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High emergency organ allocation rule in lung transplantation: a simulation study
Julien Riou1, Pierre-Yves Boëlle1, Jason D Christie2
1Sorbonne Universités, UPMC Université Paris 6, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), Paris, France.
ERJ Open Research
|November 29, 2017
Summary
Prioritizing sicker patients for lung transplants can reduce early deaths but may worsen long-term outcomes and increase waiting list size during organ scarcity.
Area of Science:
- Transplantation immunology
- Medical simulation
- Public health policy
Background:
- Lung transplantation is limited by organ donor scarcity, leading to long waiting times and patient mortality.
- Current organ allocation policies significantly impact patient outcomes and resource utilization.
Purpose of the Study:
- To evaluate the effects of a high emergency organ allocation policy on lung transplant outcomes.
- To compare waiting time, mortality, and survival rates under different allocation strategies using simulation.
Main Methods:
- Developed a simulation model of lung transplantation waiting queues.
- Compared two allocation strategies: waiting time only vs. prioritizing the sickest patients.
- Utilized data from the United Network for Organ Sharing (UNOS).
Main Results:
- High emergency allocation reduces early deaths when organ supply is sufficient.
- Lower organ supply with emergency allocation increases waiting list size and post-transplant survival deterioration.
- Emergency allocation improves waiting list mortality but can destabilize the list equilibrium.
Conclusions:
- High emergency organ allocation effectively reduces waiting list mortality.
- This strategy may have detrimental long-term effects in organ scarcity due to list disruption.
- The impact of emergency allocation is highly dependent on organ supply levels.
