Valuing Prearranged Paired Kidney Exchanges: A Stochastic Game Approach
AbstractEnd-stage renal disease (ESRD) is the ninth-leading cause of death in the U.S. Transplantation is the most viable renal replacement therapy for ESRD patients, but there is a severe disparity between the demand for kidneys for transplantation and the supply. This shortage is further complicated by incompatibilities in blood-type and antigen matching between patient-donor pairs. Paired kidney exchange (PKE), a cross-exchange of kidneys among incompatible patient-donor pairs, overcomes many difficulties in matching patients with incompatible donors. In a typical PKE, transplantation surgeries take place simultaneously so that no donor may renege after her intended recipient receives the kidney. Therefore, in a PKE, the occurrence of a transplantation requires compatibility among the pairs' willingnesses to exchange. We consider an arbitrary number of autonomous patients with probabilistically evolving health statuses in a prearranged PKE, and model their transplant timing decisions as a discrete-time non-zero-sum noncooperative stochastic game. We explore necessary and sufficient conditions for patients' decisions to be a stationary-perfect equilibrium, and formulate a mixed-integer linear programming representation of equilibrium constraints, which provides a characterization of the socially optimal stationary-perfect equilibria. We carefully calibrate our model using a large scale nationally representative clinical data, and empirically confirm that randomized strategies, which are less consistent with clinical practice and rationality of the patients, do not yield a significant social welfare gain over pure strategies. We also quantify the social welfare loss due to patient autonomy and demonstrate that maximizing the number of transplants may be undesirable. Our results highlight the importance of the timing of an exchange and the disease severity on matching patient-donor pairs.
Download InfoTo our knowledge, this item is not available for download. To find whether it is available, there are three options:
1. Check below under "Related research" whether another version of this item is available online.
2. Check on the provider's web page whether it is in fact available.
3. Perform a search for a similarly titled item that would be available.
Bibliographic InfoPaper provided by Boston College Department of Economics in its series Boston College Working Papers in Economics with number 785.
Date of creation: 10 Oct 2011
Date of revision: 14 Oct 2011
Contact details of provider:
Postal: Boston College, 140 Commonwealth Avenue, Chestnut Hill MA 02467 USA
Web page: http://fmwww.bc.edu/EC/
More information through EDIRC
medical decision making; paired kidney exchange; game theory; Markov decision processes; integer programming;
Find related papers by JEL classification:
- C78 - Mathematical and Quantitative Methods - - Game Theory and Bargaining Theory - - - Bargaining Theory; Matching Theory
- I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
This paper has been announced in the following NEP Reports:
- NEP-ALL-2011-10-22 (All new papers)
- NEP-CIS-2011-10-22 (Confederation of Independent States)
- NEP-GTH-2011-10-22 (Game Theory)
- NEP-HEA-2011-10-22 (Health Economics)
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- Alvin E. Roth & Tayfun Sönmez & M. Utku Ünver, 2004.
The Quarterly Journal of Economics,
MIT Press, vol. 119(2), pages 457-488, May.
- Alvin E. Roth & Tayfun Sonmez & M. Utku Unver, 2003. "Kidney Exchange," Game Theory and Information 0308002, EconWPA.
- Roth, Alvin & Ãœnver, M. Utku & SÃ¶nmez, Tayfun, 2004. "Kidney Exchange," Scholarly Articles 2580565, Harvard University Department of Economics.
- Alvin E. Roth & Tayfun Sonmez & M. Utku Unver, 2003. "Kidney Exchange," NBER Working Papers 10002, National Bureau of Economic Research, Inc.
- Alvin E. Roth & Tayfun Sonmez & M. Utku Unver, 2004.
"Pairwise Kidney Exchange,"
NBER Working Papers
10698, National Bureau of Economic Research, Inc.
- Alvin E. Roth & Tayfun Sonmez & M. Utku Unver, 2004. "Pairwise Kidney Exchange," Levine's Bibliography 122247000000000350, UCLA Department of Economics.
- Alvin E. Roth & Tayfun Sönmez & M. Utku Ünver, 2004. "Pairwise Kidney Exchange," Game Theory and Information 0408001, EconWPA, revised 16 Feb 2005.
- Alvin E. Roth & Tayfun Sönmez & M. Utku Ünver, 2004. "Pairwise Kidney Exchange," Boston College Working Papers in Economics 620, Boston College Department of Economics.
- Herings,P. Jean-Jacques & Peeters,Ronald J.A.P, 2000.
"Stationary Equilibria in Stochastic Games: Structure, Selection, and Computation,"
004, Maastricht University, Maastricht Research School of Economics of Technology and Organization (METEOR).
- Herings, P. Jean-Jacques & Peeters, Ronald J. A. P., 2004. "Stationary equilibria in stochastic games: structure, selection, and computation," Journal of Economic Theory, Elsevier, vol. 118(1), pages 32-60, September.
- Herings,P. Jean-Jacques & Peeters,Ronald J.A.P, 2000. "Stationary Equilibria in Stochastic Games: Structure, Selection, and Computation," Research Memoranda 004, Maastricht : METEOR, Maastricht Research School of Economics of Technology and Organization.
- Howard, David H., 2002. "Why do transplant surgeons turn down organs?: A model of the accept/reject decision," Journal of Health Economics, Elsevier, vol. 21(6), pages 957-969, November.
- Xuanming Su & Stefanos Zenios, 2004. "Patient Choice in Kidney Allocation: The Role of the Queueing Discipline," Manufacturing & Service Operations Management, INFORMS, vol. 6(4), pages 280-301, June.
- M. Utku �nver, 2010. "Dynamic Kidney Exchange," Review of Economic Studies, Oxford University Press, vol. 77(1), pages 372-414.
- Stefanos A. Zenios, 2002. "Optimal Control of a Paired-Kidney Exchange Program," Management Science, INFORMS, vol. 48(3), pages 328-342, March.
- Pakes, Ariel & McGuire, Paul, 2001. "Stochastic Algorithms, Symmetric Markov Perfect Equilibrium, and the 'Curse' of Dimensionality," Econometrica, Econometric Society, vol. 69(5), pages 1261-81, September.
- Jae-Hyeon Ahn & John C. Hornberger, 1996. "Involving Patients in the Cadaveric Kidney Transplant Allocation Process: A Decision-Theoretic Perspective," Management Science, INFORMS, vol. 42(5), pages 629-641, May.
- Oguzhan Alagoz & Lisa M. Maillart & Andrew J. Schaefer & Mark S. Roberts, 2007. "Choosing Among Living-Donor and Cadaveric Livers," Management Science, INFORMS, vol. 53(11), pages 1702-1715, November.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Christopher F Baum).
If references are entirely missing, you can add them using this form.