RAPID: Addressing Geographic Disparities in the National Organ Transplant Network

肝移植是目前唯一已知的终末期肝病的医学治疗，具有确定的生存益处。在美国，目前的分配政策在几个指标上继续导致供体器官的地域差异。差距包括等候名单上的病人死亡的比例，以及病人在该国不同地区被移植的疾病程度。这项快速反应研究（Rapid）奖支持改进和增强一种新的基于社区的器官分配方法，目前正在考虑由联合器官共享网络（UNOS）肝脏和肠道委员会的政策制定者采用。这些改进特别解决了通过更好地匹配供体器官和移植受益人来减少地域差异的问题。该奖项将为UNOS和美国更广泛的移植社区提供决策支持。该RAPID奖项将支持利用国家数据集扩展先前开发的优化模型的活动。由于该模型涉及高度复杂的多目标优化，因此对现有模型的改进极具挑战性，因为确定可接受的解决方案涉及长时间的模拟和几个参数的操纵以及器官采购组织之间的结构联系。模拟工具将公开提供，从改进的模型收集的数据预计将对广泛的人口部分产生影响。运筹学、管理科学、移植外科和肝病学界的研究人员将通过在国家会议上的演讲来接受教育。一名研究生将作为研究的一部分接受培训，临床医生也将接受教育，了解在考虑公共卫生挑战时科学建模方法的作用。

Liver transplantation is currently the only known medical treatment for End-stage Liver Disease with established survival benefits. In the United States, current allocation policies continue to result in geographical disparities for donor organs on several metrics. Disparities include the fraction of waitlisted patients dying on the waitlist, and the sickness level at which patients are transplanted in different areas of the country. This Rapid Response Research (RAPID) award supports refinements and enhancements to a novel neighborhood-based organ allocation approach currently being considered for adoption by policy makers on the United Network for Organ Sharing (UNOS) Liver and Intestine Committee. The refinements specifically address reducing geographic disparities by better matching donor organs with transplant beneficiaries. This award will provide decision support to UNOS and the broader transplantation community in the U.S.This RAPID award will support activities to take to scale the previously developed optimization model by utilizing national datasets. Because the model involves a highly complex multi-objective optimization, a refinement of the existing model is highly challenging, as identifying acceptable solutions involves lengthy simulations and manipulation of several parameters and structural linkages between organ procurement organizations. The simulation tools will be publicly available, and the data collected from an improved model is expected to have an impact on a broad population segment. Researchers in operations research, management science, transplant surgery, and the hepatology communities will be educated through presentation at national conferences. A graduate student will be trained as part of the research, and clinicians will also be educated as to the role of a scientific modeling approach when considering public health challenges.