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A Look-Ahead Strategy for Non-directed Donors in Kidney Paired Donation

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Abstract

While there is a growing need for kidney transplants to treat end-stage kidney disease, the supply of transplantable kidneys is in serious shortage. Kidney paired donation (KPD) programs serve as platforms for candidates with willing but incompatible donors to assess the possibility of exchanging donors, thus opening up new transplant opportunities for these candidates. In recent years, non-directed (or altruistic) donors (NDDs) have been incorporated into KPD programs beginning chains of transplants that benefit many candidates. In such programs, making optimal decisions in transplant exchange selection is of critical importance. With the aim of improving the selection of chains beginning with an NDD, this paper introduces a look-ahead multiple decision strategy to select chains that are easy to extend in the future. Simulation studies are adopted to assess performance of this strategy. Taking into account the extensibility of chains increases the number of realized transplants.

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Notes

  1. There are four principal blood types: A, B, AB and O. Type O can donate to any of the four blood types. Type B can donate to type B and AB, type A can donate to A or AB, and type AB can only donate to type AB. Candidates of blood type O tend to be disadvantaged since they can receive only from an O donor, but O donors can give to any blood type.

  2. For clarity, functions introduced in Sect. 2.1 are denoted by \(f_{x}\) (or \(f_{xy}\)) instead of f(x) (or f(x, y)) in Sect. 2.2.

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Acknowledgments

This research was supported by the National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK) through Grant Number 1R01-DK093513. We thank Dr. Michael A. Rees and Alan B. Leichtman for helpful discussions and for making available program data from the APD and the UM KPD, respectively.

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Authors and Affiliations

  1. Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA

    Wen Wang, Mathieu Bray, Peter X.-K. Song & John D. Kalbfleisch

  2. Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI, USA

    Wen Wang, Mathieu Bray, Peter X.-K. Song & John D. Kalbfleisch

Authors
  1. Wen Wang
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  2. Mathieu Bray
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  3. Peter X.-K. Song
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  4. John D. Kalbfleisch
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Correspondence to Wen Wang.

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Wang, W., Bray, M., Song, P.XK. et al. A Look-Ahead Strategy for Non-directed Donors in Kidney Paired Donation. Stat Biosci 9, 453–469 (2017). https://doi.org/10.1007/s12561-016-9155-y

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  • DOI: https://doi.org/10.1007/s12561-016-9155-y

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