Why do transplant surgeons turn down organs? A model of the accept/reject decision.

Despite the scarcity of transplantable organs, 45% of livers are rejected by the first surgeon to whom they are offered. I present a model in which a surgeon decides to accept or reject an organ for a patient based on the patient's current health level. Using data on transplanted patients, I show that surgeons' behavior is consistent with the solution to an optimal stopping problem in which they reject low quality organs for relatively healthy patients in the hope that they will receive a better organ offer in the future. I discuss trends in organ procurement in light of this finding.

[1]  John Rust.  Optimal Replacement of GMC Bus Engines: An Empirical Model of Harold Zurcher , 1987 .

[2]  D. Kaserman,et al.  The "Rush to Transplant" and Organ Shortages , 1995 .

[3]  P. Thompson,et al.  A positive analysis of financial incentives for cadaveric organ donation. , 2001, Journal of health economics.

[4]  Uri Yechiali,et al.  A Time-dependent Stopping Problem with Application to Live Organ Transplants , 1985, Oper. Res..

[5]  R M Arnold,et al.  Rationing failure. The ethical lessons of the retransplantation of scarce vital organs. , 1993, JAMA.

[6]  John Hornberger,et al.  Involving Patients in the Cadaveric Kidney Transplant Allocation Process: A Decision-Theoretic Perspective , 1996 .

[7]  Scope, Learning, and Cross Subsidy: Organ Transplants in a Multi-Division Hospital , 1994 .

[8]  J B Otte,et al.  Preliminary experience with a new liver allocation system within Eurotransplant. , 1993, Transplantation proceedings.

[9]  H. Peyton Young,et al.  Equity - in theory and practice , 1994 .

[10]  E. Thorne.  The cost of procuring market-inalienable human organs , 1996 .

[11]  D. Howard,et al.  Dynamic Analysis of Liver Allocation Policies , 2001, Medical decision making : an international journal of the Society for Medical Decision Making.

[12]  J. Ratcliffe,et al.  Public preferences for the allocation of donor liver grafts for transplantation. , 2000, Health economics.

[13]  K Forbes,et al.  In theory and practice. , 1993, Clinical nurse specialist CNS.

[14]  T. Beard,et al.  The medical community's opposition to organ markets: Ethics or economics? , 1993 .