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Register a new userScalable Robust Kidney Exchange
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Added by
Duncan McElfresh
Publication date
2018
fields
Informatics Engineering
and research's language is
English
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In barter exchanges, participants directly trade their endowed goods in a constrained economic setting without money. Transactions in barter exchanges are often facilitated via a central clearinghouse that must match participants even in the face of uncertainty---over participants, existence and quality of potential trades, and so on. Leveraging robust combinatorial optimization techniques, we address uncertainty in kidney exchange, a real-world barter market where patients swap (in)compatible paired donors. We provide two scalable robust methods to handle two distinct types of uncertainty in kidney exchange---over the quality and the existence of a potential match. The latter case directly addresses a weakness in all stochastic-optimization-based methods to the kidney exchange clearing problem, which all necessarily require explicit estimates of the probability of a transaction existing---a still-unsolved problem in this nascent market. We also propose a novel, scalable kidney exchange formulation that eliminates the need for an exponential-time constraint generation process in competing formulations, maintains provable optimality, and serves as a subsolver for our robust approach. For each type of uncertainty we demonstrate the benefits of robustness on real data from a large, fielded kidney exchange in the United States. We conclude by drawing parallels between robustness and notions of fairness in the kidney exchange setting.
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Motivated by kidney exchange, we study a stochastic cycle and chain packing problem, where we aim to identify structures in a directed graph to maximize the expectation of matched edge weights. All edges are subject to failure, and the failures can have nonidentical probabilities. To the best of our knowledge, the state-of-the-art approaches are only tractable when failure probabilities are identical. We formulate a relevant non-convex optimization problem and propose a tractable mixed-integer linear programming reformulation to solve it. In addition, we propose a model that integrates both risks and the expected utilities of the matching by incorporating conditional value at risk (CVaR) into the objective function, providing a robust formulation for this problem. Subsequently, we propose a sample-average-approximation (SAA) based approach to solve this problem. We test our approaches on data from the United Network for Organ Sharing (UNOS) and compare against state-of-the-art approaches. Our model provides better performance with the same running time as a leading deterministic approach (PICEF). Our CVaR extensions with an SAA-based method improves the $alpha times 100%$ ($0<alphaleqslant 1$) worst-case performance substantially compared to existing models.
In barter exchanges, participants swap goods with one another without exchanging money; exchanges are often facilitated by a central clearinghouse, with the goal of maximizing the aggregate quality (or number) of swaps. Barter exchanges are subject to many forms of uncertainty--in participant preferences, the feasibility and quality of various swaps, and so on. Our work is motivated by kidney exchange, a real-world barter market in which patients in need of a kidney transplant swap their willing living donors, in order to find a better match. Modern exchanges include 2- and 3-way swaps, making the kidney exchange clearing problem NP-hard. Planned transplants often fail for a variety of reasons--if the donor organ is refused by the recipients medical team, or if the donor and recipient are found to be medically incompatible. Due to 2- and 3-way swaps, failed transplants can cascade through an exchange; one US-based exchange estimated that about 85% of planned transplants failed in 2019. Many optimization-based approaches have been designed to avoid these failures; however most exchanges cannot implement these methods due to legal and policy constraints. Instead we consider a setting where exchanges can query the preferences of certain donors and recipients--asking whether they would accept a particular transplant. We characterize this as a two-stage decision problem, in which the exchange program (a) queries a small number of transplants before committing to a matching, and (b) constructs a matching according to fixed policy. We show that selecting these edges is a challenging combinatorial problem, which is non-monotonic and non-submodular, in addition to being NP-hard. We propose both a greedy heuristic and a Monte Carlo tree search, which outperforms previous approaches, using experiments on both synthetic data and real kidney exchange data from the United Network for Organ Sharing.
Algorithms for exchange of kidneys is one of the key successful applications in market design, artificial intelligence, and operations research. Potent immunosuppressant drugs suppress the bodys ability to reject a transplanted organ up to the point that a transplant across blood- or tissue-type incompatibility becomes possible. In contrast to the standard kidney exchange problem, we consider a setting that also involves the decision about which recipients receive from the limited supply of immunosuppressants that make them compatible with originally incompatible kidneys. We firstly present a general computational framework to model this problem. Our main contribution is a range of efficient algorithms that provide flexibility in terms of meeting meaningful objectives. Motivated by the current reality of kidney exchanges using sophisticated mathematical-programming-based clearing algorithms, we then present a general but scalable approach to optimal clearing with immunosuppression; we validate our approach on realistic data from a large fielded exchange.
Current kidney exchange pools are of moderate size and thin, as they consist of many highly sensitized patients. Creating a thicker pool can be done by waiting for many pairs to arrive. We analyze a simple class of matching algorithms that search periodically for allocations. We find that if only 2-way cycles are conducted, in order to gain a significant amount of matches over the online scenario (matching each time a new incompatible pair joins the pool) the waiting period should be very long. If 3-way cycles are also allowed we find regimes in which waiting for a short period also increases the number of matches considerably. Finally, a significant increase of matches can be obtained by using even one non-simultaneous chain while still matching in an online fashion. Our theoretical findings and data-driven computational experiments lead to policy recommendations.
In kidney exchange programmes patients with end-stage renal failure may exchange their willing, but incompatible living donors among each other. National kidney exchange programmes are in operation in ten European countries, and some of them have already conducted international exchanges through regulated collaborations. The exchanges are selected by conducting regular matching runs (typically every three months) according to well-defined constraints and optimisation criteria, which may differ across countries. In this work we give integer programming formulations for solving international kidney exchange problems, where the optimisation goals and constraints may be different in the participating countries and various feasibility criteria may apply for the international cycles and chains. We also conduct simulations showing the long-run effects of international collaborations for different pools and under various national restrictions and objectives.
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