Reshaping National Organ Allocation Policy

The Organ Procurement & Transplantation Network (OPTN) initiated in 2018 a major overhaul of all U.S. deceased-donor organ allocation policies, aiming to gradually migrate them to a so-called continuous distribution model, with the goal of creating an allocation system that is more efficient, more equitable, and more inclusive. Development of policies within this model, however, represents a major challenge because multiple efficiency and fairness objectives need to be delicately balanced. We introduce a novel analytical framework that leverages machine learning, simulation, and optimization to illuminate policy tradeoffs and enable dynamic exploration of the efficient frontier of policy options. In collaboration with the OPTN, we applied the framework to design a new national allocation policy for lungs. Since March 9, 2023, all deceased-donor lungs in the United States have been allocated according to this policy that we helped design, projected to reduce waitlist mortality by approximately 20% compared with current policy based on simulations. We discuss how we extended our collaboration with the OPTN to the redesign of kidney, pancreas, heart, and liver allocation and how our framework can be applied to other application domains, such as school choice or public housing allocation systems.