Improving Organ Procurement Operations

We study how decisions made by organ procurement organizations (OPOs)—non-profits that coordinate organ recovery from deceased donors—affect the availability of organs for transplant in the United States. We develop a structural econometric model of a pivotal OPO decision: whether to approach a potential donor’s family to request authorization for donation. Our model conceptualizes this decision in two parts. The OPO first estimates the probabilities of two downstream outcomes: authorization (i.e., family consent) and transplant (i.e., whether the donated organs would be successfully transplanted). It then applies a cost-benefit decision rule that maps these estimates to an approach decision. Our model separately identifies the OPO’s beliefs (i.e., probability estimates), its preferences (i.e., costs / benefits), and the true probabilities of authorization and transplant. We apply our model to a dataset of 35,856 potential donors referred to four OPOs between 2016 and 2021. We find that OPOs missed a substantial number of donation opportunities, recovering organs from only 39% of transplantable donors. Of these missed opportunities, an estimated 16% resulted from conservative preferences, 12% from miscalibrated beliefs, and the remaining 72% from family declines. We conduct a detailed counterfactual policy evaluation to identify impactful and actionable changes to OPO decisions. We find that drastically increasing approach rates would allow OPOs to recover organs from 43% more donors, creating over $100 million in additional annual societal benefit.