Pairwise Kidney Exchange

Abstract

The theoretical literature on exchange of indivisible goods finds natural application in organizing the exchange of live donor kidneys for transplant. However, in kidney exchange, there are constraints on the size of feasible exchanges. Initially, kidney exchanges are likely to be pairwise exchanges, between just two patient-donor pairs, as these are logistically simpler than larger exchanges. Furthermore, the experience of many American surgeons suggests to them that preferences over kidneys are approximately 0-1, i.e. that patients and surgeons should be largely indifferent among healthy donors whose kidneys are compatible with the patient. This is because, in the United States, transplants of compatible live kidneys have about equal graft survival probabilities, regardless of the closeness of tissue types between patient and donor. We show that, although the pairwise constraint eliminates some potential exchanges, there is a wide class of constrained-efficient mechanisms that are strategy-proof when patient-donor pairs and surgeons have 0-1 preferences. This class of mechanisms includes deterministic mechanisms that would accomodate the kinds of priority setting that organ banks currently use to allocate cadaver organs, as well as stochastic mechanisms that allow distributive justice issues to be