Targeted Priority Mechanisms in Organ Transplantation

Abstract

The persistent shortage of transplantable organs, compounded by high rates of organ underutilization, necessitates innovative allocation mechanisms. This dissertation develops and analyzes targeted priority mechanisms, voluntary incentive-based programs designed to enhance access for disadvantaged patient groups and improve organ-recipient matching. Using a rigorous queueing-theoretic framework, I characterize patients' equilibrium participation strategies, identifying conditions under which no-, full-, and mixed-participation equilibria emerge. I further establish the necessary and sufficient conditions for their existence and uniqueness, highlighting how careful mechanism design can align individual incentives with socially optimal outcomes.

The study extends the analysis to class-separating allocations, demonstrating the feasibility of equilibria that improve social welfare while safeguarding non-participating patients' access to high-quality organs. A clinically detailed simulation of the U.S. kidney allocation system, focusing on elderly patients, illustrates the potential benefits: a targeted threshold of 84% KDPI yields approximately 220 additional annual transplants, reduces the waiting list by more than 450 patients, and prevents over 60 pre-transplant deaths annually, with minimal impact on graft survival rates. Overall, the findings provide both theoretical and practical guidance for the design of efficient, implementable allocation mechanisms.