Collaborative Research: Kidney Exchange

合作研究：肾脏交换

• 批准号: 0616689
• 负责人: M. Utku Unver
• 金额: $ 6.99万
• 依托单位: University of Pittsburgh
• 依托单位国家: 美国
• 项目类别: Continuing Grant
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-08-01 至 2008-07-31
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=0616689&HistoricalAwards=false
• 关键词: Collaborative; Research; Kidney; Exchange

In September, 2004, the Renal Transplant Oversight Committee of New England approved the establishment of a clearinghouse for kidney exchange, proposed by Drs. Francis Delmonico, Susan Saidman and the authors of thisproposal which lead to the establishment of New England Program for Kidney Exchange (NEPKE) in Summer, 2005. The interaction of the authors with the transplantation community and practical implementation revealed several interesting aspects of kidney exchange. This proposal is on the analysis of the following aspects:1. The Importance of 3-Way Kidney Exchange: In order to avoid donors opting out from the system once their loved ones receive a transplant, all four operations should be conducted simultaneously in a 2-way kidney exchange. Similarly in a 3-way kidney exchange all six operations should be conducted simultaneously, and so on. Due to this logistical constraint, much attention has been on 2-way exchanges. In Saidman et al (2005), simulations reveal that availability of 3-way exchanges significantly increases the number of patients who receive transplants through exchange whereas the marginal benefit is much smaller when larger exchanges become available. We develop a theory of the importance 3-way kidney exchange.2. Center Incentives: Expected gains from kidney exchange gets larger as patient-donor pools increase in size. Many transplant centers in the U.S. are in the process of collaborating on kidney exchange. For example NEPKE was established by participation of all fourteen transplant centers in New England. One important hurdle for the system is avoiding individual centers to offer only harder to match pairs to the centralized pool and keep easy to match patient-donor pairs to be matched within the center. The investigators develop a theory of center incentives and design mechanisms to encourage full center participation in kidney exchange.3. Kidney Exchange with Good Samaritan Donors: Although rare, occasionally a good Samaritan donates a kidney to a kidney patient without expecting a kidney in return. It is important to integrate donations from good Samaritans with kidney exchange. In this way, although each good Samaritan donates only one kidney, he/she can facilitate other transplants which would not be possible in his/her absence. The investigators analyze the model with good Samaritans and simulate the potential gains from integrating good Samaritan donations with kidney exchange.4. Dynamic Kidney Exchange: The existing theory on kidney exchange, like much of the theory on various matching markets, is static. The practical problem, however, is dynamic. The investeigators develop a dynamic theory on kidney exchange.Intellectual Merit of The Proposed Activity: The proposed study will contribute to the literature on matching markets and practical mechanism - market design.Broader Impact: We anticipate some of the findings to influence the organization of kidney exchange in various parts of U.S. including in New England.

2004年9月，新英格兰肾移植监督委员会批准了由Francis Delmonico博士、Susan Saidman博士和该提案的作者提出的建立肾脏交换中心的建议，从而在2005年夏天建立了新英格兰肾脏交换计划(NEPKE)。作者与移植社区的互动和实际实施揭示了肾脏交换的几个有趣的方面。这项建议是基于以下几个方面的分析：1.三向肾脏交换的重要性：为了避免捐赠者在亲人接受移植后选择退出系统，在双向肾脏交换中应同时进行所有四种手术。同样，在三向肾脏交换中，所有六个手术都应该同时进行，以此类推。由于这种后勤限制，双向交流受到了很大关注。在Saidman等人(2005)中，模拟显示，3路交换的可用性显著增加了通过交换接受移植的患者的数量，而当更大的交换可用时，边际收益要小得多。结论：1.提出了三向肾互换的重要性理论。中心激励：随着患者-捐赠者池规模的扩大，肾脏交换的预期收益会变得更大。美国的许多移植中心正在就肾脏交换进行合作。例如，新英格兰的所有14个移植中心都参与建立了NEPKE。该系统的一个重要障碍是避免单个中心只提供更难匹配的配对到集中库，并保持容易匹配的患者-捐赠者对在中心内匹配。研究人员发展了中心激励理论，并设计了鼓励中心充分参与肾脏交换的机制。与好心的撒玛利亚人交换肾脏：虽然罕见，但偶尔会有好心的撒玛利亚人将肾脏捐赠给肾病患者，而不指望得到肾脏作为回报。将好心人的捐赠与肾脏交换结合起来是很重要的。这样，虽然每个好心人只捐赠一个肾脏，但他/她可以促进其他在他/她不在的情况下不可能进行的移植。研究人员用好心人对模型进行了分析，并模拟了将好心人捐赠与肾脏交换相结合的潜在收益。动态肾脏交换：现有的肾脏交换理论，就像许多关于各种配对市场的理论一样，是静态的。然而，实际问题是动态的。邀请者发展了一种关于肾脏交换的动态理论。拟议活动的智力价值：拟议的研究将有助于匹配市场和实用机制市场设计的文献。广泛影响：我们预计一些结果将影响美国不同地区的肾脏交换组织，包括新英格兰。