Collaborative Research on Kidney Exchange

肾脏交换的合作研究

• 批准号: 1061932
• 负责人: Alvin Roth
• 金额: $ 16万
• 依托单位: National Bureau of Economic Research Inc
• 依托单位国家: 美国
• 项目类别: Standard Grant
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2016-08-31
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=1061932&HistoricalAwards=false
• 关键词: Collaborative; Research; Kidney; Exchange

The need for kidney exchange arises when someone who wishes to donate a kidney to a particular recipient is incompatible with that recipient. Two or more such incompatible patient-donor pairs can sometimes both receive transplants through an exchange,when the donor in one pair is compatible with the recipient in the other (or in cycles involving more incompatible pairs). Stemming in part from previously funded NSF research, organized kidney exchanges, such as the New England Program for Kidney Exchange (NEPKE) havebecome active in the United States, and now multiple regional kidney exchanges exist and are growing, and a national exchange is being contemplated (following the passage of the Charlie W.Norwood Living Organ Donation Act in 2007). The growth of kidney exchange to include many hospitals has raised new practical and theoretical questions and this award funds research that develops new methods in mechanism design to answer these questions.The first issue is incentives. When kidney exchange programs started, the first models incorporatedpatient-donor pairs and their surgeons. However, the success of regional exchanges has demonstrated that transplant centers (hospitals) must also be included in the strategic analysis. Transplant centers deal with multiple patient-donor pairs, and their strategy sets include the possibility of withholding some pairs from the kidney exchange and revealing only those pairs that the hospital cannot match on its own. The team has observed exactly this in practice, and preliminary research results suggest that there is no way to get hospitals to reveal all their pairs while still using a efficient kidney exchange matching algorithm. Additional research explores the incentive properties of matching mechanisms in large populations. The PIs seek to demonstrate that existing mechanisms do not have good incentive properties even in large populations, but that alternative mechanisms can be designed that would have both good incentives and good efficiency properties when there are many patient-donor pairs in the pool, as would be the case in a successful national exchange.The second part of the project concerns efficiency. The PIs adapt the classical (undirected) random graph results of Erdos and Rényi (1959, 1966) to graphs that model the compatibility between patient-donor pairs, and use these to explore the behavior of large kidney exchanges, with many pairs. The first part of this work will look at general populations of patients and donors, and the second part will consider the differently structured large graphs that result when there is a large population of extremely sensitized patients who have low probability of finding a donor. (This will involve modeling the compatibility graph in more detail; instead of one node for each patient and her donors, there will have to be separate nodes for patients and donors, since the connectedness of donors will be unaffected by the patient?s low probability offinding a compatible kidney, so that, once such a kidney is found, the pair will be well connected.) We will also consider different kidney exchange strategies, including the management of possibly long chains of donations.Broader Impacts: There are over 80,000 patients on the waiting list for cadaver kidneys in the U.S. In 2009, 33,678 patients were added to the waiting list,10,441 transplants of cadaver kidneys were performed, 4,456 patients died while on the waiting list, and more than 1,941 others were removed from the list as ?Too Sick to Transplant?. There were also 6,387 transplants of kidneys from living donors in the US. There is a severe shortage of kidneys for transplant. Kidney exchange is in recent years the still small but fastest growing source of live kidney donors. Improvements in the methods used to match donors and recipients will save lives. The PIs will collaborate with transplant centers and regional alliances to take the newly developed methods into application.

当希望将肾脏捐赠给特定受体的人与该受体不相容时，需要进行肾脏交换。两个或更多这样的不相容的患者-供体对有时可以通过交换接受移植，当一对中的供体与另一对中的受体相容时（或在涉及更多不相容对的周期中）。部分源于先前资助的NSF研究，有组织的肾脏交换，如新英格兰肾脏交换计划（NEPKE）在美国变得活跃，现在存在多个区域肾脏交换并正在增长，并且正在考虑建立一个国家交换（在2007年通过查理W.诺伍德活体器官捐赠法案之后）。肾脏交换的增长包括许多医院提出了新的实践和理论问题，该奖项资助研究开发机制设计的新方法来回答这些问题。第一个问题是激励。当肾脏交换项目开始时，第一个模型包括病人-捐赠者对和他们的外科医生。 然而，区域交流的成功表明，移植中心（医院）也必须纳入战略分析。移植中心处理多个患者-捐赠者配对，他们的策略集包括可能从肾脏交换中保留一些配对，并仅显示医院无法自行匹配的配对。该团队在实践中观察到了这一点，初步研究结果表明，没有办法让医院在仍然使用有效的肾脏交换匹配算法的情况下透露所有配对。 更多的研究探讨了大群体中匹配机制的激励特性。PI试图证明，现有的机制不具有良好的激励性能，即使在大的人群，但替代机制可以设计，将有良好的激励和良好的效率属性时，有许多病人捐赠者对在池中，将是在一个成功的国家交换的情况下。PI将Erdos和Rényi（1959，1966）的经典（无向）随机图结果调整为模拟患者-供体对之间相容性的图，并使用这些图来探索具有许多对的大型肾脏交换的行为。这项工作的第一部分将着眼于患者和供体的一般人群，第二部分将考虑当存在大量极敏感患者时产生的不同结构的大型图，这些患者找到供体的可能性很低。(This将涉及更详细地建模兼容性图;而不是每个患者和她的捐赠者一个节点，患者和捐赠者必须有单独的节点，因为捐赠者的连通性将不受患者的影响？找到一个匹配的肾脏的可能性很低，因此，一旦找到这样的肾脏，这对肾脏将很好地连接起来。我们还将考虑不同的肾脏交换策略，包括管理可能较长的捐赠链。更广泛的影响：在美国，有超过80，000名患者在等待尸体肾脏。2009年，33，678名患者被添加到等待名单中，进行了10，441例尸体肾脏移植，4，456名患者在等待名单中死亡，超过1,941人被从名单上删除，因为？病得太重不能移植？美国也有6,387例活体肾脏移植。可供移植的肾脏严重短缺。 肾脏交换是近年来仍然很小但增长最快的活体肾脏捐献者来源。改进用于匹配捐赠者和接受者的方法将挽救生命。 PI将与移植中心和区域联盟合作，将新开发的方法应用于临床。