Mix and match: a strategyproof mechanism for multi-hospital kidney exchange

As kidney exchange programs are growing, manipulation by hospitals becomes more of an issue. Assuming that hospitals wish to maximize the number of their own patients who receive a kidney, they may have an incentive to withhold some of their incompatible donor–patient pairs and match them internally, thus harming social welfare. We study mechanisms for two-way exchanges that are strategyproof, i.e., make it a dominant strategy for hospitals to report all their incompatible pairs. We establish lower bounds on the welfare loss of strategyproof mechanisms, both deterministic and randomized, and propose a randomized mechanism that guarantees at least half of the maximum social welfare in the worst case. Simulations using realistic distributions for blood types and other parameters suggest that in practice our mechanism performs much closer to optimal

Private Pareto Optimal Exchange

We consider the problem of implementing an individually rational, asymptotically Pareto optimal allocation in a barter-exchange economy where agents are endowed with goods and have preferences over the goods of others, but may not use money as a medium of exchange. Because one of the most important instantiations of such economies is kidney exchange -- where the "input"to the problem consists of sensitive patient medical records -- we ask to what extent such exchanges can be carried out while providing formal privacy guarantees to the participants. We show that individually rational allocations cannot achieve any non-trivial approximation to Pareto optimality if carried out under the constraint of differential privacy -- or even the relaxation of \emph{joint} differential privacy, under which it is known that asymptotically optimal allocations can be computed in two-sided markets, where there is a distinction between buyers and sellers and we are concerned only with privacy of the buyers~\citep{Matching}. We therefore consider a further relaxation that we call \emph{marginal} differential privacy -- which promises, informally, that the privacy of every agent $i$ is protected from every other agent $j \neq i$ so long as $j$ does not collude or share allocation information with other agents. We show that, under marginal differential privacy, it is possible to compute an individually rational and asymptotically Pareto optimal allocation in such exchange economies

Kidney Exchange

Most transplanted kidneys are from cadavers, but there are also substantial numbers of transplants from live donors. Recently, there have started to be kidney exchanges involving two donor-patient pairs such that each donor cannot give a kidney to the intended recipient because of immunological incompatibility, but each patient can receive a kidney from the other donor. Exchanges are also made in which a donor-patient pair makes a donation to someone on the queue for a cadaver kidney, in return for the patient in the pair receiving the highest priority for a compatible cadaver kidney when one becomes available. We explore how such exchanges can be arranged efficiently and incentive compatibly. The problem resembles some of the housing' problems studied in the mechanism design literature for indivisible goods, with the novel feature that while live donor kidneys can be assigned simultaneously, the cadaver kidneys must be transplanted immediately upon becoming available. In addition to studying the theoretical properties of the design we propose for a kidney exchange, we present simulation results suggesting that the welfare gains would be substantial, both in increased number of feasible live donation transplants, and in improved match quality of transplanted kidneys.

Kidney Exchange

Most transplanted kidneys are from cadavers, but there are also substantial numbers of transplants from live donors. Recently, there have started to be kidney exchanges involving two donor-patient pairs such that each donor cannot give a kidney to the intended recipient because of immunological incompatibility, but each patient can receive a kidney from the other donor. Exchanges are also made in which a donor- patient pair makes a donation to someone on the queue for a cadaver kidney, in return for the patient in the pair receiving the highest priority for a compatible cadaver kidney when one becomes available. We explore how such exchanges can be arranged efficiently and incentive compatibly. The problem resembles some of the "housing" problems studied in the mechanism design literature for indivisible goods, with the novel feature that while live donor kidneys can be assigned simultaneously, the cadaver kidneys must be transplanted immediately upon becoming available. In addition to studying the theoretical properties of the design we propose for a kidney exchange, we present simulation results suggesting that the welfare gains would be substantial, both in increased number of feasible live donation transplants, and in improved match quality of transplanted kidneys.

Individualized immunosuppression in transplant patients: potential role of pharmacogenetics.

The immunosuppressive drugs used to prevent the rejection of transplanted organs have a narrow therapeutic index. Under treatment results in episodes of rejection leading to either damage or loss of the organ. Over immunosuppression increases the risk of infection and malignancy as well as drug specific complications including diabetes mellitus and nephrotoxicity. There is wide variation in the drug dose required to achieve target blood concentrations and there is often dissociation between pharmacokinetics and pharmacodynamics. Currently, immunosuppressive drug treatment is individualized based on a clinical assessment of the risk of rejection or toxicity. Therapeutic drug monitoring is routinely employed for several immunosuppressive drugs. Pharmacogenetics has the potential to complement therapeutic drug monitoring but clinical benefit has yet to be demonstrated. Novel biomarker-based approaches to risk stratification and pharmacodynamic monitoring are under development and are ready for clinical trials

On-Campus Housing: Theory vs. Experiment

Many universities in the US offer on-campus housing opportunities to incoming as well as already enrolled students. Recent research has theoretically as well as experimentally shown that the most common student assignment mechanism used in the US is subject to serious efficiency losses. In this paper we first show that a particular mechanism which is currently in use at the MIT for about two decades is in fact equivalent to a natural adaptation of the well-known Gale-Shapley mechanism of two-sided matching theory. Motivated from the increasing popularity and success of the Gale-Shapley mechanism in a number of markets, we next experimentally compare the performances of the MIT mechanism with that of the leading theory mechanism Top Trading Cycles. Contrary to theory, the MIT mechanism performs better in terms of efficiency and participation rates, while we observe no significant difference between the two mechanisms in terms of truth-telling rates .