Optimization and Simulation of Kidney Paired Donation Programs

描述（由申请人提供）：肾脏配对捐赠（KPD）是一种不断发展的策略，它采用了一种技术解决方案来克服许多肾衰竭患者所面临的障碍，这些患者有意愿，但免疫或血型不相容的活体献血者。肾脏配对捐献使用计算机算法将一对不相容的供体/受体配对到另一对互补不相容的供体/受体配对，这样第一对供体的供体给第二对受体，反之亦然。我们还考虑涉及三对或更多对器官的更复杂的交换。此外，我们允许无私的捐赠者自愿捐献肾脏，从而有可能建立一个肾脏移植链。管理KPD项目的一个基本问题是从可能产生的许多数学上可能的替代组合中选择“最佳”移植组。最优分配的选择部分取决于特定移植的分配效用。我们表明这种选择也应该依赖于随机元素，并定义新的和更好的优化方法。我们将开发一个基于数据的KPD计划微观模拟模型，并利用该模型来评估不同的分配策略，比较这些策略对绩效结果的影响，并评估不同效用分配的效果。此外，我们将开发这些模型的用户友好版本，为负责管理KPD项目的个人提供决策支持。为了完成这些任务，我们提出了以下具体目标：目标1：开发考虑效用和不确定性的KPD计划中选择交易所和链的优化方法，并将这些新方法与目前仅基于效用的方法进行比较。这包括通过在现有KPD程序中的实现来测试和改进这些方法。目标2：利用基于多个数据源的模拟方法，开发一种全面的方法来对KPD计划的各个方面进行建模，并使用该微观模拟模型来评估政策决策和方法对KPD关键绩效指标的影响。目标3：开发一个用户友好的界面，以便在主动KPD计划中使用微观模拟模型进行决策支持。

DESCRIPTION (provided by applicant): An evolving strategy known as kidney paired donation (KPD) employs a technological solution to overcome the barriers faced by many patients with kidney failure who present with willing, but immunologically or blood type incompatible living donors. Kidney paired donation uses a computerized algorithm to match one incompatible donor/recipient pair to another pair with a complementary incompatibility, such that the donor of the first pair gives to the recipient of the second, and vice versa. We also consider more complex exchanges of organs involving three or more pairs. In addition, we allow for altruistic donors who donate a kidney voluntarily and thereby have the potential to create a chain of kidney transplants. A fundamental problem in managing a KPD program is selecting the "optimal" set of transplants from among the many mathematically possible alternative combinations that could be generated. The choice of an optimal allocation depends in part on the assigned utility of a specific transplant. We show that this choice should also depend on stochastic elements and define new and better methods for optimization. We will develop a data-based micro-simulation model of KPD program, and utilize that model to evaluate different allocation strategies, to compare the impact of these strategies on performance outcomes, and to assess effects of different utility assignments. In addition, we will develop a user-friendly version of these models to provide decision support to individuals charged with managing KPD programs. To accomplish these tasks, we propose the following specific aims: Aim 1: Develop optimization methods for selecting exchanges and chains in a KPD program that take account of utility and uncertainty, and to compare these new methods with those currently in use that are based solely on utility. This includes testing and refining these methods through their implementation in existing KPD programs. Aim 2: To develop a holistic approach to the modeling of all aspects of a KPD program using simulation methods based on multiple data sources, and the use of this micro simulation model to assess the effects of policy decisions and approaches on key performance measures of a KPD. Aim 3: To develop a user friendly interface to enable the use of the micro simulation model for decision support in active KPD programs.