Optimal Management of Expedited Placement Livers

支持研究的总体目标是满足快速安置肝脏管理中决策支持的关键需求。当肝脏被捐赠时，采购协调员试图使用优先匹配列表将器官与受体放置在一起。为了加快这一过程，协调员经常同时提供多个报价。但是，如果采购协调员感觉到这一过程仍然不能足够快地匹配，则协调员可以启动“快速配售”。“一旦做出决定，协调员就会放弃名单，并将器官提供给移植中心，而不是个人;然后该中心要么拒绝器官，要么从患者名单中选择受体。从采购协调员的角度来看，感兴趣的具体决策包括：在实施匹配列表过程时，有多少同时提供？什么时候放弃匹配列表并启动加速安置？从移植中心的角度来看：它应该给哪些（如果有的话）病人分配一个快速安置器官？PI将通过对临床数据驱动的数学模型进行严格分析，检查这些敏感的资源分配问题，这些问题围绕着未公开但在分配捐赠肝脏时加速放置的常见做法。所产生的见解将为采购协调员和移植中心提供急需的支持，从而减少浪费的器官，更好的供体-受体匹配，挽救生命并提高移植后的生存预期。

The overall objective of the supported research is to fulfill the critical need for decision support in the management of expedited placement livers. When a liver is donated, a procurement coordinator attempts to place the organ with a recipient using a prioritized match list. To speed the process, coordinators often extend multiple offers simultaneously. However, if the procurement coordinator senses that the process will still not result in a match quickly enough, then the coordinator may initiate "expedited placement." Once this decision is made, the coordinator abandons the list and offers the organ not to an individual, but to a transplant center; the center then either declines the organ or selects a recipient from its list of patients. The specific decisions of interest from the procurement coordinator's perspective include: When implementing the match list process, how many simultaneous offers to extend? When to abandon the match list and initiate expedited placement? And from the transplant center's perspective: to which (if any) of its patients should it allocate an expedited placement organ? The PI will examine these sensitive resource allocation problems surrounding the unpublicized, yet common practice of expedited placement in allocating donated livers through rigorous analysis of mathematical models driven by clinical data. The insights generated will supply much needed support to procurement coordinators and transplant centers, resulting in fewer wasted organs, better donor-recipient matches, saved lives and improved post-transplant survival expectancies.