Equilibrium Allocations Under Alternative Waitlist Designs: Evidence From Deceased Donor Kidneys
Econometrica · 2021 · Nikhil Agarwal、Itai Ashlagi、Michael A. Rees、Paulo Somaini、Daniel Waldinger
中文摘要
候补名单常用于配给稀缺资源，但设计这些机制时的权衡取舍取决于参与者的偏好。我们研究已故供者肾脏候补名单在不同设计下的均衡配置。我们将接受一个器官还是等待一个更合意的器官这一决策建模为最优停止问题，并利用纽约市地区的行政数据估计偏好。我们的估计表明，尽管某些类型的肾脏对所有患者而言都具有吸引力，但肾脏对患者的价值因具体匹配而异，存在较大的异质性。随后，我们开发了评估不同机制的方法，将这些机制对患者福利的影响与供者供给的等效变化进行比较。以往肾脏候补名单改革的主要结果是再分配，其福利水平和器官弃用率与作为基准的先到先得机制相近。这些机制以及其他常被研究的理论基准机制仍远未达到最优。我们设计了一种机制，其带来的患者福利增量相当于供者供给增加18.2%所带来的福利增量。
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 percent increase in donor supply.