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Transplant Organ Shortage: Informing National Policies using Management Sciences

Transplant Organ Shortage: Informing National Policies using Management Sciences. M. Abecassis MD MBA Founding Director, Comprehensive Transplant Center. Disclosures. I have no disclosures to declare. A Few Definitions: Kidney Transplantation - I. Deceased Donors (DD):

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Transplant Organ Shortage: Informing National Policies using Management Sciences

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  1. Transplant Organ Shortage: Informing National Policies using Management Sciences M. Abecassis MD MBA Founding Director, Comprehensive Transplant Center

  2. Disclosures I have no disclosures to declare

  3. A Few Definitions: Kidney Transplantation - I • Deceased Donors (DD): • Donation after Brain Death (DBD): typically heart-beating (maintained on life support), with ‘declaration of brain death’ • Donation after Cardiac Death (DCD): after cessation of heart beat following removal of life support (when brain death cannot be declared • Living (Live) Donors (LDs): • Healthy individuals who volunteer to altruistically donate one of their two kidneys • These can be ‘related’ donors, or unrelated donors, emotionally related or otherwise • Marginal Donors: • Expansion of the donor pool by accepting ‘less than perfect organs’ • Applies mostly to DDs (age, co-morbidities, kidney function, etc.)

  4. A Few Definitions: Kidney Transplantation - II • Incompatible Donors: • ABO blood type (antibodies to A or B) • Histocompatibility antigens (antibodies to HLA) • Panel Reactive Antibodies (PRA): • Percent (%PRA)of all HLA against which a patient has antibodies • Result of pregnancy, blood transfusion, previous transplant, etc. • Sensitized patient – has some antibodies • Highly sensitized patient – has lots of antibodies • Titer of donor-specific antibodies (DSA) also important • Cross-match: • Testing recipient’s antibodies against donor antigens (HLA) • If ‘positive’ recipient will experience ‘hyperacute’ (immediate) rejection • Desensitization – remove antibodies so cross-match becomes negative

  5. Treatment Options

  6. Transplant Outcomes By Treatment Option Adjusted all-cause mortality in the ESRD & general populations, by age, 2010 Half-lives for adult kidney transplant recipients

  7. PRA – Impact on Waiting Time Active Waitlisted Patients –by PRA 25% & Median Wait in 2001 – by PRA PRA 20-79% = 16.5% (15,675 pts) 80%+ = 17.2% (16,340 pts)

  8. Framing the Symposium • John Friedewald MD: Will define the ‘problem’ • Current allocation scheme and regulations for DDs (different from LDs) • Organ shortage • Efforts to increase utility for both DDs and LDs • Sanjay Mehrotra PhD: • Will define problem of inefficiencies in current allocation scheme for DDs including geographic disparities • Will introduce use of Management Science and simulation models, to optimize utility and while minimizing geographic disparities, as a solution set • Alvin Roth PhD: • Will define problem of incompatible LDs, and make the case that every available, willing LD should be utilized • Will introduce use of Game Theory and mathematical models, to optimize use of LDs, including kidney paired exchanges, as a solution set • Mark Siegler MD: • Will define potential ethical and societal hurdles to live donation • Will provide a framework for addressing these hurdles to address these hurdles

  9. Thank you

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