Advanced Search
MyIDEAS: Login to save this article or follow this journal

Optimal Control of a Paired-Kidney Exchange Program

Contents:

Author Info

  • Stefanos A. Zenios

    ()
    (Graduate School of Business, Stanford University, Stanford, California 94305)

Registered author(s):

    Abstract

    Organ exchanges are expected to increase the utilization of living donors and to alleviate the critical shortage of organs for transplantation. The typical arrangement involves a direct exchange between two blood-type incompatible donor-candidate pairs. An alternate possibility is an indirect exchange between one such pair and the highest priority candidate on the regular waiting list for cadaveric organs. This paper focuses on the mix of direct and indirect exchanges that maximizes the expected total discounted quality-adjusted life years (QALY) of the candidates in the participating pairs. Direct exchanges are preferable because the candidate receives a living-donor organ instead of the inferior cadaveric organ an indirect exchange provides. However, the latter involves a shorter wait. To capture this tradeoff, we develop a double-ended queueing model for an exchange system with two types of donorcandidate pairs, and obtain an optimal dynamic exchange policy by invoking a Brownian approximation. The policy takes the form of a two-sided regulator in which new pairs will join the exchange system to wait for a direct exchange if and only if the process modeling the exchange system is within the regulator's two barriers. In all other circumstances, new pairs will participate in an indirect exchange. Expressions for the optimal barriers are obtained under a variety of assumptions about the objective function, including one of complete candidate autonomy. The analysis identifies three design principles that will amplify the likelihood of an exchange program's success. First, exchange programs must involve the coordinated activities of multiple local transplant centers to enjoy the substantial benefits of resource pooling. Second, participant wait must be controlled through indirect exchanges. Third, the program must respect participants' autonomy and weigh that autonomy against the broader goal of maximizing their overall welfare.

    Download Info

    If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
    File URL: http://dx.doi.org/10.1287/mnsc.48.3.328.7732
    Download Restriction: no

    Bibliographic Info

    Article provided by INFORMS in its journal Management Science.

    Volume (Year): 48 (2002)
    Issue (Month): 3 (March)
    Pages: 328-342

    as in new window
    Handle: RePEc:inm:ormnsc:v:48:y:2002:i:3:p:328-342

    Contact details of provider:
    Postal: 7240 Parkway Drive, Suite 300, Hanover, MD 21076 USA
    Phone: +1-443-757-3500
    Fax: 443-757-3515
    Email:
    Web page: http://www.informs.org/
    More information through EDIRC

    Related research

    Keywords: Kidney transplantation; Organ exchange; Patient autonomy; Double-ended queues; Brownian approximations;

    References

    No references listed on IDEAS
    You can help add them by filling out this form.

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as in new window

    Cited by:
    1. Marc Bollecker & Wilfrid Azan, 2008. "Les frontières de la recherche en contrôle de gestion : une analyse des cadres théoriques mobilisés," Post-Print halshs-00522395, HAL.
    2. Constantino, Miguel & Klimentova, Xenia & Viana, Ana & Rais, Abdur, 2013. "New insights on integer-programming models for the kidney exchange problem," European Journal of Operational Research, Elsevier, vol. 231(1), pages 57-68.
    3. Caulkins, Jonathan P., 2010. "Might randomization in queue discipline be useful when waiting cost is a concave function of waiting time?," Socio-Economic Planning Sciences, Elsevier, vol. 44(1), pages 19-24, March.
    4. Antonio Nicolò & Carmelo Rodríguez-Álvarez, 2013. "Age based preferences in paired kidney exchange," Documentos de Trabajo del ICAE 2013-38, Universidad Complutense de Madrid, Facultad de Ciencias Económicas y Empresariales, Instituto Complutense de Análisis Económico.
    5. Murat Kurt & Mark S. Roberts & Andrew J. Schaefer & M. Utku Ünver, 2011. "Valuing Prearranged Paired Kidney Exchanges: A Stochastic Game Approach," Boston College Working Papers in Economics 785, Boston College Department of Economics, revised 14 Oct 2011.
    6. Alvin E. Roth & Tayfun Sönmez & M. Utku Ünver, 2004. "Pairwise Kidney Exchange," Game Theory and Information 0408001, EconWPA, revised 16 Feb 2005.
    7. Tayfun Sönmez & M. Utku Ünver, 2009. "Matching, Allocation, and Exchange of Discrete Resources," Boston College Working Papers in Economics 717, Boston College Department of Economics.

    Lists

    This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

    Statistics

    Access and download statistics

    Corrections

    When requesting a correction, please mention this item's handle: RePEc:inm:ormnsc:v:48:y:2002:i:3:p:328-342. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Mirko Janc).

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If references are entirely missing, you can add them using this form.

    If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.