Addressing Geographical Disparities in Transplant Organ Accessibility Across United States

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The objective of this research is to develop advanced mathematical models with sufficient granularity to guide the United Network of Organ Sharing decision makers in crafting an implementable policy towards reducing the geographic disparity of Kidney allocation over time. Nearly 700,000 patients currently receive kidney replacement therapy either in the form of hemodialysis or kidney transplantation, consuming $24 billion (6.4 percent) in Medicare expenditures annually. Kidney transplantation, where a patient receives a healthy kidney from either a deceased or living donor, has a significantly better five-year patient survival of 81.2 percent, an improved quality of life, and leads to significant cost-savings. However, kidney transplantation is marred by the shortage of available kidney organs. The US Department of Health and Human Services in their "Final Rule" states, "Organs and tissues ought to be distributed on the basis of objective priority criteria, and not on the basis of accidents of geography." The current national kidney allocation system is plagued by geographic disparities in the waiting time associated with kidney transplantation. The median waiting time during 2000-2009 varies from 0.93 years to 4.14 years depending on a patient's local area of listing. The model will incorporate simulation based input and output in an optimization framework that consistently considers multiple equity objectives within a planning-type framework. Such modeling is necessary to incorporate detailed patient population characteristics, transplant center behavior, the quality of available organs, acceptability of the model generated solution by key stakeholders, and the ease of implementing the suggested policy.The solution techniques and algorithms developed for this research would be potentially applicable to other distribution problems where equity needs to be achieved. The project will involve and train graduate students and research outcomes will be used to inform the transplant community through presentations at national conferences.