The Extended David-Yechiali Rule for Kidney Allocation

The First Come First Served (FCFS) queuing policy is routinely assumed to be the benchmark policy for “fairness” in waiting-time performance. In this article, we propose a slight modification of the FCFS policy based on a natural extension of the well-established David and Yechiali (DY) rule and analyze it in the context of managing a waiting list for kidney transplants. In the proposed policy, the queuing agents are sequentially offered a stochastically arriving organ on a “first come, first served” basis while applying the individually optimal DY stopping rule. Through a realistic simulation, we show that the proposed policy, which we term Extended David and Yechiali (EDY), favorably compares to the FCFS policy in terms of medical efficiency while maintaining a comparable level of equity (i.e., fairness). Possible implications and practical aspects of the EDY are discussed.