What drives the geographical differences in deceased donor organ procurement in the United States?

The deceased-donor kidney allocation system suffers from a severe shortage of available organs. At the same time, there is significant variation in the threshold of the lowest quality organs procured across different geographies in the United States. A deceased-donor organ is procured if there is the “intent ” of transplanting it. An empirical analysis of the donor and recipient data at the Donor Service Area level reveals that the intent increases significantly with organ quality and the median waiting time for a transplant. In particular, it shows that lower quality organs are likely to be procured at a higher rate in DSAs with longer waiting times. A counterfactual study, motivated by a proposed policy change to the kidney allocation system, shows that broader sharing of the bottom 15 % quality kidneys leads to stronger intent for the organ and an increase in the procurement rates of those organs, thus increasing the supply of procured organs available for transplantation. In particular, the regional sharing of those organs leads to an expected 58 additional procured kidneys per year whereas the national sharing results in an expected 129 additional deceased-donor kidneys per year