Kidney Exchange with Inhomogeneous Edge Existence Uncertainty

Abstract

Patients with end-stage renal failure often find kidney donors who are willing to donate a lifesaving kidney, but who are medically incompatible with the patients. Kidney exchanges are organized barter markets that allow such incompatible patient-donor pairs to enter as a single agent-where the patient is endowed with a donor "item"-and engage in trade with other similar agents, such that all agents "give" a donor organ if and only if they receive an organ in return. In practice, organized trades occur in large cyclic or chain-like structures, with multiple agents participating in the exchange event. Planned trades can fail for a variety of reasons, such as unforeseen logistical challenges, or changes in patient or donor health. These failures cause major inefficiency in fielded exchanges, as if even one individual trade fails in a planned cycle or chain, all or most of the resulting cycle or chain fails. Adhoc, as well as optimization-based methods, have been developed to handle failure uncertainty; nevertheless, the majority of the existing methods use very simplified assumptions about failure uncertainty and/or are not scalable for real-world kidney exchanges.

Kidney Exchange: An Operations Perspective

“…48 Simulations that consider this tension can be found in Santos et al (2017) and . 49 Some studies consider the problem of maximizing the expected number of matches (Klimentova et al, 2016;Wang et al, 2017;Bidkhori et al, 2020) or using robust optimization (McElfresh et al, 2019). Several papers consider identifying exchanges that are not necessarily disjoint, after which more than one crossmatch would be possible while having "backup" options (Blum et al, 2013;Bray et al, 2015;Glorie et al, 2015).…”