Research

Working Papers

• The Effect of Broader Liver Sharing on Patient Outcomes and Offer Acceptance

Abstract: Liver allocation policies and strategic offer-acceptance decisions determine who ultimately receives liver transplants. For transplant candidates with greater medical need, the Share 35 policy provides priority for livers obtained from areas further away. This paper examines the policy effect on transplant outcomes and the decision to accept or decline a liver offer. First, I find that increasing access to liver transplants effectively reduces mortality risks before receiving transplants, which is the goal of the policy. Second, I find a mixed effect on the quality of transplanted livers for targeted candidates. Although livers travel further that implies lower liver quality, those candidates receive livers with better donor characteristics. This compensation on liver quality can be explained by the change in offer-acceptance incentives. Greater access to liver offers enables targeted candidates to be more selective of offered livers.

• The Role of Kidney Allocation Policy in Addressing Kidney Shortages

Abstract: Compared to policies intended to increase donations, policymakers have largely ignored the role of allocation policies in addressing current kidney shortages. This paper examines the impacts of prioritizing certain types of candidates for deceased-donor kidney allocation. Using a regression discontinuity design, I find that increased access to deceased-donor kidneys dramatically decreases mortality rates (by 43 percent relative to baseline), while decreasing the likelihood of receiving a living-donor transplant. Both of these effects vary substantially across race, blood type, and dialysis status, implying that policies that prioritize candidates who are less prone to crowd-out would improve both transplant quantity and quality.

• The Strategic Location Choice of For-profit Hemodialysis Facilities in the U.S.

Abstract: This paper identifies key factors related to the location choice of for-profit hemodialysis facilities using a dataset from the United States Renal Data System (USRDS) and structural methods. All patients with kidney failure need to receive hemodialysis treatment regularly and permanently. Because dialysis treatments are homogeneous across facilities, patients are likely to choose a treatment facility based on the distance from their homes. The strategic model introduced by Seim (2006) involves a static and incomplete information game among dialysis facilities for entry and positioning in a market. The estimation results show that in choosing an optimal location, a tradeoff occurs between local demand and competition with potential entrants.