论文标题
通过筛查改善政策受限的肾脏交换
Improving Policy-Constrained Kidney Exchange via Pre-Screening
论文作者
论文摘要
在易货交易所中,参与者互相交换商品而不交换钱;中央交换所通常会促进交流,目的是最大程度地提高掉期的总质量(或数量)。易货交易所受到多种形式的不确定性 - 在参与者的偏好,各种掉期的可行性和质量等等。我们的工作是由肾脏交易所的动机,这是一个现实世界中的易货市场,在该市场中,需要肾脏移植的患者交换愿意的活捐赠者,以找到更好的匹配。现代交流包括2-和3向掉期,使肾脏交换清除问题NP-HARD。计划的移植通常出于多种原因失败 - 如果接收者的医疗团队拒绝捐赠器官,或者发现捐助者和接受者在医学上不兼容。由于2和3向掉期,失败的移植可以通过交换“级联”;一项基于美国的交易所估计,2019年,约有85%的计划移植失败了。许多基于优化的方法旨在避免这些失败。但是,由于法律和政策限制,大多数交流无法实施这些方法。取而代之的是,我们考虑了一个设置,交换可以查询某些捐赠者和接受者的偏好,并要求他们是否接受特定的移植。我们将其描述为两个阶段的决策问题,其中交换程序(a)在进行匹配之前先查询少量移植,并且(b)根据固定的策略构建匹配。我们表明,选择这些边缘是一个具有挑战性的组合问题,除了是NP-HARD之外,它是非单调的和非管制的。我们提出了一种贪婪的启发式方法和蒙特卡洛树搜索,它使用合成数据的实验和来自联合器官共享网络的真实肾脏交换数据的实验都超过了先前的方法。
In barter exchanges, participants swap goods with one another without exchanging money; exchanges are often facilitated by a central clearinghouse, with the goal of maximizing the aggregate quality (or number) of swaps. Barter exchanges are subject to many forms of uncertainty--in participant preferences, the feasibility and quality of various swaps, and so on. Our work is motivated by kidney exchange, a real-world barter market in which patients in need of a kidney transplant swap their willing living donors, in order to find a better match. Modern exchanges include 2- and 3-way swaps, making the kidney exchange clearing problem NP-hard. Planned transplants often fail for a variety of reasons--if the donor organ is refused by the recipient's medical team, or if the donor and recipient are found to be medically incompatible. Due to 2- and 3-way swaps, failed transplants can "cascade" through an exchange; one US-based exchange estimated that about 85% of planned transplants failed in 2019. Many optimization-based approaches have been designed to avoid these failures; however most exchanges cannot implement these methods due to legal and policy constraints. Instead we consider a setting where exchanges can query the preferences of certain donors and recipients--asking whether they would accept a particular transplant. We characterize this as a two-stage decision problem, in which the exchange program (a) queries a small number of transplants before committing to a matching, and (b) constructs a matching according to fixed policy. We show that selecting these edges is a challenging combinatorial problem, which is non-monotonic and non-submodular, in addition to being NP-hard. We propose both a greedy heuristic and a Monte Carlo tree search, which outperforms previous approaches, using experiments on both synthetic data and real kidney exchange data from the United Network for Organ Sharing.