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Incentives and participation in kidney paired donation programmes

13rd National Competition for Economic Research Grants

Public economics

Senior Researcher : Carmelo Rodríguez Álvarez

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Research Centre or Institution : Universidad Complutense de Madrid


The best treatment for end stage renal disease (ESRD) is a kidney transplant. Kidneys for transplantation into ESRD patients can be obtained through the conventional process following the death of a donor (with waiting lists) or from living donors (normally relatives of the patient). Unfortunately, the kidney of a potential living donor may not be compatible with the patient and that means the implanted organ would immediately be rejected by the receiver.

In recent years a new possibility has been opened up for patients waiting for a kidney transplant. It is possible that two living donors who are incompatible with their respective patients could be compatible with the patient of the other donor and an exchange of donors would make two transplants possible. This practice of the exchange of kidneys between pairs of incompatible donors is known as Kidney Paired Donation and it has permitted significant increases in the number of transplants in recent years following the implementation of local and national programmes in the USA and in countries such as the Netherlands, South Korea, the United Kingdom and, recently, Spain.

Kidney Paired Donation programmes function as allocation mechanisms in which a Central Coordinator keeps a register of the medical details of the incompatible pairs of donors and patients who are willing to make exchanges and periodically searches for compatible exchanges between different pairs. To date, the questions related to perfect compatibility between donors and receivers have played a subsidiary role to that of finding the maximum number of exchanges. Despite the success of the practice of Kidney Paired Donation, this has not reached its maximum potential. The greatest problem is that participation in these programmes is relatively low. The main reason for the slow increase in participation is patients' reticence to participate in programmes, because they could obtain a better organ by remaining on the conventional kidney transplant waiting list.

The aim of this project is to introduce the components of quality and preferences of the patients in the design of public kidney paired donation programmes. Taking into account the most recent medical evidence that different compatible organs generate different results and that age and the general state of health are the main reasons for these differences, we will analyse the optimum design of allocation programmes which take into account the incentives of participation to patients, assuming that they would prefer to obtain organs that raise their life expectancy as much as possible, and therefore they would all prefer to receive organs from younger donors. In this new supposition, we will analyse the possible gains in efficacy generated by greater participation in the programmes. We will likewise study the effects on the rate of transplants of the incorporation of pairs with a compatible donor into the register of potential exchanges, which would make it possible to significantly increase the possibilities of finding compatible pairs.

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