Improving Access to Lung Transplant Through Broader Geographic Sharing

项目总结/摘要 病情最严重的病人应该优先获得器官移植，以避免在等待名单上死亡。 然而，虽然高急性患者占美国肺移植等待名单的10%，但他们占美国肺移植等待名单的60%。 肺移植等候名单死亡美国有59个捐助者服务区（DSA），其边界是 1984年根据少数早期移植中心的偏好创建。多年来，这些界限 我创建了一个系统，其中DSA内分配的81%的供体肺是低敏度患者，即使 匹配的高敏度患者存在于单独DSA的边界之外，导致可避免的 等待名单死亡。这项拨款是基于这样一种观念，即这些地理边界是人为的分配 限制高优先级患者接受肺移植的标准。它进一步作为对美国的回应。 政府授权确定解决方案，尽量减少地理因素在器官分配中的作用。长期 我们的目标是系统地解决器官分配的差异;其中一个例子是地理差异 获得肺移植。有证据表明，其他实体器官的更广泛的地理共享可以减少 可避免的等候名单死亡，但是，肺分配中更广泛的共享的作用仍有待阐明。的 中心假设是，更广泛的捐赠肺的地理共享将减少可避免的等待名单死亡。这 本研究将透过两个独立的特定目标来检验假设：（1）比较等候病人的效果 在可避免的等待名单死亡上，多个DSA与一个DSA相比。(2)比较共享供体肺的效果 超出了目前每日生活津贴的范围，可避免的等待名单死亡。这笔赠款还将评估旅行的影响 患者和移植中心的成本可能是政策实施的障碍。拟议研究 是重要的，因为它可以减少可避免的等待名单死亡，并适用于其他实体器官 移植该提案具有创新性，因为它是第一个将已知方法应用于经济建模的提案 以更好地了解政策变化对患者和移植中心的影响。这 研究将在Raed Dweik博士的指导下进行，他具有丰富的指导经验 K获奖，并担任全市范围内，多学科KL 2学者计划主任。一个辅导 该委员会结合了移植专业知识和指导科学家走向R 01的记录 独立性（黑石、Erzurum、Palmer和Valapour博士）帮助制定了职业发展计划 这将有助于成功获得博士学位。我们的目标是获得技能，将建立在良好的- 导师和合作者的既定技能，只能通过在 职业生涯的早期阶段。该应用程序强调致力于以患者为导向的研究，强 指导，以及克利夫兰诊所致力于培训下一代独立R 01资助 医学科学家

Project Summary/Abstract The sickest patients should receive priority access for organ transplant to avoid dying on the waitlist. However, while high acuity patients comprise 10% of the U.S. lung transplant waitlist, they account for 60% of lung transplant waitlist deaths. There are 59 Donor Service Areas (DSAs) in the U.S. whose boundaries were created in 1984 based on the preferences of the few early transplant centers. Over the years, these boundaries have created a system where 81% of donor lungs allocated within a DSA are to low acuity patients even when a matched higher acuity patient exists just outside the boundaries in a separate DSA, resulting in an avoidable waitlist death. This grant is premised on the notion that these geographic boundaries are an artificial allocation criterion limiting access of high priority patients to lung transplant. It further serves as a response to a U.S. government mandate to identify solutions to minimize the role of geography in organ allocation. The long-term goal is to systematically address disparities in organ allocation; an example of which is the geographic disparity in access to lung transplant. Evidence suggests that broader geographic sharing of other solid organs can reduce avoidable waitlist deaths, however the role of broader sharing in lung allocation remains to be elucidated. The central hypothesis is that broader geographic sharing of donor lungs will reduce avoidable waitlist deaths. This hypothesis will be tested through two independent specific aims: (1) Compare the effect of waitlisting patients in multiple DSAs vs one DSA on avoidable waitlist deaths. (2) Compare the effect of sharing donor lungs beyond current DSA boundaries on avoidable waitlist deaths. This grant will also assess the impact of travel costs on patients and transplant centers which may be a barrier to policy implementation. The proposed research is significant because it could reduce avoidable waitlist deaths and have applications to other solid organ transplants. The proposal is innovative because it is the first to apply known methodologies in economic modeling to organ allocation to better understand the impact of policy changes on patients and transplant centers. This research will be performed under the mentorship of Dr. Raed Dweik, who has extensive experience mentoring K awardees and serves as director of the city-wide, multidisciplinary KL2 Scholars Program. A mentoring committee which combines transplant expertise and a track record of guiding scientists towards R01 independence (Drs. Blackstone, Erzurum, Palmer, and Valapour) has helped create a career development plan that will build towards a successful PhD degree. The objective is to gain skills that will build on the well- established skillset of the mentors and collaborators which can only be earned through further education during this early career phase. This application emphasizes a commitment to patient-oriented research, strong mentorship, and the dedication of the Cleveland Clinic to training the next generation of independent R01 funded physician scientists.