Using Deceased-Donor Kidneys to Initiate Chains of Living Donor Kidney Paired Donations

Abstract

We design a flexible algorithm that exploits deceased donor kidneys to initiate chains of living donor kidney paired donations, combining deceased and living donor allocation mechanisms to improve the quantity and quality of kidney transplants. The advantages of this approach have been measured using retrospective data on the pool of donor/recipient incompatible and desensitized pairs at the Padua University Hospital, the largest center for living donor kidney transplants in Italy. The experiments show a remarkable improvement on the number of patients with incompatible donor who could be transplanted, a decrease in the number of desensitization procedures, and an increase in the number of UT patients (that is, patients unlikely to be transplanted for immunological reasons) in the waiting list who could receive an organ. Related worksThis paper contributes to the kidney exchange literature initiated by (Delmonico 2004;Delmonico et al. 2004a; arXiv:1901.02420v1 [q-bio.TO]

Long term simulation analysis of deceased donor initiated chains in kidney exchange programs

“…Constraint (8) ensures that maximum donation in a replication is bounded by k. Thus a chain or cycle can be formed with a maximum length of k. Constraint (9) ensures that for a node i, maximum donation over all replications can maximum be 1 and (12) ensures that maximum 1 kidney can be received to a recipient over all replications. Constraint (13) represents that variable x l (i,j) is binary variable.…”

“…But this will create fairness issues as top wait-listed recipients in DD wait-list registry may have to wait long to get a compatible kidney. We have proposed that one of the two DD kidneys should be given directly to the DD wait-list to maintain the fairness criteria and only one kidney should be used to start DD chain [9]. Also, non-simultaneous executions may lead to breaking down of a chain and the DD wait-list won't get a kidney which they would have got otherwise.…”

“…A retrospective study of deceased donor initiated chains is done by Cornelio et al [9]. They have proposed a sequential procedure to create DD chains and worked on the historical data of Padua's transplantation center.…”

“…A two length deceased donor chain was performed in Italy last year. A study of creating deceased donor chains and some retrospective analysis of possibilities of such chains was done recently [9]. Extending the analysis of such chains, a long term simulation study of deceased donor chains is done here on some realistic data from Indian registries.…”