Choices and Outcomes in Assignment Mechanisms: The Allocation of Deceased Donor Kidneys
评估了死亡供体肾脏分配机制，基于患者移植后生命年（LYFT）衡量选择的作用，发现当前设计平均LYFT为9.29年，比随机分配高1.75年，但最大可达14.08年，政策制定者面临在更危重患者与生命延长最长的患者之间权衡的困境。
While the mechanism design paradigm emphasizes notions of efficiency based on agent preferences, policymakers often focus on alternative objectives. School districts emphasize educational achievement, and transplantation communities focus on patient survival. It is unclear whether choice‐based mechanisms perform well when assessed based on these outcomes. This paper evaluates the assignment mechanism for allocating deceased donor kidneys on the basis of patient life‐years from transplantation (LYFT). We examine the role of choice in increasing LYFT and compare realized assignments to benchmarks that remove choice. Our model combines choices and outcomes in order to study how selection affects LYFT. We show how to identify and estimate the model using instruments derived from the mechanism. The estimates suggest that the design in use selects patients with better post‐transplant survival prospects and matches them well, resulting in an average LYFT of 9.29, which is 1.75 years more than a random assignment. However, the maximum aggregate LYFT is 14.08. Realizing the majority of the gains requires transplanting relatively healthy patients, who would have longer life expectancies even without a transplant. Therefore, a policymaker faces a dilemma between transplanting patients who are sicker and those for whom life will be extended the longest.