Abstract: Organ transplantation can improve life expectancy for recipients, but the probability of a successful transplant depends on the compatibility between donor and recipient features. Current medical practice relies on coarse rules for donor-recipient matching, but is short of domain knowledge regarding the complex factors underlying organ compatibility. In this paper, we formulate the problem of learning data-driven rules for donor-recipient matching using observational data for organ allocations and transplant outcomes. This problem departs from the standard supervised learning setup in that it involves matching two feature spaces (for donors and recipients), and requires estimating transplant outcomes under counterfactual matches not observed in the data. To address this problem, we propose a model based on representation learning to predict donor-recipient compatibility—our model learns representations that cluster donor features, and applies donor-invariant transformations to recipient features to predict transplant outcomes under a given donor-recipient feature instance. Experiments on several semi-synthetic and real-world datasets show that our model outperforms state-of-art allocation models and real-world policies executed by human experts.