Policy and Practice Impacts

School Choice  Kidney Exchange  | Cadet-Branch Matching


Policy and Practice Impacts on Kidney Exchange

New England Program for Kidney Exchange (NEPKE) & Alliance for Paired Donation (APD): 

Together with New England surgeons and tissue typing experts, especially Frank Delmonico and Susan Saidman, we (Alvin Roth, Utku Ünver and I) have launched the centralized New England Program for Kidney Exchange (NEPKE) in to cover six New England states (and 14 transplant centers) in 2004. NEPKE is the first kidney exchange program to use optimization in kidney exchanges. We have also been running matches for Drs. Steve Woodle and Michael Rees and their colleagues in the Paired Donation Consortium they started in Ohio, and more recently for the Alliance for Paired Donation (APD). [ Media ]

Kidney Exchange and the US Federal Law:

National Organ Transplant Act (NOTA) of 1984 prohibits “any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation…” When we initially helped found NEPKE, it was unclear whether kidney exchange is a violation of NOTA. Since then a bill that amends NOTA to clarify that “kidney exchange (or kidney paired donation) shall not be considered to involve the transfer of a human organ for valuable consideration has passed in the Senate.

Adoption of Our Approach In Other Regions/Centers:

Shortly after our first paper on the topic “Kidney Exchange” was published in and the second paper “Pairwise Kidney Exchange” appeared as NBER working paper 10698, transplant surgeons at Johns Hopkins started actively promoting the importance of optimization in this context. See the Pairwise Kidney Exchange methodology adopted by Johns Hopkins University Kidney Paired Donation Program.

The Birth of Kidney Chains: 

One of the tools we develop in our paper (w-chains) is based on the following idea: When a live-donor kidney becomes available for donation (through indirect exchange for instance), more than one patient can benefit if it is integrated with the kidney-exchange pool. See Johns Hopkins Medicine press release Three-Way “Domino” Kidney Transplant Includes a First for the first real-life application of this idea. In this application the live-donor kidney became available not through an indirect exchange but directly from a Good Samaritan donor (i.e. a non-directed donor).

The Birth of Never-Ending Altruistic Donor (NEAD) Chains:

In our 2006 American Journal of Transplantation article we have argued that, unlike in direct kidney exchange via cycles, chains initiated by Good Samaritan donors do not need to be conducted simultaneously. This idea is now implemented by the Alliance for Paired Donation where it has increased kidneys received via kidney exchange very dramatically. Here is an ABC News broadcast of a story on the first non-simultaneous such chain conducted by Michael Rees and a People magazine story on one of these chains which provided kidneys for 10 patients as of November 2009.

2012 Update: Non-simultaneous chains initiated by Good Samaritan donors (a.k.a. non-directed donors) became one of our most successful innovations in practice. Here is a April 2012 NSF Science Nation story focusing on the practical success of this innovation.

National Kidney Exchange in the US and UK:

Our ideas are now implemented at national scale in the UK by NHS Blood and Transplant, and in the U.S. by OPTN!

  • Since 2009, NHS Blood and Transplant run National Matching Scheme for Paired and Pooled Kidney Donation in the UK.
  • Since 2010, OPTN run the Kidney Paired Donation Pilot Program in the U.S.

NSF Testimony Before U.S. House of Representatives:

Here is June 2, 2011 testimony of Dr. Myron Gutmann before the Committee on Science Space and Technology, United States House of Representatives, quoting our kidney exchange research as an example of why NSF funding for Social, Economic, and Behavioral Sciences shall not be discontinued.

Kidney Exchange and 2012 Economics Nobel Prize:

2012 Nobel Prize Presentation Speech by Torsten Persson summarizes the role kidney exchange played on this ultimate recognition quite well.

Section 5.3 of the following Scientific Background on the Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel 2012  gives a more detailed account of the early developments on kidney exchange.