Diagnostic Thresholds, Written Consent Requirements, and the Utilization of Scarce Organs — by Hannah Bae, Jeffrey Clemens
This paper explores how diagnostic thresholds and a written consent requirement affect decision making between patients and transplant surgeons regarding the use of deceased donor kidneys. Combining administrative data on the universe of organ donors and transplant recipients in the United States, we show that age-based discontinuities within the Expanded Criteria Donor system (ECD), which was in place from late 2002 to late 2014, led to 4.0 and 5.4 percentage point differences in the rates at which otherwise indistinguishable kidneys were discarded. A discontinuity within the subsequent presentation of the Kidney Donor Profile Index (KDPI) led to a 2.6 percentage point difference. We present evidence that diagnostic thresholds have nuanced effects on decision making and information acquisition; procurement biopsy rates, for example, rose substantially at the ECD system’s age-based discontinuities. We further show that written consent requirements triggered within the ECD and KDPI labeling systems substantially reduced the number of potential recipients to whom kidneys were offered prior to being discarded. This channel can explain the majority of the increased rate at which “High-KDPI” kidneys are discarded under the current system.
