Newswise — It sounds like a reasonable, well-meaning policy: To help boost the persistently low supply of human organs for transplant, a few countries allow individuals who pledge their organs for donation to receive priority status if they should ever need a transplant themselves.

Yet, as a Johns Hopkins University researcher argues in a new study, the “donor-priority rule” might create unintended consequences because it provides a stronger incentive to individuals who are more likely to seek a transplant in the future. The supply might increase, but at the risk of potentially reducing the quality of organs.

Also, a psychological burden might befall high-risk individuals who feel compelled to pledge donations they otherwise might not have made.

A simple operational remedy could correct these flaws, says Assistant Professor Tinglong Dai of the Johns Hopkins Carey Business School. He proposes that each pledge be followed by a “freeze period” of a specified length of time. Anyone who promises a donated organ would not be given priority for a transplant until the freeze has expired.

As a result, Dai explains, the quality of donated organs would face less of a threat of becoming compromised, and individuals with a high likelihood of needing transplants might not feel pressured to pledge their organs just for a chance to move toward the front of the transplant queue.

“When used in conjunction with the donor-priority rule, this remedy can ensure social-welfare improvement by expanding the size of the donor registry without reducing the average quality of donated organs or inducing unnecessarily high [psychological] costs of donating,” the paper states. 

The psychological costs of the priority rule are a factor even in a scenario in which all donated organs would come from healthy individuals. According to the paper’s findings ― attained through a queueing theoretic model that Dai developed with two co-authors ― the rule might induce healthy people to pledge to donate their organs, not because they wish to but because they feel they must do so to gain special consideration in case they would ever need a transplant.

All these factors, Dai says, cast doubt on the donor-priority rule’s intended benefit to the greater society.

But, he adds, the rule needn’t be discarded, as long as it can be combined with a well-calibrated freeze period.

“The freeze serves as a disincentive for healthy as well as less healthy people to become donors, but the disincentive would be stronger for the high-risk people than for the low-risk ones. So, having this freeze can mitigate the quality-distorting effect that’s introduced by the donor-priority rule,” says Dai, an expert in health care operations management who earned his PhD in industrial administration from Carnegie Mellon University.

Chile, Singapore, and Israel have implemented the donor-priority rule in recent decades, leading to an increase in the number of registered organ donors. Israel has implemented the policy along with a three-year freeze period. Still, until this research, there have not been rigorous queueing theoretic models to elucidate the social-welfare consequence of the donor-priority rule and the necessity of the freeze period.  

The working paper, “Jumping the Line, Charitably: Analysis and Remedy of Donor-Priority Rule,” was co-written by Dai, Assistant Professor Ronghuo Zheng of the University of Texas at Austin, and Professor Katia Sycara of Carnegie Mellon University. It won the Public Sector Operations Research Best Paper Award at the annual meeting of the Institute for Operations Research and the Management Sciences (INFORMS), held in October 2017 in Houston, Texas.

 An award from Johns Hopkins University and a grant from the United States Army Research Office helped fund the study.



The Johns Hopkins Carey Business School is the AACSB-accredited business school of Johns Hopkins University. Established in 2007, the Carey Business School creates and shares knowledge that shapes business practices while educating business leaders who will grow economies and societies, and are exemplary citizens. With locations in Baltimore and Washington, D.C., the Carey Business School offers graduate degree programs for full-time, part-time, and online students. For more information, visit