When a person decides to donate a kidney, expecting nothing in return, clearly one person’s life could be saved. But this single act of altruism actually can save dozens of lives. For this to happen, though, kidney exchange programs need to take considerable care in deciding how to allocate the kidney of the altruistic donor and how to structure subsequent transplants.
Kidney exchanges were established in the past decade to solve a problem affecting thousands of people with kidney disease:
They have a loved one willing to donate a kidney, but the two have incompatible blood or tissue types. Organized in a clearinghouse or exchange, however, incompatible pairs can trade with each other, forming cycles in which each patient needing a kidney receives one from the donor of a different pair. Cycles have to be short—usually two or three pairs—because the transplants must be done simultaneously so each pair donating a kidney knows for certain it will receive one in return.
But if a donor comes forward who is not part of a pair, the potential for more life saving transplants arises. Because each pair can receive a kidney before donating one, the transplants do not have to be done simultaneously. What is the best way to use the kidney of an altruistic donor so that the greatest number of patients get transplants?
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