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Am J Transplant. 2018 May;18(5):1177-1186. doi: 10.1111/ajt.14566. Epub 2017 Dec 5.

Effect of match-run frequencies on the number of transplants and waiting times in kidney exchange.

Author information

1
Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.
2
Texas Transplant Institute, Methodist Specialty and Transplant Hospital, San Antonio, TX, USA.
3
Operations Research Center, MIT, Cambridge, MA, USA.
4
Yale School of Management, Yale University, New Haven, CT, USA.
5
Sloan School of Management, MIT, Cambridge, MA, USA.
6
Southwest Immunodiagnostics Laboratory, San Antonio, TX, USA.
7
Department of Economics, Stanford University, Stanford, CA, USA.
8
Department of Surgery, Stanford University, Stanford, CA, USA.
9
University of Toledo, Toledo, OH, USA.
10
Alliance for Paired Donation, Perrysburg, OH, USA.

Abstract

Numerous kidney exchange (kidney paired donation [KPD]) registries in the United States have gradually shifted to high-frequency match-runs, raising the question of whether this harms the number of transplants. We conducted simulations using clinical data from 2 KPD registries-the Alliance for Paired Donation, which runs multihospital exchanges, and Methodist San Antonio, which runs single-center exchanges-to study how the frequency of match-runs impacts the number of transplants and the average waiting times. We simulate the options facing each of the 2 registries by repeated resampling from their historical pools of patient-donor pairs and nondirected donors, with arrival and departure rates corresponding to the historical data. We find that longer intervals between match-runs do not increase the total number of transplants, and that prioritizing highly sensitized patients is more effective than waiting longer between match-runs for transplanting highly sensitized patients. While we do not find that frequent match-runs result in fewer transplanted pairs, we do find that increasing arrival rates of new pairs improves both the fraction of transplanted pairs and waiting times.

KEYWORDS:

donors and donation: paired exchange; economics; ethics and public policy; health services and outcomes research; kidney transplantation/nephrology; organ procurement and allocation

PMID:
29087017
DOI:
10.1111/ajt.14566

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