非配对肾脏交换：无需货币克服需求的双重巧合

Review of Economic Studies · 2024 · [{"name": "Mohammad Akbarpour", "affiliation": ["Stanford University"]}, {"name": "Julien Combe", "affiliation": ["École Polytechnique", "Centre de Recherche en Économie et Statistique"]}, {"name": "Yinghua He", "affiliation": ["Rice University"]}, {"name": "Victor Hiller", "affiliation": ["Université Paris-Panthéon-Assas"]}, {"name": "Robert Shimer", "affiliation": ["University of Chicago"]}, {"name": "Olivier Tercieux", "affiliation": ["Centre National de la Recherche Scientifique", "Paris School of Economics"]}]

中文摘要

摘要：对于不相容的患者-供体配对，肾脏交换通常禁止“先接受后捐赠”（患者在供体捐赠前先接受肾脏）和“先捐赠后接受”，这会导致需求的双重巧合问题。我们研究了一种算法——非配对肾脏交换算法，该算法消除了这一问题。在一个动态匹配模型中，我们表明，非配对算法下患者的等待时间接近最优，且显著短于广泛使用的算法所带来的等待时间。利用来自法国的丰富行政数据，我们发现非配对算法实现了63%的匹配率，移植患者的平均等待时间为176天。（不可行的）最优算法仅略优（匹配率64%，等待时间144天）；广泛使用的算法匹配率不足40%，等待时间至少为232天。我们讨论了一系列可以解决非配对算法潜在实践激励挑战的方案。特别是，我们将分析扩展到一个可以纳入已故捐献者等待名单以提升算法表现的环境中，并表明我们的理论与实证比较结论依然成立。最后，基于这些分析，我们提出了非配对算法的一个实用版本。

Abstract

Abstract For an incompatible patient–donor pair, kidney exchanges often forbid receipt-before-donation (the patient receives a kidney before the donor donates) and donation-before-receipt, causing a double-coincidence-of-wants problem. We study an algorithm, the Unpaired kidney exchange algorithm, which eliminates this problem. In a dynamic matching model, we show that the waiting time of patients under Unpaired is close to optimal and substantially shorter than under widely used algorithms. Using a rich administrative dataset from France, we show that Unpaired achieves a match rate of 63% and an average waiting time of 176 days for transplanted patients. The (infeasible) optimal algorithm is only slightly better (64% and 144 days); widely used algorithms deliver less than 40% match rate and at least 232 days waiting times. We discuss a range of solutions that can address the potential practical incentive challenges of Unpaired. In particular, we extend our analysis to an environment where a deceased donor waitlist can be integrated to improve the performance of algorithms. We show that our theoretical and empirical comparisons continue to hold. Finally, based on these analyses, we propose a practical version of the Unpaired algorithm.