Kidney Exchange
Many end-stage renal disease sufferers who require a kidney transplant to prolong their lives have relatives or associates who have volunteered to donate a kidney to them, but whose kidney is incompatible with their intended recipient. This incompatibility can be sometimes overcome by exchanging kidneys with another incompatible donor pair. Such kidney exchanges have emerged as a standard mode of kidney transplantation in the United States. The Alliance for Paired Donation (APD) developed and implemented an innovative operations research based methodology of non-simultaneous extended altruistic donor (NEAD) chains, which, by allowing a previously binding constraint (of simultaneity) to be relaxed, allowed better optimized matching of potential donors to patients, which greatly increases the number of possible transplants. Since 2006, the APD has saved more than 220 lives through its kidney exchange program, with more than 75% of these achieved through long non-simultaneous chains. The technology and methods pioneered by APD have been adopted by other transplant exchanges, resulting in thousands of lives already saved, with the promise of increasing impact in coming years. The percentage of transplants from non-simultaneous chains has already reached more than 6% of the total number of transplants from live donors (including directed living donors) in the last year. We describe the long-term optimization and market design research that supports this innovation. We also describe how the team of physicians and operations researchers worked to overcome the skepticism and resistance of the medical community to the NEAD innovation.
