A Simulation-Based Optimization Model to Study the Impact of Multiple-Region Listing and Information Sharing on Kidney Transplant Outcomes
Abstract
:1. Introduction
- Multiple-listing: Transferring to a region with a shorter wait time or waitlisting in multiple regions can help a patient by increasing her chance to receive a kidney transplant earlier. Consequently, the patient can improve post-transplant outcomes due to less health deterioration of staying on dialysis. However, developing a strategy to guide the patient’s decision to transferring or multilisting is not easy. We formulate the decision as a utility maximization problem under a set of budget, distance, and facility constraints at the regional level. Supply and demand vary widely across the 11 US regions and for different blood types. Such a variation results in widely varying wait times, leading to different expected utilities and optimal kidney acceptance strategies (expressed as optimal kidney quality thresholds). To derive a patient’s utility for different regions, we use the simulation model to obtain the utility under individualized optimal kidney transplant acceptance decisions based on the patient’s health status and supply and demand for the patient’s blood type. We use the obtained information to solve the optimization problem and derive an optimal region selection policy.
- Information technology: Rapid and precise communication between UNOS and transplant centers is necessary to make organ allocation more efficient, which even becomes more critical in the face of multilisted patients. UNOS has the goal to increase the use of information technology in organ allocation and transplantation. They have implemented a secure online-based system that collects data to enhance the transplant system’s capability to improve the patient’s chance of receiving a life-saving organ. As technology has evolved, UNOS also encourages developing and using modern technology such as mobile devices for faster and more efficient consideration of donor’s kidney offers to achieve a higher kidney utilization rate [22].For instance, mobile devices will make it easier to collect up-to-date patients’ availability for transplantation (e.g., via an app). Using this information, OPTN will allocate the kidney faster, reducing kidney deterioration and discard. In the ideal case of perfect information, OPTN could find the first patient on the waitlist who will instantly accept the kidney, reducing CIT and discard to a minimum. The presented simulation evaluates the effect of a realistic case of imperfect information sharing.
2. Literature Review
2.1. Medical Literature
2.2. Analytical Literature
3. Models Description
3.1. Simulation Model
3.1.1. Organ Demand
3.1.2. Organ Supply
3.1.3. Kidney Acceptance/Rejection Decision
3.1.4. Patient’s Post-Transplant Utility
3.2. Region Selection and Multiple Listing Optimization Model
4. Applications and Numerical Results
4.1. Parameters Estimation
4.2. Region Selection and Multiple Listing
4.3. The Effect of Information Sharing on Allocation Efficiency
- The patient’s acceptance threshold k: Each patient reports her kidney quality acceptance threshold k decided by herself and her physician.
- Any additional decision criteria used by the patient: The patient’s and surgeon’s decision can be affected by information not included in the kidney quality assessment (KDPI). Having more standardized quality parameters, where the patient can prespecify what she accepts, would improve kidney allocation. Under complete information, OPTN could instantly identify the patients who would accept the kidney and save valuable CIT.
- The patient’s current availability: An up-to-date indication if the patient can currently receive transplantation. Factors include current health and traveling.
- The transplant center’s availability: Considers the availability of the transplant center’s facility such as prepared operating rooms, surgeons, nurses, and staffs for performing the surgery on time.
5. Concluding Remarks
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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One-Year Post Transplant Patient and Graft Survival Rate | ||||
---|---|---|---|---|
Region | Patient Survival Rate | 95% Confidence | Graft Survival Rate | 95% Confidence |
1 | 96 | (94.9, 96.8) | 93 | (91.6, 94.1) |
2 | 95.7 | (95.1, 96.2) | 92 | (91.3, 92.7) |
3 | 96.4 | (95.9, 96.8) | 93.5 | (92.8, 94.0) |
4 | 95.8 | (95.2, 96.4) | 93.1 | (92.3, 93.8) |
5 | 97 | (96.6, 97.4) | 94 | (93.5, 94.5) |
6 | 98 | (97.2, 98.5) | 96.3 | (95.3, 97.1) |
7 | 95.3 | (94.5, 96.0) | 93 | (92.0, 93.8) |
8 | 97 | (96.3, 97.5) | 93.7 | (92.8, 94.5) |
9 | 95.2 | (94.5, 96.1) | 91.6 | (90.5, 92.5) |
10 | 95.7 | (95.0, 96.3) | 92.6 | (91.7, 93.4) |
11 | 96.6 | (96.0, 97.0) | 93.3 | (92.6, 94.0) |
1 | 82.1 | (80.0, 84.0) | 75 | (72.7, 77.1) |
2 | 80.7 | (79.6, 81.8) | 69.9 | (68.6, 71.1) |
3 | 84.7 | (83.8, 85.6) | 76.2 | (75.1, 77.3) |
4 | 84.6 | (83.4, 85.8) | 75.1 | (73.6, 76.5) |
5 | 85.5 | (84.6, 86.4) | 79 | (78.0, 80.0) |
6 | 88.8 | (87.0, 90.3) | 82.7 | (80.7, 84.6) |
7 | 82.3 | (81.0, 83.6) | 73.8 | (72.3, 75.2) |
8 | 84 | (82.6, 85.4) | 75.5 | (73.8, 77.0) |
9 | 80 | (78.5, 81.5) | 69.8 | (68.1, 71.5) |
10 | 81.7 | (80.3, 83.0) | 71.9 | (70.3, 73.4) |
11 | 82.5 | (81.4, 83.6) | 72.3 | (71.0, 73.5) |
US | A | B | D | H | HR | NL | SLO | Total ET | |
---|---|---|---|---|---|---|---|---|---|
Total deceased donors | 11,152 | 197 | 276 | 904 | 167 | 127 | 289 | 50 | 2010 |
Deceased kidney transplantation | 16,534 | 298 | 426 | 1536 | 281 | 158 | 445 | 53 | 3197 |
Waitlist mortality | 4012 | 30 | 29 | 399 | 52 | 10 | 67 | 1 | 588 |
No longer eligible for transplant | 4285 | 23 | 43 | 187 | 24 | 7 | 112 | 9 | 405 |
Waiting list addition | 34,480 | 487 | 616 | 2797 | 376 | 223 | 1510 | 77 | 6086 |
Current kidney waiting list length | 99,122 | 616 | 870 | 6881 | 824 | 231 | 803 | 95 | 10,320 |
Region | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | All Regions |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Deceased donor | 399 | 1373 | 1639 | 1196 | 1758 | 475 | 833 | 854 | 461 | 953 | 1211 | 11,152 |
Transplant (from deceased donor) | 597 | 1885 | 2491 | 1632 | 2771 | 605 | 1122 | 1151 | 1039 | 1350 | 1891 | 16,534 |
Current waitlist length | 4846 | 12,580 | 12,818 | 10,447 | 22,366 | 2512 | 7258 | 3741 | 7696 | 5348 | 9523 | 99,122 |
Waitlist addition | 1546 | 4178 | 4687 | 3990 | 5884 | 1007 | 2741 | 1771 | 2369 | 2445 | 3862 | 34,480 |
Waitlist removal (death) | 197 | 523 | 560 | 387 | 1021 | 49 | 268 | 141 | 327 | 201 | 338 | 4012 |
Waitlist removal (health) | 184 | 551 | 588 | 530 | 677 | 159 | 375 | 173 | 264 | 282 | 502 | 4285 |
Numbers of OPOs | 2 | 5 | 10 | 4 | 8 | 3 | 4 | 5 | 4 | 6 | 7 | 58 |
Numbers of Transplant centers | 14 | 36 | 30 | 29 | 31 | 10 | 23 | 18 | 16 | 20 | 24 | 251 |
Blood Type | % of US | Can Donate Kidney to | Can Receive Kidney from |
---|---|---|---|
O | 45% | O, A, B, AB | O |
A | 40% | A, AB | O, A |
B | 11% | B, AB | O, B |
AB | 4% | AB | O, A, B, AB |
Region | Kindey Arrival Rate to Blood Type A Queue () | Blood Type A Patient Arrival Rate () |
---|---|---|
1 | 229 | 536 |
2 | 748 | 1774 |
3 | 892 | 1680 |
4 | 587 | 1154 |
5 | 882 | 1914 |
6 | 270 | 378 |
7 | 461 | 1008 |
8 | 436 | 690 |
9 | 220 | 735 |
10 | 548 | 1040 |
11 | 590 | 1089 |
Region | Kidney Arrival Rate | Optimal Kidney Quality | Average Life Years Gain |
---|---|---|---|
b | to Blood Type A Queue () | Acceptance Threshold () | form Transplant () |
1 | 229 | 0.60 | 9.12 |
2 | 748 | 0.85 | 13.23 |
3 | 892 | 0.85 | 13.57 |
4 | 587 | 0.80 | 12.81 |
5 | 882 | 0.85 | 13.50 |
6 | 270 | 0.65 | 9.65 |
7 | 461 | 0.75 | 12.00 |
8 | 436 | 0.75 | 11.90 |
9 | 220 | 0.60 | 8.9 |
10 | 548 | 0.80 | 12.70 |
11 | 590 | 0.80 | 12.84 |
Region | Cost of Living per Month | Expected Wait Time in Years | Evaluations | Evaluation Cost | Survival Rate (5 Year) | Distance (Air Miles) | |
---|---|---|---|---|---|---|---|
1 | $2454 | 2.4 | 4 | $6381 | 73% | 2200 | 9.1 |
2 | $1879 | 1.8 | 3 | $4614 | 70% | 1904 | 13.2 |
3 | $1637 | 1.9 | 3 | $4541 | 76% | 1706 | 13.6 |
4 | $2328 | 1.4 | 2 | $3166 | 75% | 1160 | 12.8 |
5 | $2130 | 2.5 | 5 | $7815 | 79% | 374 | 13.5 |
6 | $2413 | 1.6 | 3 | $0 | 83% | 0 | 9.7 |
7 | $2686 | 2.3 | 4 | $6474 | 74% | 670 | 12.0 |
8 | $2869 | 1.4 | 2 | $3274 | 76% | 569 | 11.9 |
9 | $2705 | 2.2 | 4 | $6482 | 69% | 1195 | 8.9 |
10 | $2005 | 1.8 | 3 | $4651 | 72% | 565 | 12.7 |
11 | $2706 | 1.4 | 2 | $3241 | 72% | 941 | 12.8 |
Group Size g | Waitlist Position (Mean) | Waitlist Position (Max) | Average q | Average Patient Utility (Year) |
---|---|---|---|---|
5 | 6.00 | 45 | 0.66 | 10.76 |
10 | 8.00 | 80 | 0.62 | 11.20 |
20 | 10.00 | 119 | 0.60 | 11.14 |
100 | 22.00 | 344 | 0.57 | 11.35 |
100,000 | 58.00 | 1383 | 0.55 | 11.50 |
Group Size g | Kidney Utilization Rate | Kidney Discard Rate | Waitlist Removal Rate | Kidney Transplant Rate |
---|---|---|---|---|
5 | 85.0% | 15.0% | 8.9% | 17% |
10 | 90.9% | 9.1% | 8.3% | 20% |
20 | 94.3% | 5.7% | 7.9% | 21.5% |
100 | 98.5% | 1.5% | 7.3% | 23.8% |
100,000 | 99.98% | 0.02% | 7.1% | 25.2% |
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Gharibi, Z.; Hahsler, M. A Simulation-Based Optimization Model to Study the Impact of Multiple-Region Listing and Information Sharing on Kidney Transplant Outcomes. Int. J. Environ. Res. Public Health 2021, 18, 873. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18030873
Gharibi Z, Hahsler M. A Simulation-Based Optimization Model to Study the Impact of Multiple-Region Listing and Information Sharing on Kidney Transplant Outcomes. International Journal of Environmental Research and Public Health. 2021; 18(3):873. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18030873
Chicago/Turabian StyleGharibi, Zahra, and Michael Hahsler. 2021. "A Simulation-Based Optimization Model to Study the Impact of Multiple-Region Listing and Information Sharing on Kidney Transplant Outcomes" International Journal of Environmental Research and Public Health 18, no. 3: 873. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18030873