Research

Job Market Paper

Organ Availability and Transplant Candidate Behavior
[Draft forthcoming]

Liver transplant candidates decline more than half of the organs offered to them, even though no alternative treatment exists. Each year, roughly one in eight dies or becomes too sick for transplant while waiting. This paper studies how candidates make these decisions. The 2020 Acuity Circles reform changed how candidates are prioritized, redrawing both the geographic boundaries and redefining the medical urgency groups. Using offer-level data from the Scientific Registry of Transplant Recipients, I show that candidates who gained access became more selective: a one-standard-deviation increase in expected offer arrival rates lowers the probability of accepting an offer by 4.7 percentage points, a 12.6 percent decline. To interpret this behavior, I estimate a dynamic discrete choice model of the accept-or-wait decision. Candidates weigh the offer at hand against the chance of a better offer later, knowing they may die or become too sick while waiting. The estimated model implies that the reform raised average welfare at listing by an amount equivalent to roughly doubling donor supply, with only 1.6 percent of candidates made worse off. I then evaluate several counterfactual policy changes, including a widely debated one which would replace the remaining boundaries with a continuous score that incorporates both medical urgency and proximity. I find that prioritizing the sickest candidates raises average welfare but at the cost of wasted organs.

Work in Progress

The Intergenerational Transmission of Task Content and Skills

Regulation-Induced Mergers: Incentives and Outcomes in Organ Procurement