Position: Machine Learning for Heart Transplant Allocation Policy Optimization Should Account for Incentives
This study addresses the misaligned incentives among transplant centers, clinicians, and regulatory agencies—a critical yet overlooked factor that undermines the effectiveness of current heart allocation policies. For the first time, organ allocation is modeled as a multi-agent strategic process, and an incentive-aware allocation framework is proposed that integrates mechanism design with data-driven methodologies. By synthesizing insights from mechanism design, strategic classification, causal inference, and social choice theory, the work systematically quantifies the real-world adverse impacts of incentive misalignment in adult heart transplantation in the United States. The resulting framework offers a novel paradigm for designing allocation policies that are not only more equitable and efficient but also robust to strategic behavior, thereby advancing interdisciplinary innovation at the intersection of machine learning and social science.