Does Transportation Mean Transplantation? Impact of New Airline Routes on Sharing of Cadaveric Kidneys

Every year, nearly 5,000 patients die while waiting for kidney transplants, and yet an estimated 3,500 procured kidneys are discarded. Such a polarized coexistence of dire scarcity and massive wastefulness has been mainly driven by insufficient pooling of cadaveric kidneys across geographic regions. Although numerous policy initiatives are aimed at broadening organ pooling, they rarely account for a key friction—efficient airline transportation, ideally direct flights, is necessary for long-distance sharing, because of the time-sensitive nature of kidney transplantation. Conceivably, transplant centers may be reluctant to accept kidney offers from far-off locations without direct flights. In this paper, we estimate the effect of the introduction of new airline routes on broader kidney sharing. By merging the U.S. airline transportation and kidney transplantation data sets, we create a unique sample tracking (1) the evolution of airline routes connecting all the U.S. airports and (2) kidney transplants between donors and recipients connected by these airports. We estimate the introduction of a new airline route increases the number of shared kidneys by 7.3%. We also find a net increase in the total number of kidney transplants and a decrease in the organ discard rate with the introduction of new routes. Notably, the posttransplant survival rate remains largely unchanged, although average travel distance increases after the introduction of new airline routes. Our results are robust to alternative empirical specifications and have important implications for improving access to the U.S. organ transplantation system.