In September, 2004, the Renal Transplant Oversight Committee of New England approved the establishment of a clearinghouse for kidney exchange, proposed by Drs. Francis Delmonico, Susan Saidman and the authors of thisproposal which lead to the establishment of New England Program for Kidney Exchange (NEPKE) in Summer, 2005. The interaction of the authors with the transplantation community and practical implementation revealed several interesting aspects of kidney exchange. This proposal is on the analysis of the following aspects:
1. The Importance of 3-Way Kidney Exchange: In order to avoid donors opting out from the system once their loved ones receive a transplant, all four operations should be conducted simultaneously in a 2-way kidney exchange. Similarly in a 3-way kidney exchange all six operations should be conducted simultaneously, and so on. Due to this logistical constraint, much attention has been on 2-way exchanges. In Saidman et al (2005), simulations reveal that availability of 3-way exchanges significantly increases the number of patients who receive transplants through exchange whereas the marginal benefit is much smaller when larger exchanges become available. We develop a theory of the importance 3-way kidney exchange.
2. Center Incentives: Expected gains from kidney exchange gets larger as patient-donor pools increase in size. Many transplant centers in the U.S. are in the process of collaborating on kidney exchange. For example NEPKE was established by participation of all fourteen transplant centers in New England. One important hurdle for the system is avoiding individual centers to offer only harder to match pairs to the centralized pool and keep easy to match patient-donor pairs to be matched within the center. The investigators develop a theory of center incentives and design mechanisms to encourage full center participation in kidney exchange.
3. Kidney Exchange with Good Samaritan Donors: Although rare, occasionally a good Samaritan donates a kidney to a kidney patient without expecting a kidney in return. It is important to integrate donations from good Samaritans with kidney exchange. In this way, although each good Samaritan donates only one kidney, he/she can facilitate other transplants which would not be possible in his/her absence. The investigators analyze the model with good Samaritans and simulate the potential gains from integrating good Samaritan donations with kidney exchange.
4. Dynamic Kidney Exchange: The existing theory on kidney exchange, like much of the theory on various matching markets, is static. The practical problem, however, is dynamic. The investeigators develop a dynamic theory on kidney exchange.
Intellectual Merit of The Proposed Activity: The proposed study will contribute to the literature on matching markets and practical mechanism - market design.
Broader Impact: We anticipate some of the findings to influence the organization of kidney exchange in various parts of U.S. including in New England.
