死亡捐献者器官分配中的动态汇集与区域参与
Dynamic Pooling and Regional Participation in Deceased-Donor Organ Allocation
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中文总结 AI 辅助
本文研究死亡捐献者器官分配中从分散等待名单转向汇集名单的帕累托改进，提出动态风险汇集为主要来源，并设计多项式时间的约束帕累托前沿搜索算法，在保持区域参与激励的同时实现全局效率。
中文摘要 AI 辅助
在死亡捐献者器官移植中，从地理碎片化的等待名单转向汇集名单可以提高效率，但这引发了关于区域公平性和参与激励的担忧。本文在一个具有不耐烦患者、易逝物品和可处理的同质兼容性摩擦的多类别排队模型中，研究了此类转变带来的帕累托改进。与关注静态匹配质量或忽略动态环境中区域激励的标准方法不同，我们的分析将动态风险汇集确定为区域帕累托改进的主要来源：汇集减少了因随机供需波动、时间错配和随机兼容性结果导致的器官浪费。尽管这种动态盈余理论上允许帕累托改进，但当区域不对称时，一种对所有患者一视同仁的纯粹功利主义政策往往无法实现这些改进。在这种情况下，功利主义再分配从高供给区域提取过多器官，违反了这些区域的参与约束。为解决这一冲突，我们证明了可实现效用集合可以通过静态优先级指数政策的混合来描述。基于这一结构，我们提出了约束帕累托前沿搜索（CPFS），这是一种多项式时间程序，能够计算具有任意小参与约束违反的近似最优分配政策。结果表明，通过调整优先级指数，将再分配保持在汇集供给、需求和兼容性风险的收益范围内，政策制定者可以在保持局部参与激励的同时实现全局效率。
英文摘要
Moving from geographically fragmented to pooled waiting lists in deceased-donor organ transplantation can improve efficiency, but it raises concerns about regional fairness and participation incentives. This paper studies Pareto gains from such transitions in a multi-class queueing model with impatient agents, perishable items, and a tractable homogeneous compatibility friction. Unlike standard approaches that focus on static match quality or ignore regional incentives in dynamic settings, our analysis identifies dynamic risk pooling as the main source of Pareto improvements for regions: pooling reduces organ waste due to stochastic supply-demand fluctuations, temporal mismatches, and random compatibility outcomes. Although this dynamic surplus theoretically permits Pareto improvements, a purely utilitarian policy that treats all patients equally across regions often fails to deliver them when regions are asymmetric. In such cases, utilitarian redistribution extracts too many organs from high-supply regions and violates their participation constraints. To resolve this conflict, we show that the set of achievable utilities can be described by mixtures of static priority index policies. Building on this structure, we propose the Constrained Pareto Frontier Search (CPFS), a polynomial-time procedure that computes an approximately optimal allocation policy with arbitrarily small participation-constraint violations. The results suggest that, by adjusting priority indices to keep redistribution within the gains from pooled supply, demand, and compatibility risk, policymakers can attain global efficiency while preserving local participation incentives.
发表机构
- Graduate School of Economics, the University of Tokyo（东京大学经济学研究科）
机构由 AI 辅助整理，请以论文原文为准。
