Long term simulation analysis of deceased donor initiated chains in kidney exchange programs

ABSTRACT

Kidney exchange programs (KEPs) aim to find compatible kidneys for recipients with incompatible donors. Patients without a living donor depend upon deceased donor (DD) donations to get a kidney transplant. In India, a ©DD donates kidneys directly to a©DD wait-list. The idea of initiating an exchange chain starting from a ©DD kidney is proposed in a few articles (and executed in Italy in 2018), but no mathematical formulation has been given for this merger. We have introduced an integer programming formulation that creates ©DD-initiated chains, considering both paired exchange registry and ©DD allocations simultaneously and addressing the overlap issue between the exchange registry and ©DD wait-list as recipients can register for both registries independently. A long-term simulation study is done to ©analyse the gain of these DD-initiated chains over time. It suggests that even with small numbers of ©DDs, these chains can significantly increase potential transplants.

KEYWORDS:

• Health care management
• kidney exchange program
• deceased donor allocation
• integer programming model
• simulation

Acknowledgments

We would like to acknowledge Zonal Transplant Co-ordination Centre (ZTCC), Mumbai, for their feedback and data distributions.

Disclaimer

Only the blood group data number of the wait-listed patients has been shared by ZTCC, and the contents are not verified or ratified by that ZTCC.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article [and/or] its supplementary materials.

Code availability

The code that supports the findings of this study is available fr–om the corresponding author upon request.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.