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Ideally many medical institutions should participate in a matching program to increase the chance for successful matches. However, to fulfill legal requirements current systems use complicated policy-based data protection mechanisms that effectively exclude smaller medical facilities to participate. Employing secure multi-party computation (MPC) techniques provides a technical way to satisfy data protection requirements for highly sensitive personal health information while simultaneously reducing the regulatory\u00a0burdens.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>We have designed, implemented, and benchmarked SPIKE, a secure MPC-based privacy-preserving KEP protocol which computes a locally optimal solution by finding matching donor\u2013recipient pairs in a graph structure. SPIKE matches 40 pairs in cycles of length 2 in less than 4 min and outperforms the previous state-of-the-art protocol by a factor of <jats:inline-formula><jats:alternatives><jats:tex-math>$$400\\times$$<\/jats:tex-math><mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                    <mml:mrow>\n                      <mml:mn>400<\/mml:mn>\n                      <mml:mo>\u00d7<\/mml:mo>\n                    <\/mml:mrow>\n                  <\/mml:math><\/jats:alternatives><\/jats:inline-formula> in runtime while providing medically more robust solutions.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>We show how to solve the KEP in a robust and privacy-preserving manner achieving significantly more practical performance than the current state-of-the-art (Breuer et al., WPES\u201920 and CODASPY\u201922). The usage of MPC techniques fulfills many data protection requirements on a technical level, allowing smaller health care providers to directly participate in a kidney exchange with reduced legal processes. As sensitive data are not leaving the institutions\u2019 network boundaries, the patient data underlie a higher level of protection than in the currently employed (centralized) systems. Furthermore, due to reduced legal barriers, the proposed decentralized system might be simpler to implement in a transnational, intereuropean setting with mixed (national) data protecion laws.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12911-022-01994-4","type":"journal-article","created":{"date-parts":[[2022,9,22]],"date-time":"2022-09-22T17:09:24Z","timestamp":1663866564000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["SPIKE: secure and private investigation of the kidney exchange problem"],"prefix":"10.1186","volume":"22","author":[{"given":"Timm","family":"Birka","sequence":"first","affiliation":[]},{"given":"Kay","family":"Hamacher","sequence":"additional","affiliation":[]},{"given":"Tobias","family":"Kussel","sequence":"additional","affiliation":[]},{"given":"Helen","family":"M\u00f6llering","sequence":"additional","affiliation":[]},{"given":"Thomas","family":"Schneider","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2022,9,22]]},"reference":[{"key":"1994_CR1","doi-asserted-by":"crossref","unstructured":"Murphy D, McCulloch CE, Lin F, Banerjee T, Bragg-Gresham JL, Eberhardt MS, Morgenstern H, Pavkov ME, Saran R, Powe NR, Hsu C-Y. 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