Nber Working Paper Series Individual Rationality and Participation in Large Scale, Multi-hospital Kidney Exchange

As multi-hospital kidney exchange clearinghouses have grown, the set of players has grown from patients and surgeons to include hospitals. Hospitals have the option of enrolling only their hard-to-match patient-donor pairs, while conducting easily arranged exchanges internally. This behavior has already started to be observed. We show that the cost of making it individually rational for hospitals to participate fully is low in almost every large exchange pool (although the worst-case cost is very high), while the cost of failing to guarantee individually rational allocations could be large, in terms of lost transplants. We also identify an incentive compatible mechanism. Itai Ashlagi E62-577, Sloan School of Management, MIT [email protected] Alvin E. Roth Harvard University Department of Economics Littauer 308 Cambridge, MA 02138-3001 and NBER [email protected] Individual rationality and participation in large scale, multi-hospital kidney exchange Itai Ashlagi and Alvin E. Roth∗