Newswise — In the USA, around three individuals pass away per day while waiting for a liver transplant, causing the loss of nearly 1,200 lives in 2021. Over the past decade, there have been significant revisions to liver allocation policies. However, a recent investigation by researchers has revealed that despite the modifications, regional disparities remain. The writers suggest a more effective and just approach to the distribution of livers.
The analysis, conducted by scholars from Carnegie Mellon University (CMU) and the University of Maryland (UMD), is soon to be published in Manufacturing & Service Operations Management.
Shubham Akshat, who helmed the research and serves as an Assistant Professor of Operations Management at CMU’s Tepper School of Business, recommends that policymakers abandon the current 'one-size-fits-all' approach and instead concentrate on aligning supply and demand to formulate liver allocation policies that perform well in terms of both efficiency and regional fairness.
In 1984, the U.S. government established the Organ Procurement and Transplantation Network (OPTN) to manage a nationwide transplant system and optimize the use of limited donor organs for transplants. Since 1986, the United Network for Organ Sharing, a nonprofit private organization, has been responsible for the day-to-day operations of OPTN. The Final Rule, a significant regulatory framework governing organ transplantation, was adopted by the U.S. Department of Health and Human Services in 1998. The rule stipulates that policies should not be based on a candidate's place of residence. However, unequal access to organs has been a persistent issue for over two decades. In 2012, OPTN's board embraced a strategic plan that aimed to reduce geographic disparities in accessing transplantation.
The United States is divided into 11 geographic regions, consisting of 58 Donation Service Areas (DSAs), for the purpose of organ allocation. A DSA-based allocation policy was implemented for 30 years, from 1989 to February 2020. It was later replaced by the Acuity Circles policy, which offers a one-size-fits-all approach to broader sharing.
Within the transplant community, broader organ sharing is viewed as a way to reduce geographic disparities in access to organs, such as variation in transplant rates, patient survival rates, waiting times, and offers. In this investigation, researchers devised a model based on approximately 40 medical characteristics of both patients and donors to examine allocation policies that differ from existing and proposed policies. The goal was to determine whether a superior alternative exists.
The researchers' model was successful in accurately forecasting the change in a patient's probability of accepting an organ offer as a result of a policy change. To accomplish this, they drew on data from the Scientific Registry of Transplant Recipients, which contains information on all donors, wait-listed candidates, and transplant recipients in the United States.
The researchers' model predictions led them to conclude that broader sharing, as part of Acuity Circles, may not be the optimal approach to achieve a balance between geographic equity and efficiency. Instead, they recommend a policy that equalizes the ratio of deceased donors to waiting list patients across geographic regions as a better alternative for achieving geographic equity with the least impact on efficiency.
Raghavan, Professor of Management Science and Operations Management at UMD and co-author of the study, asserts that recent policies are gravitating toward broader sharing in theory, but the current Acuity Circles policy results in even lower efficiency. Raghavan emphasizes that a tailored approach that involves equalizing the supply-to-demand ratios across the geographical regions of the United States is a superior alternative.
According to Liye Ma, Associate Professor of Marketing at UMD and co-author of the study, the model they created can be utilized to furnish more precise policy assessments to decision-makers.
Journal Link: Manufacturing and Service Operations Management
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