Market Failure in Kidney Exchange

• 成果类型: Article
• 署名作者: Agarwal, Nikhil; Ashlagi, Itai; Azevedo, Eduardo; Featherstone, Clayton R.; Karaduman, Omer
• 署名单位: Massachusetts Institute of Technology (MIT); National Bureau of Economic Research; Stanford University; Massachusetts Institute of Technology (MIT)
• 刊物名称: AMERICAN ECONOMIC REVIEW
• ISSN/ISSBN: 0002-8282
• DOI: 10.1257/aer.20180771
• 发表日期: 2019
• 页码: 4026-4070
• 关键词: paired donation; PRODUCTIVITY; transplantation; incentives

摘要

We show that kidney exchange markets suffer from market failures whose remedy could increase transplants by 30 to 63 percent. 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.