Optimal acceptance of incompatible kidneys

Xingyu Ren, Michael C. Fu and Steven I. Marcus

Journal of the Operational Research Society, 2025, vol. 76, issue 9, 1777-1802

Abstract: Incompatibility between patient and donor is a major barrier in kidney transplantation (KT). The increasing shortage of kidney donors has driven the development of desensitization techniques to overcome this immunological challenge. Compared with compatible KT, patients undergoing incompatible KTs are more likely to experience rejection, infection, malignancy, and graft loss. We study the optimal acceptance of possibly incompatible kidneys for individual end-stage kidney disease patients. To capture the effects of incompatibility, we propose a Markov Decision Process (MDP) model that explicitly includes compatibility as a state variable. The resulting higher-dimensional model makes it more challenging to analyze, but under suitable conditions, we derive structural properties including control limit-type optimal policies that are easy to compute and implement. Numerical examples illustrate the behavior of the optimal policy under different mismatch levels and highlight the importance of explicitly incorporating the incompatibility level into the acceptance decision when desensitization therapy is an option.

Date: 2025
References: Add references at CitEc
Citations:

Downloads: (external link)
http://hdl.handle.net/10.1080/01605682.2024.2444410 (text/html)
Access to full text is restricted to subscribers.

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:taf:tjorxx:v:76:y:2025:i:9:p:1777-1802

Ordering information: This journal article can be ordered from
http://www.tandfonline.com/pricing/journal/tjor20

DOI: 10.1080/01605682.2024.2444410

Access Statistics for this article

Journal of the Operational Research Society is currently edited by Tom Archibald

More articles in Journal of the Operational Research Society from Taylor & Francis Journals
Bibliographic data for series maintained by Chris Longhurst ().