The heart-allocation simulation model: A tool for comparison of transplantation allocation policies

Numerous studies have investigated prognostic factors for the survival of transplant candidates waiting for a donor organ, but little is known about the impact of allocation policies on waiting list outcome. Simulation models would allow a comparison of different policies for allocating donor hearts...

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Published in:	Transplantation Vol. 76; no. 10; pp. 1492 - 1497
Main Authors:	VAN DEN BOUT, Wilbert B, SMITS, Jacqueline M. A, DENG, Mario C, HUMMEL, Manfred, SCHOENDUBE, Friedrich, SCHELD, Hans H, PERSIJN, Guido G, LAUFER, Gunther
Format:	Journal Article
Language:	English
Published:	Hagerstown, MD Lippincott 27-11-2003
Subjects:	Biological and medical sciences Combined surgery. Multiple transplantations Computer Simulation Europe Heart Heart Transplantation - mortality Heart Transplantation - statistics & numerical data Humans Medical sciences Predictive Value of Tests Resource Allocation - methods Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Tissue and Organ Procurement - methods Tissue and Organ Procurement - organization & administration Tissue Donors - supply & distribution Waiting Lists Europe Heart Health policy Treatment Allocation Simulation Surgery Graft Transplantation Circulatory system Simulation model Homotransplantation Comparative study
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Summary:	Numerous studies have investigated prognostic factors for the survival of transplant candidates waiting for a donor organ, but little is known about the impact of allocation policies on waiting list outcome. Simulation models would allow a comparison of different policies for allocating donor hearts on pretransplant outcome. A model was built for the Eurotransplant waiting list for heart transplantation. Survival and delisting distributions were estimated from the Eurotransplant transplant candidate inflow between 1995 and 2000 (n=7,142). Other characteristics were obtained directly from the transplant candidate inflow of 1999 and 2000 (n=2,097) and the donor organs of 1998 and 1999 (n=1,520). Overall and subgroup waiting list mortality were estimated for allocation policies differing by ABO blood group, border, and clinical profile rules. The model estimated that international organ exchange reduces waiting list mortality in the different countries by 1.9% to 12.4%. An allocation policy incorporating the initial clinical profile of the transplant candidates further reduced waiting list mortality by 1.7%. Changing ABO rules toward identical matching yielded a slightly more equitable survival for the different groups, without an overall effect on mortality. The best possible allocation policy is the policy where organs are allocated to patients that are at highest risk of dying, and withholding organs from patients that would eventually delist because of improvement. Patients benefit from international organ exchange and by a heart allocation scheme based on clinical profiles. Timely delisting of patients who are-temporarily-too well for transplantation is the best waiting list policy.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0041-1337 1534-6080
DOI:	10.1097/01.tp.0000092005.95047.e9