Decision Algorithm for Heuristic Donor-Recipient Matching

This paper introduces the application of artificial intelligence paradigm towards precision medicine in renal transplantation. The match of the optimal donor-recipient pair in kidney transplantation in Latvian Transplant Centre (LTC) has been constrained by the lack of prediction models and algorithms. Consequently, LTC seeks for practical intelligent computing solution to assist the clinical setting decision-makers during their search for the optimal donor-recipient match. Therefore, by optimizing both the donor and recipient profiles, prioritizing importance of the features, and based on greedy algorithm approach, advanced decision algorithm has been created. The strength of proposed algorithm lies in identification of suitable donors for a specific recipient based on evaluation of criteria by points principle. Experimental study demonstrates that the decision algorithm for heuristic donor-recipient matching integrated in machine learning approach improves the ability of optimal allocation of renal in LTC. It is an important step towards personalized medicine in clinical settings

Kidney Exchange Programs: Incentives for Compatible Couples

openThe increasing number of kidney diseases and the shortage of kidneys for transplantations are critical points for the public health in the world and in Italy as well. Dialysis procedures are helpful treatments, but they do not represent the optimal choice in the long term, neither for the costs nor for the health of the patients. The waiting list for an organ from a deceased donor require a lot of time and cannot be predicted. Anyway, the transplantation from living donor is the best choice, ceteris paribus. There are incompatibilities among the people that hinder the transplantations and others that can be overcome only through extremely expensive. Thanks to the kidney exchange programs, it is possible to find the best matches for the couples, but it is important which objectives need to be prioritized. Through the counterfactual exercise conducted on the pool of transplanted couples and incompatible couples in Padua, it has been possible to verify the efficiency of a proposal for an exchange program. The three categories of couples (compatible, half-compatible and incompatible) have different urgencies and the likelihood of participating to a kidney exchange program is not the same. The priority should be given to the incompatible couples, who do not have a viable alternative for the transplantation but are forced to wait for a deceased donor with a compatible kidney. They should be the first target of the exchange programs. The half-compatible couples can be transplanted after desensitization, which is an expensive treatment, and does not guarantee the same expected outcome of a compatible kidney. Therefore, half-compatible couples should be favored in finding a match that avoids desensitization. The objective of avoiding the HLA desensitization is prepended to the objective of avoiding the ABO desensitization due to the higher graft reject. The compatible couples are the ones with less incentive to participate to such programs because they may undergo transplantation, but there are factors that suggests that they may benefit from finding another match. For instance, a younger organ or a more balanced BMI ratio between donor and recipient are factors that improve the expected outcome. The threshold of the LKDPI improvement should balance the expected benefits and the risk of participating without finding a better match, that is the worst option. The Living Donor Kidney Profile Index (LKDPI) is a measurement that assist in the prediction of the outcome of a transplantation. It is useful to classify the compatible couples and understand their likelihood to take part to a kidney exchange program. A low value of the LKDPI means a lower probability of finding a better match. Consequentially, a high value implies a high probability of finding a better match. For this reason, it is useful to create four categories for the compatible couples, according to their LKDPI score. To each category there is a probability associated, which represent the likelihood of participating or not to a kidney exchange program. It is downward according to the LKDPI of the couple. The participation of all the compatible couples is not an optimal choice because a large part will not find a better match and will have to bear the extra costs of the dialysis with all the psychological and physical costs related. The inclusion of the categories is finalized to limit this time waste. The results of the counterfactual exercise confirmed that the participation of the compatible couples is fundamental because it enlarges the number of couples participating. With a larger pool, it is easier to find a compatible match for the incompatible couples, that can finally undergo the transplantation, and for the half-compatible couples, that can avoid the desensitization processes. Thus, the participation of the compatible couples is fundamental for the right functioning of the kidney exchange programs.The increasing number of kidney diseases and the shortage of kidneys for transplantations are critical points for the public health in the world and in Italy as well. Dialysis procedures are helpful treatments, but they do not represent the optimal choice in the long term, neither for the costs nor for the health of the patients. The waiting list for an organ from a deceased donor require a lot of time and cannot be predicted. Anyway, the transplantation from living donor is the best choice, ceteris paribus. There are incompatibilities among the people that hinder the transplantations and others that can be overcome only through extremely expensive. Thanks to the kidney exchange programs, it is possible to find the best matches for the couples, but it is important which objectives need to be prioritized. Through the counterfactual exercise conducted on the pool of transplanted couples and incompatible couples in Padua, it has been possible to verify the efficiency of a proposal for an exchange program. The three categories of couples (compatible, half-compatible and incompatible) have different urgencies and the likelihood of participating to a kidney exchange program is not the same. The priority should be given to the incompatible couples, who do not have a viable alternative for the transplantation but are forced to wait for a deceased donor with a compatible kidney. They should be the first target of the exchange programs. The half-compatible couples can be transplanted after desensitization, which is an expensive treatment, and does not guarantee the same expected outcome of a compatible kidney. Therefore, half-compatible couples should be favored in finding a match that avoids desensitization. The objective of avoiding the HLA desensitization is prepended to the objective of avoiding the ABO desensitization due to the higher graft reject. The compatible couples are the ones with less incentive to participate to such programs because they may undergo transplantation, but there are factors that suggests that they may benefit from finding another match. For instance, a younger organ or a more balanced BMI ratio between donor and recipient are factors that improve the expected outcome. The threshold of the LKDPI improvement should balance the expected benefits and the risk of participating without finding a better match, that is the worst option. The Living Donor Kidney Profile Index (LKDPI) is a measurement that assist in the prediction of the outcome of a transplantation. It is useful to classify the compatible couples and understand their likelihood to take part to a kidney exchange program. A low value of the LKDPI means a lower probability of finding a better match. Consequentially, a high value implies a high probability of finding a better match. For this reason, it is useful to create four categories for the compatible couples, according to their LKDPI score. To each category there is a probability associated, which represent the likelihood of participating or not to a kidney exchange program. It is downward according to the LKDPI of the couple. The participation of all the compatible couples is not an optimal choice because a large part will not find a better match and will have to bear the extra costs of the dialysis with all the psychological and physical costs related. The inclusion of the categories is finalized to limit this time waste. The results of the counterfactual exercise confirmed that the participation of the compatible couples is fundamental because it enlarges the number of couples participating. With a larger pool, it is easier to find a compatible match for the incompatible couples, that can finally undergo the transplantation, and for the half-compatible couples, that can avoid the desensitization processes. Thus, the participation of the compatible couples is fundamental for the right functioning of the kidney exchange programs

Textbook of Patient Safety and Clinical Risk Management

Implementing safety practices in healthcare saves lives and improves the quality of care: it is therefore vital to apply good clinical practices, such as the WHO surgical checklist, to adopt the most appropriate measures for the prevention of assistance-related risks, and to identify the potential ones using tools such as reporting & learning systems. The culture of safety in the care environment and of human factors influencing it should be developed from the beginning of medical studies and in the first years of professional practice, in order to have the maximum impact on clinicians' and nurses' behavior. Medical errors tend to vary with the level of proficiency and experience, and this must be taken into account in adverse events prevention. Human factors assume a decisive importance in resilient organizations, and an understanding of risk control and containment is fundamental for all medical and surgical specialties. This open access book offers recommendations and examples of how to improve patient safety by changing practices, introducing organizational and technological innovations, and creating effective, patient-centered, timely, efficient, and equitable care systems, in order to spread the quality and patient safety culture among the new generation of healthcare professionals, and is intended for residents and young professionals in different clinical specialties