Optimal Decisions for Organ Exchanges in a Kidney Paired Donation Program
Optimal Decisions for Organ Exchanges in a Kidney Paired Donation Program
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DOI：
10.1007/s12561-013-9082-0
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发表时间：
2014-05-01
影响因子：
1
通讯作者：
Kalbfleisch, John D.
中科院分区：
文献类型：
--
作者：
Li, Yijiang;Song, Peter X. -K.;Kalbfleisch, John D.
经济学中的传统易货交换概念在现代已扩展到活体-捐赠者肾脏移植领域，即一对不相容的捐赠者-候选肾与另一对血型互不相容的捐赠者配对，即一对中的捐赠者将器官捐赠给另一对中相容的候选者，反之亦然。肾脏配对捐献(KPD)计划为活体血型不合的供者-候选者对交换器官以实现互利提供了一个独特而重要的平台。在本文中，我们提出了新的器官分配策略来安排不确定情况下的肾脏交换，其优点包括：(I)允许对潜在的肾脏移植进行基于一般效用的评估，并明确考虑KPD计划中固有的随机特征；以及(Ii)当最初计划的分配不能完全执行时，开发可能的替代交换。这一分配策略使用整数规划(IP)公式实现，并通过基于数据的模拟系统通过跟踪一系列比赛运行中不断演变的KPD计划来评估其含义。文中还提供了大量的仿真研究来说明我们提出的方法。
The traditional concept of barter exchange in economics has been extended in the modern era to the area of living-donor kidney transplantation, where one incompatible donor-candidate pair is matched to another pair with a complementary incompatibility, such that the donor from one pair gives an organ to a compatible candidate in the other pair and vice versa. Kidney paired donation ( KPD) programs provide a unique and important platform for living incompatible donor-candidate pairs to exchange organs in order to achieve mutual benefit. In this paper, we propose novel organ allocation strategies to arrange kidney exchanges under uncertainties with advantages, including (i) allowance for a general utility-based evaluation of potential kidney transplants and an explicit consideration of stochastic features inherent in a KPD program; and (ii) exploitation of possible alternative exchanges when the originally planned allocation cannot be fully executed. This allocation strategy is implemented using an integer programming (IP) formulation, and its implication is assessed via a data-based simulation system by tracking an evolving KPD program over a series of match runs. Extensive simulation studies are provided to illustrate our proposed approach.