Kidney Exchange and the Alliance for Paired Donation: Operations Research Changes the Way Kidneys Are Transplanted

Abstract

Many end-stage renal disease sufferers who require a kidney transplant to prolong their lives have relatives or associates who have volunteered to donate a kidney to them, but whose kidney is incompatible with their intended recipient. This incompatibility can be sometimes overcome by exchanging kidneys with another incompatible donor pair. Such kidney exchanges have emerged as a standard mode of kidney transplantation in the United States. The Alliance for Paired Donation (APD) developed and implemented an innovative operations research based methodology of non-simultaneous extended altruistic donor (NEAD) chains, which, by allowing a previously binding constraint (of simultaneity) to be relaxed, allowed better optimized matching of potential donors to patients, which greatly increases the number of possible transplants. Since 2006, the APD has saved more than 220 lives through its kidney exchange program, with more than 75% of these achieved through long non-simultaneous chains. The technology and methods pioneered by APD have been adopted by other transplant exchanges, resulting in thousands of lives already saved, with the promise of increasing impact in coming years. The percentage of transplants from non-simultaneous chains has already reached more than 6% of the total number of transplants from live donors (including directed living donors) in the last year. We describe the long-term optimization and market design research that supports this innovation. We also describe how the team of physicians and operations researchers worked to overcome the skepticism and resistance of the medical community to the NEAD innovation.

Simulating the Impact of Crossover Kidney Transplantation on the Nord Italia Transplant Program

“…Finally, we want to mention some other very recent approaches to the kidney exchange problem, mainly focused on the mathematics dealing with the case when a samaritan donation is present, see [22,23].…”

Market design for living-donor organ exchanges: an economic policy perspective

“…This is the approach utilized in APKD starting from 2005 until now (for example, see Anderson et al, 2015b).…”

Case Article—DeLand Crayon Company: An Application of the Traveling Salesman Problem to Production Scheduling with Sequence-Dependent Setup Times

“…Models of TSP's many variations (e.g., multiple salesmen, multiple depots, time windows, and tour length constraints), algorithms and heuristics to solve them, and their real-life applications are reported extensively in operations research/management science (OR/ MS) literature. A quick (nonexhaustive) survey reveals the rich variety of applications of TSP, including drilling of printed circuit boards (Magirou 1986), collection of spent batteries (Schultmann et al 2003), kidney transplantation (Anderson et al 2015), telescope scheduling (Chlond 2002), delivering meals on wheels (Bartholdi et al 1983), NBA team travel scheduling (Bean and Birge 1980), milk collection (Caramia and Guerriero 2010), warehouse order picking (Dekker et al 2004), logistics load planning (Keskin et al 2014), optimizing delivery routes (Faulin et al 2005, Holland et al 2017, production scheduling (Moss et al 2000), printing multiedition periodicals (Gorenstein 1970), construction tower crane scheduling Zavichi et al 2014, waste management Sahoo et al 2005ing games in the Canadian football league (Kostuk and Willoughby 2012), and scheduling umpires in major league baseball (Trick et al 2012). In a unique and interesting application, TSP has also been applied to minimize waste in wallpapering (Garfinkel 1977)!…”