Will Computers Decide Who Gets Organs?

Will an algorithm – instead of a human – decide who gets a replacement kidney or a liver or a heart?

Yes. Not just any algorithm, but one using AI (artificial intelligence). This is considered an ideal scenario for living kidney donors, especially where multiple kidney donors and recipients are involved. It’s called KPD (Kidney Paired Donation) and refers to a transplant option for patients who have a living donor who is medically able, but cannot donate a kidney, to the intended recipient because of medical incompatibility.

The KPD idea emerged from a 1986 paper authored by a US surgeon Dr Felix Rapaport. He argued that kidneys could be transplanted across two willing donor-recipient pairs: Patient A receives a kidney from Donor B; in exchange, Donor A gives a kidney to Patient B.

The first KPD was done, not in the US, but in Seoul. In 1991, nephrologist Dr Kiil Park performed KPD on two donor-patient pairs at the Yonsei Univ College of Medicine. It took another 8 years for the next country, Switzerland, to set up a KPD exchange.

The US got into the act seriously only in 2000. Here\’s the story, as narrated by writer Corinne Purtill in Quartz: “One night in 2000, tired of delivering the heartbreaking news to patients and their loved ones that no suitable kidney could be found, US nephrologist Michael Rees lugged home several crates of files and spent the next few hours scrutinizing blood, antibody, and tissue data, and comparing patient charts. The work was mentally grueling. Eventually, he realized he had no viable matches — but also, that if the pool were bigger, pairs could be made. Working with his father Alan Rees, a computer scientist, Michael Rees created a simple computer program that did the work of pairing up donors and recipients, introducing AI to the matching process.

Meanwhile, a Harvard professor of economics, Alvin Roth, had designed algorithms to match new doctors to residency programs. He next focused on KPD.

“Today, multiple US hospitals run their own paired kidney donation programs,” writes Purtill.

“In 2012, Prof Roth won the Nobel Prize for his work on market design. He brought Dr Rees with him to the ceremony. By then, 2,000 people in the US had received transplant as a result of the system they helped create. Thousands more have since.

There are now three KPD US exchanges in the US: UNOS, National Kidney Registry (NKR), and Alliance for Paired Kidney Donation (APKD). National KPD exchanges are also in Canada, Holland, Britain, India and South Africa. The key to success? AI-based algorithms that analyze a clutch of medical variables across thousands of patients to arrive at optimal matches. The next frontier? Taking the learning from KPD to similar exchanges for other organs, such as lungs and livers.