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Primum Non Nocere: Avoiding Harm to Vulnerable Wait List Candidates in an Indirect Kidney Exchange

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  • Zenios, Stefanos

    (Stanford U)

  • Woodle, E. Steve

    (U of Cincinnati)

  • Ross, Lainie Friedman

    (U of Chicago)

Abstract

Background: One proposal to increase kidney transplantation is to exchange kidneys between pairs of ABO-incompatible (or crossmatch -incompatible) living donors and their recipients. One variation that has greater potential exchanges living donor kidneys for cadaveric donor kidneys (indirect exchanges). A primary concern with indirect exchanges is the potential to disadvantage blood group O wait list candidates. Using wait list modeling, we examine whether this proposal would disadvantage cadaveric kidney blood group O wait list candidates, and present an approach for minimizing these negative effects. Methods: A probability model estimated the total number and blood type frequencies of donor-recipient pairs that would participate in indirect exchanges. A supply-to-demand model for the cadaveric kidney wait list estimated the mean wait time under different allocation policies and donor selection mechanisms for candidates on the wait list classified according to the candidates' race and blood type. Results: Indirect exchanges will reduce the mean wait time for cadaveric kidney wait list candidates. The mean wait time of blood group O cadaveric kidney wait list candidates increases when the participating living donors self-select and when kidney allocation is determined by efficiency. This is neutralized when the transplant team preferentially selects blood group O living donors and cadaveric kidney allocation is determined by need. Conclusion: Indirect exchange programs will significantly shorten the wait times for cadaveric kidney wait list candidates. The wait times of blood group O candidates will not be affected adversely if blood group O living donors are selected preferentially and if allocation is based on need.

Suggested Citation

  • Zenios, Stefanos & Woodle, E. Steve & Ross, Lainie Friedman, 2001. "Primum Non Nocere: Avoiding Harm to Vulnerable Wait List Candidates in an Indirect Kidney Exchange," Research Papers 1684, Stanford University, Graduate School of Business.
    • Handle: RePEc:ecl:stabus:1684
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    Citations

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    Cited by:

    1. Alvin E. Roth & Tayfun Sönmez & M. Utku Ünver, 2005. "Efficient Kidney Exchange: Coincidence of Wants in a Structured Market," Boston College Working Papers in Economics 621, Boston College Department of Economics.
    2. Alvin E. Roth & Tayfun Sönmez & M. Utku Ünver, 2004. "Kidney Exchange," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 119(2), pages 457-488.
    3. Yu Wang & Aradhna Krishna, 2006. "Timeshare Exchange Mechanisms," Management Science, INFORMS, vol. 52(8), pages 1223-1237, August.
    4. Sönmez, Tayfun & Ünver, M. Utku, 2014. "Altruistically unbalanced kidney exchange," Journal of Economic Theory, Elsevier, vol. 152(C), pages 105-129.
    5. Roth, Alvin E. & Sonmez, Tayfun & Utku Unver, M., 2005. "Pairwise kidney exchange," Journal of Economic Theory, Elsevier, vol. 125(2), pages 151-188, December.
    6. Cheng, Yao & Yang, Zaifu, 2021. "Efficient Kidney Exchange with Dichotomous Preferences," Journal of Health Economics, Elsevier, vol. 80(C).
    7. Saidman, Susan L. & Roth, Alvin E. & Sonmez, Tayfun & Unver, M. Utku & Delmonico, Francis L., 2014. "Increasing the Opportunity of Live Kidney Donation by Matching for Two and Three Way Exchanges," MPRA Paper 58247, University Library of Munich, Germany.
    8. Silvia Villa & Fioravante Patrone, 2009. "Incentive compatibility in kidney exchange problems," Health Care Management Science, Springer, vol. 12(4), pages 351-362, December.
    9. Itai Ashlagi & Alvin E. Roth, 2021. "Kidney Exchange: An Operations Perspective," Management Science, INFORMS, vol. 67(9), pages 5455-5478, September.
    10. Toulis, Panos & Parkes, David C., 2015. "Design and analysis of multi-hospital kidney exchange mechanisms using random graphs," Games and Economic Behavior, Elsevier, vol. 91(C), pages 360-382.
    11. Monica Salvioli & Roberto Lucchetti & Rosanna Torelli, 2016. "Simulating the Impact of Crossover Kidney Transplantation on the Nord Italia Transplant Program," Games, MDPI, vol. 7(4), pages 1-9, October.
    12. Sönmez, Tayfun & Ünver, M. Utku & Yılmaz, Özgür, 2018. "How (not) to integrate blood subtyping technology to kidney exchange," Journal of Economic Theory, Elsevier, vol. 176(C), pages 193-231.
    13. Roth, Alvin E. & Sonmez, Tayfun & Unver, Utku & Delmonico, Francis & Saidman, Susan L., 2014. "Utilizing List Exchange and Non-directed Donation through “Chain” Paired Kidney Donations," MPRA Paper 58246, University Library of Munich, Germany.
    14. 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.
    15. Tayfun Sönmez & Alvin E. Roth & M. Utku Ünver, 2007. "Efficient Kidney Exchange: Coincidence of Wants in Markets with Compatibility-Based Preferences," American Economic Review, American Economic Association, vol. 97(3), pages 828-851, June.
    16. Itai Ashlagi & Alvin E. Roth, 2011. "Individual Rationality and Participation in Large Scale, Multi-Hospital Kidney Exchange," NBER Working Papers 16720, National Bureau of Economic Research, Inc.
    17. Tayfun Sönmez & M. Utku Ünver, 2006. "Kidney Exchange with Good Samaritan Donors: A Characterization," Boston College Working Papers in Economics 640, Boston College Department of Economics.
    18. Morrill, Thayer, 2010. "The roommates problem revisited," Journal of Economic Theory, Elsevier, vol. 145(5), pages 1739-1756, September.
    19. Stefanos A. Zenios, 2002. "Optimal Control of a Paired-Kidney Exchange Program," Management Science, INFORMS, vol. 48(3), pages 328-342, March.

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