Addressing Geographical Disparities in Transplant Organ Accessibility Across United States

这项研究的目的是开发具有足够粒度的先进数学模型，以指导器官共享联合网络决策者制定一项可实施的政策，以减少肾脏分配的地理差异。 目前有近70万患者接受血液透析或肾移植形式的肾脏替代治疗，每年消耗240亿美元（6.4%）的医疗保险支出。 肾移植，即患者从已故或活着的捐赠者那里接受健康的肾脏，具有81.2%的显着更好的五年患者生存率，提高了生活质量，并节省了显着的成本。 然而，肾移植因可用肾器官短缺而受到损害。 美国卫生与公众服务部在其“最终规则”中指出，“器官和组织的分配应基于客观的优先标准，而不是基于地理上的偶然性。" 目前的国家肾脏分配系统受到与肾脏移植相关的等待时间的地理差异的困扰。 在2000-2009年期间，根据病人所在地区的不同，平均等待时间从0.93年到4.14年不等。 该模型将在一个优化框架中纳入基于模拟的输入和输出，该框架在规划型框架内始终考虑多个股权目标。 这样的建模是必要的，将详细的患者人群的特征，移植中心的行为，可用器官的质量，可接受的模型生成的解决方案的关键利益相关者，并易于实施的建议policy.The解决方案的技术和算法开发的这项研究将有可能适用于其他分配问题的公平需要实现。 该项目将涉及并培训研究生，研究成果将通过在国家会议上的介绍用于向移植界提供信息。

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.