93 research outputs found
Simulating the Allocation of Organs for Transplantation
The demand for donated organs greatly exceeds supply and many candidates die awaiting transplantation. Policies for allocating deceased donor organs may address equity of access and medical efficacy, but typically must be implemented with incomplete information. Simulation-based analysis can inform the policy process by predicting the likely effects of alternative policies on a wide variety of outcomes of interest. This paper describes a family of simulations developed by the US Scientific Registry of Transplant Recipients and initial experience in the application of one member of this family, the Liver Simulated Allocation Model (LSAM).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45816/1/10729_2004_Article_5277541.pd
Organ donation in the United States
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72348/1/j.1600-6143.3.s4.4.x.pd
End-stage liver disease candidates at the highest model for end-stage liver disease scores have higher wait-list mortality than status-1A candidates
Candidates with fulminant hepatic failure (Statusâ1A) receive the highest priority for liver transplantation (LT) in the United States. However, no studies have compared waitâlist mortality risk among endâstage liver disease (ESLD) candidates with high Model for EndâStage Liver Disease (MELD) scores to those listed as Statusâ1A. We aimed to determine if there are MELD scores for ESLD candidates at which their waitâlist mortality risk is higher than that of Statusâ1A, and to identify the factors predicting waitâlist mortality among those who are Statusâ1A. Data were obtained from the Scientific Registry of Transplant Recipients for adult LT candidates (n = 52,459) listed between September 1, 2001, and December 31, 2007. Candidates listed for repeat LT as Statusâ1 A were excluded. Starting from the date of wait listing, candidates were followed for 14 days or until the earliest occurrence of death, transplant, or granting of an exception MELD score. ESLD candidates were categorized by MELD score, with a separate category for those with calculated MELD > 40. We compared waitâlist mortality between each MELD category and Statusâ1A (reference) using timeâdependent Cox regression. ESLD candidates with MELD > 40 had almost twice the waitâlist mortality risk of Statusâ1A candidates, with a covariateâadjusted hazard ratio of HR = 1.96 ( P = 0.004). There was no difference in waitâlist mortality risk for candidates with MELD 36â40 and Statusâ1A, whereas candidates with MELD 20 ( P = 0.6). Conclusion : Candidates with MELD > 40 have significantly higher waitâlist mortality and similar posttransplant survival as candidates who are Statusâ1A, and therefore, should be assigned higher priority than Statusâ1A for allocation. Because ESLD candidates with MELD 36â40 and Statusâ1A have similar waitâlist mortality risk and posttransplant survival, these candidates should be assigned similar rather than sequential priority for deceased donor LT. (H epatology 2012)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/89518/1/24632_ftp.pd
- âŠ