Transplant quality and patientsʼ preferences in paired kidney exchange
Paired Kidney Exchange (PKE) programs solve incompatibility problems of donor–patient pairs in living donor kidney transplantation by arranging exchanges of donors among several pairs. Further efficiency gains may emerge if the programs consider the quality of the matches between patients and donors. Limitations on the number of simultaneous required operations imply that every efficient PKE program introduces incentives for the patients to misreport how they rank the option of remaining in dialysis with respect to the available kidneys. Truthfully revealing their preferences is however, the unique protective (lexicographic maximin) strategy for patients under pairwise exchange maximizing PKE programs. ► We model Paired Kidney Exchange (PKE) under logistic feasibility constraints. ► The quality of the match between donors and recipients affects the results of PKE. ► Individually rational and efficient PKE rules are manipulable by the patients. ► Patients are extreme-risk averters and follow the protective behavior. ► Pairwise exchange maximizing rules induce truthful behavior for the patients.