Mitigating Geographic Disparity in Deceased-Donor Liver Allocation using a Systems-Approach.

Northwestern University, Evanston IL

Investigators

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Abstract

Thousands of Americans in need of a liver for transplantation are affected by the shortage of available organs. The majority of organs are procured from deceased donors and allocated nationwide by policy. Unfortunately, access to transplant varies significantly across geographic regions. Patients with similar medical urgency in different parts of the country face significantly different waiting times. This defies the U.S. Department of Health and Human Services' mandate that ?organs and tissues ought to be distributed on the basis of objective priority criteria, and not on the basis of accidents of geography.? Reforms that mitigate such disparities have been proposed recently, but they lack evidence of being resilient to changes in organ donation rates and patient waitlist rates over time. This study proposes a multidisciplinary investigation that aims to formulate an optimization model which minimizes geographic disparity in liver allocation. The model formulation, which is based on flexible manufacturing systems, offers potentially greater resilience to changes in organ donation rates and patient waitlist rates over time by ?linking? geographic regions. Moreover, the model formulation bears enough resemblance to current reforms to warrant a realistic implementation in practice. Additionally, this study aims to validate the model's performance in a more realistic simulation environment and disseminate the results to policymakers in transplantation. The intended study is part of the principal investigator's remaining doctoral dissertation. He and his research mentors have worked intensively on this topic and are engaged with relevant policy authorities to resolve this important issue.