A kidney exchange program, also called a kidney paired donation program, can be viewed as a repeated, dynamic trading and allocation mechanism. This suggests that a dynamic algorithm for transplant exchange selection may have superior performance in comparison to the repeated use of a static algorithm. We confirm this hypothesis using a full scale simulation of the Canadian Kidney Paired Donation Program: learning algorithms, that attempt to learn optimal patient-donor weights in advance via dynamic simulations, do lead to improved outcomes. Specifically, our learning algorithms, designed with the objective of fairness (that is, equity in terms of transplant accessibility across cPRA groups), also lead to an increased number of transplants and shorter average waiting times. Indeed, our highest performing learning algorithm improves egalitarian fairness by 10% whilst also increasing the number of transplants by 6% and decreasing waiting times by 24%. However, our main result is much more surprising. We find that the most critical factor in determining the performance of a kidney exchange program is not the judicious assignment of positive weights (rewards) to patient-donor pairs. Rather, the key factor in increasing the number of transplants, decreasing waiting times and improving group fairness is the judicious assignment of a negative weight (penalty) to the small number of non-directed donors in the kidney exchange program.

Tuomas Sandholm is the winner of the 2023 AAAI Award for Artificial Intelligence for the Benefit of Humanity. This award recognizes positive impacts of artificial intelligence to protect, enhance, and improve human life in meaningful ways. Tuomas delivered an invited talk at the AAAI Conference on Artificial Intelligence, during which he spoke about the work that won him the award – using algorithms for organ exchanges. Kidney disease is becoming more prevalent in the world, and, in the USA alone, over 90,000 people are waiting for a kidney transplant. This waiting list keeps growing year on year.

Kidney exchange, where candidates with organ failure trade incompatible but willing donors, is a life-saving alternative to the deceased donor waitlist, which has inadequate supply to meet demand. While fielded kidney exchanges see huge benefit from altruistic kidney donors (who give an organ without a paired needy candidate), a significantly higher medical risk to the donor deters similar altruism with livers. In this paper, we begin by exploring the idea of large-scale liver exchange, and show on demographically accurate data that vetted kidney exchange algorithms can be adapted to clear such an exchange at the nationwide level. We then propose cross-organ donation where kidneys and livers can be bartered for each other. We show theoretically that this multi-organ exchange provides linearly more transplants than running separate kidney and liver exchanges. This linear gain is a product of altruistic kidney donors creating chains that thread through the liver pool; it exists even when only a small but constant portion of the donors on the kidney side of the pool are willing to donate a liver lobe. We support this result experimentally on demographically accurate multi-organ exchanges. We conclude with thoughts regarding the fielding of a nationwide liver or joint liver-kidney exchange from a legal and computational point of view.

Kidney exchange, where candidates with organ failure trade incompatible but willing donors, is a life-saving alternative to the deceased donor waitlist, which has inadequate supply to meet demand. While fielded kidney exchanges see huge benefit from altruistic kidney donors (who give an organ without a paired needy candidate), a significantly higher medical risk to the donor deters similar altruism with livers. In this paper, we begin by proposing the idea of liver exchange, and show on demographically accurate data that vetted kidney exchange algorithms can be adapted to clear such an exchange at the nationwide level. We then explore cross-organ donation where kidneys and livers can be bartered for each other. We show theoretically that this multi-organ exchange provides linearly more transplants than running separate kidney and liver exchanges; this linear gain is a product of altruistic kidney donors creating chains that thread through the liver pool. We support this result experimentally on demographically accurate multi-organ exchanges. We conclude with thoughts regarding the fielding of a nationwide liver or joint liver-kidney exchange from a legal and computational point of view.

In many dynamic matching applications — especially high-stakes ones — the competitive ratios of prior-free online algorithms are unacceptably poor. The algorithm should take distributional information about possible futures into account in deciding what action to take now. This is typically done by drawing sample trajectories of possible futures at each time period, but may require a prohibitively large number of trajectories or prohibitive memory and/or computation to decide what action to take. Instead, we propose to learn potentials of elements (e.g., vertices) of the current problem. Then, at run time, we simply run an offline matching algorithm at each time period, but subtracting out in the objective the potentials of the elements used up in the matching. We apply the approach to kidney exchange. Kidney exchanges enable willing but incompatible patient-donor pairs (vertices) to swap donors. These swaps typically include cycles longer than two pairs and chains triggered by altruistic donors. Fielded exchanges currently match myopically, maximizing the number of patients who get kidneys in an offline fashion at each time period. Myopic matching is sub-optimal; the clearing problem is dynamic since patients, donors, and altruists appear and expire over time. We theoretically compare the power of using potentials on increasingly large elements: vertices, edges, cycles, and the entire graph (optimum). Then, experiments show that by learning vertex potentials, our algorithm matches more patients than the current practice of clearing myopically. It scales to exchanges orders of magnitude beyond those handled by the prior dynamic algorithm.