Paired and altruistic kidney donation in the UK: Algorithms and experimentation

We study the computational problem of identifying optimal sets of kidney exchanges in the UK. We show how to expand an integer programming-based formulation due to Roth et al. [2007] in order to model the criteria that constitute the UK definition of optimality. The software arising from this work has been used by the National Health Service Blood and Transplant to find optimal sets of kidney exchanges for their National Living Donor Kidney Sharing Schemes since July 2008. We report on the characteristics of the solutions that have been obtained in matching runs of the scheme since this time. We then present empirical results arising from experiments on the real datasets that stem from these matching runs, with the aim of establishing the extent to which the particular optimality criteria that are present in the UK influence the structure of the solutions that are ultimately computed. A key observation is that allowing four-way exchanges would be likely to lead to a moderate number of additional transplants

Paired and altruistic kidney donation in the UK: algorithms and experimentation

We study the computational problem of identifying optimal sets of kidney exchanges in the UK. We show how to expand an integer programming-based formulation [1, 19] in order to model the criteria that constitute the UK definition of optimality. The software arising from this work has been used by the National Health Service Blood and Transplant to find optimal sets of kidney exchanges for their National Living Donor Kidney Sharing Schemes since July 2008.We report on the characteristics of the solutions that have been obtained in matching runs of the scheme since this time. We then present empirical results arising from the real datasets that stem from these matching runs, with the aim of establishing the extent to which the particular optimality criteria that are present in the UK influence the structure of the solutions that are ultimately computed. A key observation is that allowing 4-way exchanges would be likely to lead to a significant number of additional transplants

Beyond Gift and Bargain: Some Suggestions for Increasing Kidney Exchanges

Each year, thousands of people in the United States die from end stage renal disease (ESRD), despite the fact that we have the medical knowledge necessary to save them. The reason is simple: these people need a kidney transplant and we have too few kidneys. Given our current technology, the only way to meet the massive annual shortfall between the number of kidneys that are donated and the number of kidneys that are necessary to save the lives of those with ESRD is to increase the number of living donations. The debate on how to do so has often pitted those who favor creating a “free market” in human organs against those who believe that the selling of organs by human donors poses unacceptable evils and risks. Current law prohibits donors from being paid for kidneys. Once the donation has been made, however, the kidney will often change hands in exchange for money several times before reaching the patient. There are no serious proposals to ban such transactions. This article generally sympathizes with those who favor the free alienation of kidneys by donors in exchange for payment. The goal of this article, however, is not to make another charge across the no man’s land separating free-marketeers from prohibitionists. Rather, it aims to explore ways in which we can increase trust in order to foster a promising new development in transplant medicine: extended kidney exchange

How operational research helps kidney patients in the UK

No abstract available

Pairwise Kidney Exchange over the Blood Group Barrier

Advances in medical technology have made kidney transplants over the blood group barrier feasible. This paper investigates how such technology should be implemented when designing pairwise kidney exchange programs. The possibility to receive a kidney transplant from a blood group incompatible donor motivates an extension of the preference domain, allowing patients to distinguish between compatible donors and half-compatible donors (i.e., blood group incompatible donors that only become compatible after undergoing an immunosuppressive treatment). It is demonstrated that the number of transplants can be substantially increased by providing an incentive for patients with half-compatible donors to participate in kidney exchange programs. The results also suggest that the technology is beneficial for patient groups that are traditionally disadvantaged in kidney exchange programs (e.g., blood group O patients). The positive effect of allowing transplants over the blood group barrier is larger than the corresponding effects of including altruistic patient-donor pairs or of allowing three-way exchanges in addition to pairwise exchanges

If you can’t sell your kidney, can you trade it? Examining the morality of alternative kidney exchange institutions

In the absence of kidney markets, alternative institutions for exchanging kidneys have arisen to give donors incentives to donate. I examine thirteen such institutions, and ask whether moral arguments against markets, such as commodification, apply to them or not. I find that most arguments against kidney arguments also argue against these alternative institutions, meaning those arguments are not strong enough to prevent society from using institutions to exchange kidneys. Two arguments that do explain which kidney exchange institutions are socially accepted and which are not are that institutions should not be want-regarding and should not be exploitative.Screening donors to eliminate those with socially unacceptable motives for donation and those who are in a position of being exploited could make kidney markets acceptable, since they would then only be vulnerable to arguments which have not prevented alternative exchange institutions from functioning

Reverse Transplant Tourism

In this article, we propose a novel form of kidney swap, which we label “Reverse Transplant Tourism.” This proposal has the potential to increase the number of successful transplants in the US at a time of great need, while reducing costs. It also will provide benefits to impoverished international patients with willing, compatible donors who otherwise would have no access to transplantation. Instead of non-US kidney donors being offered money through a black market middleman in exchange for one of their kidneys, Reverse Transplant Tourism would provide a legal and ethical exchange of living donor kidneys through kidney-paired donation. In this way, the donors will not receive money for their kidneys, but rather will receive a transplant for someone they love, while also helping a US pair who would otherwise be unable to transplant due to biological incompatibility

Better the donor you know?:A qualitative study of renal patients' views on ‘altruistic’ live-donor kidney transplantation

AbstractBackgroundIn the UK there is a short-fall between individuals requiring a renal transplant and kidneys available for transplantation. Non-directed ‘altruistic’ living kidney donation has emerged as a strategy for bridging this gap between supply and demand, with the number increasing each year.ObjectiveThis study aimed to explore the views of potential recipients towards non-directed ‘altruistic’ live-donor kidney transplantation.MethodsSemi-structured interviews with 32 UK deceased-donor kidney transplant recipients were performed. Interviews explored willingness to consider directed and non-directed live-donor kidney transplants (LDKTs). Interviews were recorded, transcribed verbatim and transcripts were analysed using the constant comparison method described in Grounded Theory.ResultsFor those not willing to accept a non-directed ‘altruistic’ LDKT, the following themes were identified: i) Prioritising other recipients above self; ii) Fear of acquiring an unknown donor's characteristics, and iii) Concern for the donor – unnecessary risk. For those willing to accept a non-directed ‘altruistic’ LDKT the following themes were identified: iv) Prioritising known above unknown persons, v) Belief that they are as deserving as other potential recipients, and vi) Advantages of a LDKT.ConclusionsDrawing on ‘gift exchange theory’, this study contributes to our understanding of the experience of the intended recipient of a gift. The anonymity of the donor-recipient appears to be seen as a benefit of non-directed ‘altruistic’ live-donor transplants, freeing recipients from the obligations of the gift. However, those who feel unworthy of the ‘gifted transplant’ are concerned about the donor and by the lack of opportunity for direct reciprocity. Highlighting the ‘reciprocal benefits’ reported by donors may allow individuals whose preference is a live-donor transplant to accept one if offered. These insights provide the transplant community with targets for intervention, through which the concerns of potential recipients might be addressed

Contract Development In A Matching Market: The Case of Kidney Exchange

We analyze a new transplant innovation — Advanced Donation, referred to by some as a kidney “gift certificate,” “layaway plan,” or “voucher — as a case study offering insights on both market and contract development. Advanced Donation provides an unusual window into the evolution of the exchange of a single good — a kidney for transplantation — from gift, to simple barter, to exchange with a temporal separation of obligations that relies solely on trust and reputational constraints for enforcement, to a complex matching market in which the parties rely, at least in part, on formal contract to define and clarify their obligations to each other. The transplant community, however, has historically viewed formal contracts in the transplant setting with discomfort, and that traditional discomfort remains evident in current Advanced Donation practice. We conclude that the use of formal contracts in Advanced Donation is likely inadvertent, and the contracts, in a number of ways, are inadequate to tackle the complex, nonsimultaneous exchange of kidneys in which patients donate a kidney before their intended recipients have been matched with a potential donor