Modernizing the Design Process for US Organ Allocation Policy: Toward a Continuous Distribution Policy for Kidneys.

Abstract

Background: The allocation of a limited supply of donor organs remains a critical challenge for organ transplantation. The analytical tools that policymakers rely upon for improving allocation policy have seen little advancement since the introduction of computer simulation in 1995. In recent years, simulation has increasingly become a bottleneck in the policy design process. Partnering with the Organ Procurement and Transplantation Network Kidney Transplantation Committee, our team introduced new analytical techniques into the policy design process.

Methods: A new simulation algorithm was developed that reduces the time required to simulate 1 y of allocation from >6 h down to about 15 s while using the same simulation model as the preexisting simulator used by the Organ Procurement and Transplantation Network. This improvement enabled the simulation of thousands of allocation policies, allowing the introduction of multiobjective optimization as a primary method for policy design. An interactive website was created for committee members to analyze results and perform policy optimization.

Results: These techniques were applied to the development of new continuous distribution allocation policies for kidneys. We detail the policy design process, present graphical results from 50 000 policy simulations, and highlight 4 policies optimized to balance between multiple objectives differently.

Conclusions: Advances in analytical tools offer a path to improving organ transplantation through more effective and equitable organ allocation policies.