Efficient and Fair Heart Allocation Policies forTransplantation

摘要

>Background: The optimal allocation of limited donated hearts to patients on the waiting list is one of the top priorities in heart transplantation management. We developed a simulation model of the US waiting list for heart transplantation to investigate the potential impacts of allocation policies on several outcomes such as pre- and posttransplant mortality. >Methods: We used data from the United Network for Organ Sharing (UNOS) and the Scientific Registry of Transplant Recipient (SRTR) to simulate the heart allocation system. The model is validated by comparing the outcomes of the simulation with historical data. We also adapted fairness schemes studied in welfare economics to provide a framework to assess the fairness of allocation policies for transplantation. We considered three allocation policies, each a modification to the current UNOS allocation policy, and analyzed their performance via simulation. The first policy broadens the geographical allocation zones, the second modifies the health status order for receiving hearts, and the third prioritizes patients according to their waiting time. >Results: Our results showed that the allocation policysimilar to the current UNOS practice except that it aggregates the threeimmediate geographical allocation zones, improves the health outcomes, and is“closer” to an optimal fair policy compared to all other policies considered inthis study. Specifically, this policy could have saved 319 total deaths (out of3738 deaths) during the 2006 to 2014 time horizon, in average. This policyslightly differs from the current UNOS allocation policy and allows for easyimplementation. >Conclusion: We developed a model to compare theoutcomes of heart allocation policies. Combining the three immediategeographical zones in the current allocation algorithm could potentially reducemortality rate and is closer to an optimal fair policy.