists are often used to ration scarce resources, but the trade-offs in designing these mechanisms depend on agents' preferences. We study equilibrium allocations under alternative designs for the deceased donor kidney waitlist. We model the decision to accept an organ or wait for a preferable one as an optimal stopping problem and estimate preferences using administrative data from the New York City area. Our estimates show that while some kidney types are desirable for all patients, there is substantial match-specific heterogeneity in values. We then develop methods to evaluate alternative mechanisms, comparing their effects on patient welfare to an equivalent change in donor supply. Past reforms to the kidney waitlist primarily resulted in redistribution, with similar welfare and organ discard rates to the benchmark first-come, first-served mechanism. These mechanisms and other commonly studied theoretical benchmarks remain far from optimal. We design a mechanism that increases patient welfare by the equivalent of an 18.2% increase in donor supply.

"The estimated payoffs show that while some organs are systematically more desirable than others, there is substantial match-specific heterogeneity in values. For instance, organs from younger donors are preferred by all patients, but younger patients place a higher value on such organs. This and other sources of match-specific heterogeneity, such as immunological similarity, create scope for redesigning the allocation mechanism to improve match quality by incorporating detailed patient and donor characteristics into the priority system."