Nonsimultaneous Chains and Dominos in Kidney- Paired Donation-Revisited

被引:102
作者
Ashlagi, I. [2 ]
Gilchrist, D. S. [3 ,4 ]
Roth, A. E. [3 ,4 ]
Rees, M. A. [1 ,5 ]
机构
[1] Univ Toledo, Dept Urol, Med Ctr, Toledo, OH 43606 USA
[2] MIT, Alfred P Sloan Sch Management, Dept Operat Management, Cambridge, MA 02139 USA
[3] Harvard Univ, Sch Business, Boston, MA 02163 USA
[4] Harvard Univ, Dept Econ, Boston, MA 02115 USA
[5] Alliance Paired Donat Inc, Maumee, OH USA
基金
美国国家科学基金会;
关键词
ABO incompatibility; allosensitization; paired kidney exchange; regional sharing; simulation models; transplantation policy; WAIT-LIST CANDIDATES; EXCHANGE; TRANSPLANTATION; PROGRAM;
D O I
10.1111/j.1600-6143.2011.03481.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
Since 2008, kidney exchange in America has grown in part from the incorporation of nondirected donors in transplant chains rather than simple exchanges. It is controversial whether these chains should be performed simultaneously 'domino-paired donation', (DPD) or nonsimultaneously 'nonsimultaneous extended altruistic donor, chains (NEAD). NEAD chains create 'bridge donors' whose incompatible recipients receive kidneys before the bridge donor donates, and so risk reneging by bridge donors, but offer the opportunity to create more transplants by overcoming logistical barriers inherent in simultaneous chains. Gentry et al. simulated whether DPD or NEAD chains would produce more transplants when chain segment length was limited to three transplants, and reported that DPD performed at least as well as NEAD chains. As this finding contrasts with the experience of several groups involved in kidney-paired donation, we performed simulations that allowed for longer chain segments and used actual patient data from the Alliance for Paired Donation. When chain segments of 4-6 transplants are allowed in the simulations, NEAD chains produce more transplants than DPD. Our simulations showed not only more transplants as chain length increased, but also that NEAD chains produced more transplants for highly sensitized and blood type O recipients.
引用
收藏
页码:984 / 994
页数:11
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