Liver Simulated Allocation Modeling: Were the Predictions Accurate for Share 35?

Area of Science:

• Hepatology
• Transplant Surgery
• Health Policy Analysis

Background:

• The liver simulated allocation model (LSAM) is a tool for evaluating liver transplant allocation policy impacts.
• The Share 35 policy change in June 2013 provided an opportunity to test LSAM's predictive accuracy.

Purpose of the Study:

• To assess the predictive performance of LSAM by comparing its projections with actual outcomes following the Share 35 policy implementation.
• To evaluate LSAM's ability to forecast changes in organ offers, acceptance, waitlist survival, and posttransplant survival.

Main Methods:

• LSAM projections for liver transplants one year pre- and post-Share 35 were compared to observed data.
• Key metrics analyzed included organs recovered, organ sharing, transplant rates, and waitlist mortality rates.

Main Results:

• LSAM accurately predicted an increase in accepted organs and a decrease in discarded organs post-Share 35.
• The model correctly projected increased regional and national organ sharing, higher transplant rates, and decreased waitlist mortality.
• While the magnitude of some changes was overestimated, LSAM's predictions aligned with the observed direction of outcomes.

Conclusions:

• LSAM demonstrated effectiveness in predicting the directional changes in liver transplant outcomes following the Share 35 policy.
• The model's predictions for discarded organs, organ sharing, waitlist mortality, and transplant rates were consistent with real-world data.
• Despite underestimating the total number of transplants, LSAM provides a valuable tool for policy analysis in liver transplantation.