Computing Balanced Solutions for Large International Kidney Exchange Schemes

To overcome incompatibility issues, kidney patients may swap their donors. In international kidney exchange programmes (IKEPs), countries merge their national patient-donor pools. We consider a recent credit system where in each round, countries are given an initial kidney transplant allocation which is adjusted by a credit function yielding a target allocation. The goal is to find a solution in the patient-donor compatibility graph that approaches the target allocation as closely as possible, to ensure long-term stability of the international pool. As solutions, we use maximum matchings that lexicographically minimize the country deviations from the target allocation. We first give a polynomial-time algorithm for computing such matchings. We then perform, for the first time, a computational study for a large number of countries. For the initial allocations we use, besides two easy-to-compute solution concepts, two classical concepts: the Shapley value and nucleolus. These are hard to compute, but by using state-of-the-art software we show that they are now within reach for IKEPs of up to fifteen countries. Our experiments show that using lexicographically minimal maximum matchings instead of ones that only minimize the largest deviation from the target allocation (as previously done) may make an IKEP up to 52% more balanced.