Economic Incentives and Organ Procurement: Evidence from a U.S. Reform

In 2019, the United States implemented new regulations for Organ Procurement Organizations (OPOs) aimed at increasing transparency and strengthening accountability. These rules introduced stronger performance incentives designed to improve organ procurement outcomes. This paper examines the impact of the reform on organ donations, transplant activity, and associated system costs, with a particular focus on kidneys, given their clinical characteristics and the structure of the reform’s organizational incentives. We estimate that the new policy led to an average increase of 7.13 kidneys procured per OPO per month, relative to a baseline mean of 24.78. The largest effects are observed among top-performing OPOs prior to the reform, with similar patterns for transplanted organs. Consistent with these findings, we document an overall rise in total OPO costs, with statistically significant increases concentrated among low-performing OPOs. Finally, we present a back-of-the-envelope calculation estimating the fiscal impact of the reform.