Transplant quality and patientsʼ preferences in paired kidney exchange

► We model Paired Kidney Exchange (PKE) under logistic feasibility constraints. ► The quality of the match between donors and recipients affects the results of PKE. ► Individually rational and efficient PKE rules are manipulable by the patients. ► Patients are extreme-risk averters and follow the protective behavior. ► Pairwise exchange maximizing rules induce truthful behavior for the patients.