{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T08:24:55Z","timestamp":1787041495332,"version":"build-2736575974"},"reference-count":29,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T00:00:00Z","timestamp":1784419200000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Learning Health Systems"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The allocation and timing for kidney matching and transplantation among incompatible donor\u2010recipient pairs in the Paired Kidney Exchange face significant operational challenges of managing an uncertain waitlist. The time for dialysis of patients waiting for biologically compatible kidneys follows the concept of a stochastic queueing system. This study embodies the Learning Health System approach by integrating real\u2010world data and mathematical modeling to generate actionable insights that guide decision\u2010making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This work employs an  model with Poisson arrivals and exponentially distributed service times for incompatible donor\u2013recipient pairs in a single transplant facility. Inter\u2010arrival and service times are used to derive queue length and waiting\u2010time measures to characterize system congestion and instability, with performance measures evaluated as indicative approximations analyzing the corresponding metrics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The system is persistently overloaded, with arrival rates exceeding service rates (  ;  1), causing prolonged waiting times. Analytical and Hutson\u2010B bootstrap confidence interval analysis shows congestion persists across plausible variations, and sensitivity analysis indicates moderate perturbations do not alleviate overload. Regression and correlation analyses indicate that delays are associated with arrival pressure and biologically imposed constraints, supporting compatibility\u2010constrained matching as the primary operational challenge. Patients experience uncertain, extended waiting periods, reflecting stochastic instability in biologically constrained queueing systems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Transplant service management requires systematic reforms, as clinical matching and allocation delays hinder timely care. Establishing a national transplant registry, integrated real\u2010time queue monitoring, decentralized planning with expansion of transplant centers and improved inter\u2010center coordination for paired exchange and increasing its cycle lengths are essential to ensure efficient service delivery and informed healthcare policy. These interventions create a continuous feedback loop where operational data informs queueing\u2010theoretic analysis, informs policy, system redesign, and ultimately improves patient access and outcomes, demonstrating how data\u2010driven learning optimizes complex healthcare services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lrh2.70107","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:07:02Z","timestamp":1784506022000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Learning From Queues: Operational Analysis and Performance Evaluation of Dialysis Duration in a Paired Kidney Exchange With an\n                    <i>M\/M\/<\/i>\n                    1 System"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0836-0170","authenticated-orcid":false,"given":"Samrajya Raj","family":"Acharya","sequence":"first","affiliation":[{"name":"Department of Mathematics, School of Science Kathmandu University  Dhulikhel Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sushil","family":"Ghimire","sequence":"additional","affiliation":[{"name":"Department of Mathematics, School of Science Kathmandu University  Dhulikhel Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ram Prasad","family":"Ghimire","sequence":"additional","affiliation":[{"name":"Department of Mathematics, School of Science Kathmandu University  Dhulikhel Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,19]]},"reference":[{"issue":"8","key":"e_1_2_13_2_1","doi-asserted-by":"crossref","DOI":"10.1177\/20543581211017412","article-title":"In Search of a Better Outcome: Opting Into the Live Donor Paired Kidney Exchange Program","volume":"26","author":"Vinson A. J.","year":"2021","journal-title":"Canadian Journal of Kidney Health and Disease"},{"key":"e_1_2_13_3_1","doi-asserted-by":"crossref","unstructured":"I.Ashlagi P.Jaillet andV. H.Manshadi \u201cKidney Exchange in Dynamic Sparse Heterogeneous Pools \u201d(2013) Proceedings of the 14th ACM Conference on Economics and Computation (EC'13).","DOI":"10.1145\/2482540.2482565"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-200211270-00005"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-018-4633-1"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/lrh2.10328"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11134-009-9147-4"},{"key":"e_1_2_13_8_1","volume-title":"Operations Research: Theory and Applications","author":"Sharma J. K.","year":"2016"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1019162331525"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare11050768"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1504\/IJMOR.2024.137041"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1108\/IJPPM-12-2015-0193"},{"issue":"4","key":"e_1_2_13_13_1","first-page":"193","article-title":"Application of Queueing Theory in Designing and Developing of Health Care Model","volume":"10","author":"Lohiya R.","year":"2023","journal-title":"Universal Research Reports"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1287\/opre.33.3.491"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11134-014-9417-7"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/poms.13697"},{"key":"e_1_2_13_17_1","first-page":"1454","volume-title":"2009 Chinese Control and Decision Conference","author":"Ge R. D.","year":"2009"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0269964810000318"},{"key":"e_1_2_13_19_1","unstructured":"C.\u2010H.Chang \u201cEffects of Patient Heterogeneity in a First\u2010Come\u2010First\u2010Serve Kidney Transplant Model \u201d(Master's Thesis University of Texas at Austin 2020)."},{"key":"e_1_2_13_20_1","unstructured":"Y.Ding \u201cA Scoring\u2010Based Ranking System and Its Application in Cadaver Kidney Allocation \u201d(PhD Thesis Stanford University 2012)."},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0252069"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10100-021-00742-9"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1011405610919"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.3390\/math10050714"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.4240\/wjgs.v3.i8.119"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1287\/opre.48.4.549.12418"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13561-021-00312-4"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781119453765"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.4258\/hir.2017.23.1.35"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1080\/03610918.2026.2641163"}],"container-title":["Learning Health Systems"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lrh2.70107","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lrh2.70107","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lrh2.70107","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T07:35:07Z","timestamp":1787038507000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lrh2.70107"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":29,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1002\/lrh2.70107"],"URL":"https:\/\/doi.org\/10.1002\/lrh2.70107","archive":["Portico"],"relation":{},"ISSN":["2379-6146","2379-6146"],"issn-type":[{"value":"2379-6146","type":"print"},{"value":"2379-6146","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2025-09-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70107"}}