Zachary Sollie

Itai Zilberstein, Ioannis Anagnostides, Zachary W. Sollie et al.

Each year, thousands of patients in need of heart transplants face life-threatening wait times due to organ scarcity. While allocation policies aim to maximize population-level outcomes, current approaches often fail to account for the dynamic arrival of organs and the composition of waitlisted candidates, thereby hampering efficiency. The United States is transitioning from rigid, rule-based allocation to more flexible data-driven models. In this paper, we propose a novel framework for non-myopic policy optimization in general online matching relying on potentials, a concept originally introduced for kidney exchange. We develop scalable and accurate ways of learning potentials that are higher-dimensional and more expressive than prior approaches. Our approach is a form of self-supervised imitation learning: the potentials are trained to mimic an omniscient algorithm that has perfect foresight. We focus on the application of heart transplant allocation and demonstrate, using real historical data, that our policies significantly outperform prior approaches -- including the current US status quo policy and the proposed continuous distribution framework -- in optimizing for population-level outcomes. Our analysis and methods come at a pivotal moment in US policy, as the current heart transplant allocation system is under review. We propose a scalable and theoretically grounded path toward more effective organ allocation.

Ioannis Anagnostides, Itai Zilberstein, Zachary W. Sollie et al.

The allocation of scarce donor organs constitutes one of the most consequential algorithmic challenges in healthcare. While the field is rapidly transitioning from rigid, rule-based systems to machine learning and data-driven optimization, we argue that current approaches often overlook a fundamental barrier: incentives. In this position paper, we highlight that organ allocation is not merely a static optimization problem, but rather a complex game involving transplant centers, clinicians, and regulators. Focusing on US adult heart transplant allocation, we identify critical incentive misalignments across the decision-making pipeline, and present data showing that they are having adverse consequences today. Our main position is that the next generation of allocation policies should be incentive aware. We outline a research agenda for the machine learning community, calling for the integration of mechanism design, strategic classification, causal inference, and social choice to ensure robustness, efficiency, and fairness in the face of strategic behavior from the various constituent groups.