Organ Transplant: The Kidney Exchange Problem

Background:

Despite the continuing and dramatic advances in medicine and health technology, the demand for organs for transplantation drastically exceeds the number of donors. To help this situation, US Congress passed the National Organ Transplant Act in 1984, establishing the Organ Procurement and Transplantation Network (OPTN) to match organ donors to patients with organ needs. Even with all this organizational technology and service in place, there are nearly 94,000 transplant candidates in the US waiting for an organ transplant and this number is predicted to exceed 100,000 very soon. The average wait time exceeds three years—double that in some areas, such as large cities. Organs for transplant are obtained either from a cadaver queue or from living donors. The keys for the effective use of the cadaver queue are cooperation and good communication throughout the network. The good news is that the system is functioning and more and more donors (alive and deceased) are identified and used each year with record numbers of transplants taking place every month. The bad news is that the candidate list grows longer and longer. Some people think that the current system with both regional and national aspects is headed for collapse with consequential failures for some of the neediest patients. Moreover, fundamental questions remain: Can this network be improved and how do we improve the effectiveness of a complex network like OPTN? Different countries have different processes and policies, which of these work best? What is the future status of the current system?