Long term simulation analysis of deceased donor initiated chains in kidney exchange programs

Kidney exchange programs (KEPs) aim to find compatible kidneys for recipients with incompatible donors. Patients without a living donor depend upon deceased donor (DD) donations to get a kidney transplant. In India, a (c) DD donates kidneys directly to a (c) DD wait-list. The idea of initiating an exchange chain starting from a (c) DD kidney is proposed in a few articles (and executed in Italy in 2018), but no mathematical formulation has been given for this merger. We have introduced an integer programming formulation that creates (c) DD-initiated chains, considering both paired exchange registry and (c) DD allocations simultaneously and addressing the overlap issue between the exchange registry and (c) DD wait-list as recipients can register for both registries independently. A long-term simulation study is done to (c) analyse the gain of these DD-initiated chains over time. It suggests that even with small numbers of (c) DDs, these chains can significantly increase potential transplants.