The results of our survey are shown in Table 10.

The decision that a patient and a clinician jointly make when a donor organ is offered for transplantation is critical and carries serious consequences.

Kidney transplantation is the preferred treatment for end-stage renal disease, yet the scarcity of donors and inefficiencies in allocation systems create major bottlenecks, resulting in prolonged wait times and alarming mortality rates. Despite their severe scarcity, timely and effective interventions to prevent non-utilization of life-saving organs remain inadequate. Expedited out-of-sequence placement of hard-to-place kidneys to centers with the highest likelihood of utilizing them has been recommended in the literature as an effective strategy to improve placement success. Nevertheless, current attempts towards this practice is non-standardized and heavily rely on the subjective judgment of the decision-makers. This paper proposes a novel data-driven, machine learning-based ranking system for allocating hard-to-place kidneys to centers with a higher likelihood of accepting and successfully transplanting them. Using the national deceased donor kidney offer and transplant datasets, we construct a unique dataset with donor-, center-, and patient-specific features. We propose a data-driven out-of-sequence placement policy that utilizes machine learning models to predict the acceptance probability of a given kidney by a set of transplant centers, ranking them accordingly based on their likelihood of acceptance. Our experiments demonstrate that the proposed policy can reduce the average number of centers considered before placement by fourfold for all kidneys and tenfold for hard-to-place kidneys. This significant reduction indicates that our method can improve the utilization of hard-to-place kidneys and accelerate their acceptance, ultimately reducing patient mortality and the risk of graft failure. Further, we utilize machine learning interpretability tools to provide insights into factors influencing the kidney allocation decisions.

Modern complex datasets often consist of various sub-populations. To develop robust and generalizable methods in the presence of sub-population heterogeneity, it is important to guarantee a uniform learning performance instead of an average one. In many applications, prior information is often available on which sub-population or group the data points belong to. Given the observed groups of data, we develop a min-max-regret (MMR) learning framework for general supervised learning, which targets to minimize the worst-group regret. Motivated from the regret-based decision theoretic framework, the proposed MMR is distinguished from the value-based or risk-based robust learning methods in the existing literature. The regret criterion features several robustness and invariance properties simultaneously. In terms of generalizability, we develop the theoretical guarantee for the worst-case regret over a super-population of the meta data, which incorporates the observed sub-populations, their mixtures, as well as other unseen sub-populations that could be approximated by the observed ones. We demonstrate the effectiveness of our method through extensive simulation studies and an application to kidney transplantation data from hundreds of transplant centers.

The scene at OneLegacy in Asuza on a recent Friday morning would have been familiar to anyone who's been in a hospital intensive care unit. Three adults were tucked into hospital beds, still and apparently asleep, with ventilators and other machines of artificial life doing the work that their bodies couldn't do. If you didn't know better, you'd think all the tubes and wires and boxes and screens were designed to save the lives of these patients, but it was too late for that. Instead, the machines were keeping oxygenated blood circulating through soon-to-be-donated organs of three people who had recently been declared brain dead. OneLegacy, you see, is not a hospital. And the kidneys, livers and other organs in those three bodies could save the lives of up to 24 people.

We present a credit-based matching mechanism for dynamic barter markets — and kidney exchange in particular — that is both strategy proof and efficient, that is, it guarantees truthful disclosure of donor-patient pairs from the transplant centers and results in the maximum global matching. Furthermore, the mechanism is individually rational in the sense that, in the long run, it guarantees each transplant center more matches than the center could have achieved alone. The mechanism does not require assumptions about the underlying distribution of compatibility graphs — a nuance that has previously produced conflicting results in other aspects of theoretical kidney exchange. Our results apply not only to matching via 2-cycles: the matchings can also include cycles of any length and altruist-initiated chains, which is important at least in kidney exchanges. The mechanism can also be adjusted to guarantee immediate individual rationality at the expense of economic efficiency, while preserving strategy proofness via the credits. This circumvents a well-known impossibility result in static kidney exchange concerning the existence of an individually rational, strategy-proof, and maximal mechanism. We show empirically that the mechanism results in significant gains on data from a national kidney exchange that includes 59% of all US transplant centers.