There are a big variety of procedures used for kidney exchange in Europe. Here are a set of simulations meant to explore their effects.
Druzsin, Kristóf, Péter Biró, Xenia Klimentova, and Rita Fleiner. "Performance evaluation of national and international kidney exchange programmes with the ENCKEP simulator." Central European Journal of Operations Research (2024): 1-21.
"we are aware of four international KEPs running worldwide:
Czech-Austrian-Israeli collaboration,
KEPSAT involving Italy, Portugal, Spain,
STEP, run by Scandiatransplant,
NZKX by Australia and New Zealand.
One of the main aspects that can differ in between international KEPs is collaboration polices. In KEPSAT each of the three countries conducts a national matching run first, and only after that they seek for international cycles in the remaining pools. The other three international KEPs merge their pools and conduct one single matching run."
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Not surprisingly, maximizing domestic kidney exchange first leaves only hard to match pairs, which limits the effectiveness of international cooperation. A 2023 paper from Portugal reports that, since 2017, only three Portuguese pairs were matched in the KEPSAT program with Spain and Italy.
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