Monday, November 13, 2017

How often should a kidney exchange network run matches? (Often, it turns out...)

Forthcoming in the American Journal of Transplantation:

The effect of match-run frequencies on the number of transplants and waiting times in kidney exchange

Authors

  • This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/ajt.14566


Abstract

Numerous kidney exchange (kidney paired donor (KPD)) registries in the U.S have gradually shifted to high frequency match-runs, raising the question of whether this harms the number of transplants. We conduct simulations using clinical data from two KPD registries—the Alliance for Paired Donation, which runs multi-hospital exchanges, and Methodist San Antonio, which runs single center exchanges–to study how the frequency of match-runs impacts the number of transplants and the average waiting times. We simulate the options facing each of the two registries by repeated resampling from their historical pools of patient-donor pairs and non-directed donors, with arrival and departure rates corresponding to the historical data. We find that longer intervals between match-runs do not increase the total number of transplants, and that prioritizing highly sensitized patients is more effective than waiting longer between match-runs for transplanting highly sensitized patients. While we do not find that frequent match-runs result in fewer transplanted pairs we do find that increasing arrival rates of new pairs improves both the fraction of transplanted pairs and waiting times.

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