Optimal Management of Expedited Placement Livers

得到支持的研究的总体目标是满足快速安置肝脏管理中对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接受者放置在一起。为了加快这一过程，协调人通常会同时延长多个报价。但是，如果采购协调员感觉这一过程仍然不会足够快地产生匹配结果，则协调员可启动“加速安置”。一旦做出这一决定，协调员就会放弃名单，将器官不是提供给个人，而是提供给移植中心；然后该中心要么拒绝该器官，要么从其患者名单中选择一个接受者。从采购协调员的角度看，涉及的具体决定包括：在执行匹配清单程序时，同时延长多少报盘？什么时候放弃配对名单，开始快速安置？从移植中心的角度来看：它应该为哪位患者(如果有的话)分配一个快速放置的器官？PI将通过对由临床数据驱动的数学模型的严格分析，审查围绕着未公开但普遍存在的加速放置捐赠肝脏的做法的这些敏感资源分配问题。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，更好地匹配捐赠者和接受者，拯救生命，并提高移植后的存活预期。

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.