| Summary: | Abstract Background The kidney exchange problem (KEP) addresses the matching of patients in need for a replacement organ with compatible living donors. 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 burdens. Results 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–recipient 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 $$400\times$$ 400 × in runtime while providing medically more robust solutions. Conclusions 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’20 and CODASPY’22). 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’ 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.
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