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• Working Paper | 2012

  The Need for (long) Chains in Kidney Exchange

  Itai Ashlagi, David Gamarnik, Michael A. Rees and Alvin E. Roth

  It has been previously shown that for sufficiently large pools of patient-donor pairs, (almost) efficient kidney exchange can be achieved by using at most 3-way cycles, i.e., by using cycles among no more than 3 patient-donor pairs. However, as kidney exchange has grown in practice, cycles among n>3 pairs have proved useful, and long chains initiated by non-directed, altruistic donors have proven to be very effective. We explore why this is the case, both empirically and theoretically. We provide an analytical model of exchange when there are many highly sensitized patients and show that large cycles of exchange or long chains can significantly increase efficiency when the opportunities for exchange are sparse. As very large cycles of exchange cannot be used in practice, long non-simultaneous chains initiated by non-directed donors significantly increase efficiency in patient pools of the size and composition that presently exist. Most importantly, long chains benefit highly sensitized patients without harming low-sensitized patients.

  Citation:

  Ashlagi, Itai, David Gamarnik, Michael A. Rees, and Alvin E. Roth. "The Need for (long) Chains in Kidney Exchange." NBER Working Paper Series, No. 18202, July 2012.

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• Conference Presentation | 13 Oct 2011

  Family Enterprises: Beyond the Three Circles

  John A. Davis, A. Kinkade and J. Richardson

  Keywords: Family Business;

  Citation:

  Davis, John A., A. Kinkade, and J. Richardson. "Family Enterprises: Beyond the Three Circles." Paper presented at the Family Firm Institute Annual Conference, Boston, MA, October 13, 2011.

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• Article | Nephrology, Dialysis, Transplantation | July 2011

  Kidney Paired Donation

  C. Bradley Wallis, Kannan P. Samy, Alvin E. Roth and Michael A. Rees

  Kidney paired donation (KPD) was first suggested in 1986, but it was not until 2000 when the first paired donation transplant was performed in the U.S. In the past decade, KPD has become the fastest growing source of transplantable kidneys, overcoming the barrier faced by living donors deemed incompatible with their intended recipients. This review provides a basic overview of the concepts and challenges faced by KPD as we prepare for a national pilot program with the United Network for Organ Sharing. Several different algorithms have been creatively implemented in the U.S. and elsewhere to transplant paired donors, each method uniquely contributing to the success of KPD. As the paired donor pool grows, the problem of determining allocation strategies that maximize equity and utility will become increasingly important as the transplant community seeks to balance quality and quantity in choosing the best matches. Financing for paired donation is a major issue, as philanthropy alone cannot support the emerging national system. We also discuss the advent of altruistic or non-directed donors in KPD, and the important role of chains in addition to exchanges. This review is designed to provide insight into the challenges that face the emerging national KPD system in the U.S., now five years into its development.

  Keywords: Giving and Philanthropy; Health Care and Treatment; Growth and Development Strategy; Success; Problems and Challenges; Programs; System; United States;

  Citation:

  Wallis, C. Bradley, Kannan P. Samy, Alvin E. Roth, and Michael A. Rees. "Kidney Paired Donation." Nephrology, Dialysis, Transplantation 26, no. 7 (July 2011): 2091–2099.

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