Incentive-Compatible Triaging in Deceased Donor Transplantation

In the allocation of hearts and livers, the U.S. transplantation authority has recurrently faced a pervasive problem of asymmetric information about transplant candidates’ medical urgency. I investigate the optimal design of prioritization rules under different social welfare functions while taking patients’ incentives to misrepresent medical needs into account. I find that the current prioritization scheme is not incentive compatible. Moreover, I deliver a way of incentivizing truth-telling by prioritizing patients using their medical urgency histories, which is remarkably different from how the latter are used in practice. Despite screenining is possible, when the social objective is to prioritize medically urgent patients its optimality is ambiguous, and in some parameter regions pooling is preferred. In sharp contrast, when social preferences are utilitarian pooling is preferred most of the time. On top of providing insights for addressing the informational asymmetries, these results offer a novel perspective on a controversy among stakeholders and ethicists on the principles for allocating organs