Kurt R. Sweat

Research

Working papers

Endogenous Priority in Centralized Matching Markets: The Design of the Heart Transplant Waitlist

[Link to current draft]

Centralized matching markets that prioritize specific participants to achieve certain policy goals are common in practice, but priority is often assigned using endogenous characteristics of participants. In the heart transplant waitlist in the United States, the treatment that a patient receives is used to assign waitlist priority. Policymakers recently changed the prioritization in an attempt to reduce waitlist mortality by assigning higher priority to patients receiving specific treatments previously associated with high waitlist mortality. First, I document a significant response to waitlist incentives in treatments given and transplants that take place. Then, I develop and estimate a structural model of treatment and transplant choices to evaluate the effect of the policy change on patients' outcomes and doctors' decisions. I find three main results from my model. First, there is little change in aggregate survival, and the effect of the change has been mainly redistributive. Second, the change has effectively targeted patients with lower untransplanted survival, with these patients receiving higher expected survival under the current design. Third, the effect on survival is largely driven by changes in the decision to accept/decline offers for transplants rather than directly due to a change in treatment decisions. The policy implications suggest that future designs of the waitlist should disincentivize declining offers for transplants.

Conference presentations: SITE 2023: Market Design; INFORMS; University of Tokyo: Rising Stars in Market Design; Essen Health Conference; DSE Conference; NBER Market Design Working Group Meeting; ESAM 2024; APIOC 2024

Publications (* denotes co-first authorship for medical publications)

Contemporary Pediatric Heart Transplant Waitlist Mortality

(Alyssa Power*, Kurt R. Sweat*, Alvin Roth, John C. Dykes, Beth Kaufman, Michael Ma, Sharon Chen, Seth A. Hollander, Elizabeth Profita, David N. Rosenthal, Lynsey Barkoff, Chiu-Yu Chen, Ryan R. Davies, and Christopher S. Almond)

Journal of the American College of Cardiology, August 2024, 84 (7): 620-632.

Press coverage: Stanford Medicine News, TCTMD

Research-in-progress 

Signaling or Muddling in Assignment Mechanisms: An Application to the Heart Transplant Waitlist 

(Nikhil Agarwal, Charles Hodgson, Paulo Somaini, and Kurt R. Sweat)

Medical conference presentations (presenters name underlined)

International Society for Heart and Lung Transplantation, 43rd Annual Meeting & Scientific Sessions (April 2023):

"Racial and Geographic Disparities in Utilization of Listing by Exception Among US Children Listed for Heart Transplantation" (D.M. Torpoco Rivera, K.R. Sweat, B. Kaufman, R. Kameny, A. Burgart, M. Miller, E. Profita, S. Hollander, C.S. Almond)

"Racial Disparities in the Use of Ventricular Assist Devices (VADs) in US Children Listed for Heart Transplantation" (D.M. Torpoco Rivera, K.R. Sweat, B. Kaufman, J. Dykes, J. Murray, T. Nasirov, A. Burgar, M. Miller, R. Kameny, C.S. Almond)

International Society for Heart and Lung Transplantation, 42nd Annual Meeting & Scientific Sessions (April 2022):

"Pediatric VAD Growth in the US: What Factors May be Driving Growth Jumps?” (M.S. Iqbal, K.R. Sweat, J.C. Dykes, J. Murray, M. Ma, E. Martin, D.N. Rosenthal, C.S. Almond)

"Impact of the 2018 Adult Heart Allocation Change on Pediatric Donor Offers and Waitlist Outcomes" (K.R. Sweat, B. Kaufman, L. Barkoff, C. Chen, E. Profita, E. Lee, M. Rosenberg, S. Chen, S. Hollander, C.S. Almond)

International Society for Heart and Lung Transplantation, 41st Annual Meeting & Scientific Sessions (March 2021):

"Waitlist Mortality for Children Listed for Heart Transplant in the United States: How are We Doing?" (A. Power, K.R. Sweat, J.C. Dykes, M. Ma, S. Chen, J. Schmidt, B.D. Kaufman, S.A. Hollander, E. Profita, D.N. Rosenthal, C. Chen, C.S. Almond)

"UNOS Match Runs for Pediatric Heart Transplant Organ Allocation—How Well Do They Sequence Patients Based on Medical Urgency?" (K.R. Sweat, A. Power, J.C. Dykes, M. Ma, R. Davies, S.A. Hollander, E. Profita, D.N. Rosenthal, C. Chen, C.S. Almond)