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David Robinson
David Robinson

Upturn, Cornell University

Kidney Allocation Policy as Algorithmic Governance


In this work in progress, David Robinson will be exploring a real-world example of collaborative algorithmic governance: The allocation of deceased-donor kidneys in the United States. Although popular sources often speak of a “waiting list” for kidney transplants, there is not a first-come, first-served queue for these organs. Instead, whenever a kidney becomes available, an algorithm managed by a nonprofit in Richmond Virginia conducts a “match run,” to suggest a recipient for that organ. The algorithm reflects a complex blend of medical, logistical and moral factors. On December 4, 2014, after more than a decade of debate, analysis, and public consultation, a new and redesigned version of this algorithm came into effect. The new system was designed to increase the total benefit from a fixed pool of organs, and also to spread that benefit more equitably, including by reducing longstanding racial disparities in transplant access. Early data suggest that there has been at least some success with each of these objectives.


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