Nikhil Agarwal, Charles Hodgson, Paulo Somaini, 17 January 2021

In the US, most patients who need a kidney transplant must participate in a centralised deceased-donor kidney allocation mechanism. The allocation system seeks to make the best use of available organs and maximise ‘life years from transplant’. This column estimates the life years from transplant generated by the US kidney assignment system, using data on transplants and outcomes for patients on the waiting list between 2000 and 2010. Patient choice to reject or accept the transplant increases life years from transplant. The policy goal to maximise life years from transplant would result in younger, healthier patients receiving transplants at the expense of older, more urgently sick patients.

Julio J. Elias, Nicola Lacetera, Mario Macis, 15 October 2016

Certain ‘repugnant’ transactions, such as the sale of organs, are prohibited on moral grounds, despite substantial potential efficiency gains. This column uses a survey-based experiment to explore public perceptions of the morality–efficiency trade-off in the context of the US kidney procurement system. Respondents are found to accept higher levels of repugnance for higher levels of efficiency. These results suggest room for efficiency concerns alongside moral and ethical considerations.

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