Sunday, May 19, 5:45 - 6:15 pm
|Nobel laureate Alvin E. Roth, PhD, will discuss the economics of kidney exchange when he delivers the Keynote Lecture.|
"This lecture will be an opportunity to offer an economist's perspective to a community of clinicians, surgeons and other health professionals, and explain what I see as some of the issues involved in implementing kidney exchange effectively," he said. "As an economist, I study how exchanges can be organized, and there is a great deal that has been, and can be, done to help organize kidney exchange."
The issues of organization emerge at different levels — within a transplant center, within a kidney exchange network, in collaboration among kidney exchange networks and in the development of national policy for kidney exchange. While much of the conversation focuses on what kinds of kidneys are suitable for the different patients needing transplantation, Dr. Roth said, attention also needs to be paid to how to make kidney exchange work well for transplant centers so that it can continue to grow.
Dr. Roth comes to the lecture with decades of contributions in game theory, market design and experimental economics, and in applying economic theory to solutions for real-world problems. He ventured into the real-world problem of kidney exchange when he and economist colleagues wrote a National Bureau of Economic Research paper "Kidney Exchange," which was ultimately published in the May 2, 2004, edition of the Quarterly Journal of Economics. They corresponded with transplant surgeon luminary Francis L. Delmonico, MD, and immunologist Susan L. Saidman, PhD, of Massachusetts General Hospital, Boston, and ultimately collaborated in forming the New England Program for Kidney Exchange (NEPKE) in 2005. Dr. Roth also worked with transplant surgeon E. Steve Woodle, MD, urologist Michael A. Rees, MD, and colleagues in developing the Paired Donation Consortium in Ohio and the Alliance for Paired Donation.
Currently, Dr. Roth is the Craig and Susan McCaw Professor of Economics at Stanford University and the George Gund Professor of Economics and Business Administration Emeritus at Harvard University. He was awarded the Nobel Memorial Prize in Economic Sciences jointly with Lloyd Shapley for his work on the theory of stable allocations and the practice of market design.
Transplant surgeons and economists are joining forces to implement efficient, effective paired kidney donation exchange systems. Learn how economics plays a role in this endeavor when Nobel laureate Alvin E. Roth, PhD, speaks about "Kidney Exchange: An Economist's Perspective" during the Keynote Lecture at 5:45 pm today in Room 6E. He won the Nobel Memorial Prize in Economic Sciences jointly with Lloyd Shapley, PhD, in 2012 for his work on the theory of stable allocations and the practice of market design.
"Organized kidney exchange clearinghouses arose out of collaborations between transplant professionals interested in improving patient care by expanding the number of transplants, and economists interested in market design. Transplant institutions have their different interests and ways of looking at patient care, and treating people with end-stage renal disease is a multi-billion dollar industry in the United States, so it's not surprising to find that sometimes complicated economic interests are also at play," said Dr. Roth, the Craig and Susan McCaw Professor of Economics at Stanford University and the George Gund Professor of Economics and Business Administration Emeritus at Harvard University.
Exploring how those economic and medical institution interests can interact will help all parties involved determine how to move forward, Dr. Roth said. Kidney exchange will require innovations in how to arrange, coordinate and conduct surgeries, and in how to assemble and organize efficient clearinghouses. Therefore, paired kidney exchange is a natural area of collaboration between surgeons and economists.
Issues of organization entail the various levels of kidney exchange, he noted. Within a single transplant center, the question is how to organize surgeries to obtain the most suitable transplants for the most patients. At the next level, there is the question of how different transplant centers can coordinate with one another in a kidney exchange network. And then there are questions about how different kidney exchange networks function and interact with each other. Thus questions about organizing kidney exchange nationally are often at least partly about economics.
A recent challenge is that many transplant centers now have enough experience with kidney exchange to conduct their own exchanges internally among their patient-donor pairs. The unintended result, Dr. Roth said, is that kidney exchange pools now consist increasingly of highly sensitized patients. One response to an over-representation of highly sensitized patients is the development of long non-simultaneous, non-directed donor chains to match compatible kidneys for these patients.
"We have to figure out ways to get more of the easy-to-match pairs into pools where they can be matched with harder-to-match pairs," he said. "Suppose you have many highly sensitized patients, and when you find a compatible kidney from an incompatible pair that would work for another pair, it's unlikely the receiving pair can donate a kidney back. That's why chains are particularly important for highly sensitized patients. Long non-directed donor chains are beneficial to the most highly sensitized patients. Transplant centers can exchange paired kidney donations on a national level and still perform the surgeries in their own centers."
What can transplant surgeons, clinicians and allied health professionals do? Attend Dr. Roth's lecture, understand the benefits of kidney exchange and contribute to growing it. Transplant professionals and economists alike are still working out how to make kidney exchange work well for patients, donors and transplant centers.
"Working those things out will make it easier for transplant centers to enroll their patients and donors," Dr. Roth said. "There are gains to achieve through collaboration among transplant professionals with different kinds of expertise. It is a great privilege as an economist to be able to contribute to this endeavor. It is good that transplant professionals interested in kidney exchange have been able to look outside of what is known just in the surgical community to bring in other kinds of help. It is good for us as economists that we are able to obtain these insights from surgical experts so that we can assist them."