Optimizing the Regional Distribution of Organ Procurement Organizations

University Of Pittsburgh, Pittsburgh PA

Investigators

Abstract

This project addresses the design of regions for organ transplantations. Over 82 thousand Americans are currently waiting for an organ transplant, and this number is still increasing. By optimizing regions for organ transplantation this research will increase the quality of the matches. Furthermore, by explicitly modeling equity issues, this research can be used to ensure that all groups have fair access to organs for transplants. The previous work will extend in three important directions. The first will model the complex nature of organ transplantation carefully to estimate the expected number and quality of organ transplants within each potential region. This will involve both demographic and physiological modeling. The second will consider fairness within an organ transplantation system. This is roughly equivalent to the notion that all citizens should have comparable access to organs. The notion of equity is often in conflict with medical efficiency. This research will consider various ways of balancing these competing interests. The third will develop methods for solving the large-scale integer programs arising in these studies. Borrowing ideas from previous work, particularly airline planning, we will develop state-of-the-art optimization methods for solving these difficult problems. We will use a branch-and-price framework, using specialized techniques for branching and solving the sub problems. For purposes of liver transplantation, the United States is currently divided into 59 OPOs, which are aggregated into 11 regions. Organs are more likely to stay in the OPO and region where they originate. Due to the hierarchical nature of organ transplantation, the composition of these regions can greatly affect the number and quality of organ transplantations, as well as other concerns, such as fair access to organs for all. From the point of view of medical efficiency, an ideal region has a high population so many matches are possible, but is geographically compact, so that organs need not travel long distances. However, employing such regions tends to leave the sparsely populated parts of the country with significantly lower access to organs. This proposal addresses the following question: How should the OPOs be organized into the best set regions, considering both medical efficiency and equity? The focus will be on the liver transplantation, but the results will apply to other organs.