Long term simulation analysis of deceased donor initiated chains in kidney exchange programs

Kidney exchange programs have been developed to find compatible kidneys for recipients who have incompatible donors. On the other hand, patients who do not have a living donor depend upon deceased donor (DD) donations to get a kidney transplant. Currently, in India a deceased donor donates kidneys directly to a deceased donor wait-list. The idea of initiating an exchange chain starting from a deceased donor kidney is proposed in a few articles (and recently executed in Italy), but no mathematical formulation has been given for this merger. We have introduced an integer programming formulation that creates deceased donor initiated chains, considering both paired exchange registry and deceased donor allocations simultaneously. There is a possibility of overlap between paired exchange registry and deceased donor wait-list registry data as recipients can register for both registries independently. This has also been addressed in the paper. A long term simulation study is done to analyze the gain of these DD initiated chains over time. It suggests that even with small numbers of deceased donors, these chains can increases the number of potential transplants significantly. Also, waiting time and dropout rates in the merged registry decreases substantially.