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.

Nikhil Agarwal, Itai Ashlagi, Eduardo Azevedo, Clayton Featherstone, Omer Karaduman, 03 November 2018

National kidney exchange platforms significantly boost the number of life-saving kidney transplants by finding complicated exchange arrangements that are not possible within any single hospital. This column examines US data and finds that the majority of kidney exchanges continue to be performed within hospitals, suggesting a fragmented market that comes at a large efficiency cost. National platforms may need to be redesigned to encourage full participation, with reimbursement reform.

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