Kidney Transplantation: A Simulation Model for Examining Demand and Supply

Article Abstract:

In most regions of the United States there is a serious imbalance between the number of kidneys donated for transplantation and the number of persons wishing to receive a transplant. This not only affects the quality of life of those unable to obtain a transplant, but it also has important repercussions on the large and rapidly growing federal expenditures for the treatment of end-stage renal disease by transplantation and dialysis. A simulation model was constructed to assess the impact that changes in the number of cadaveric kidneys donated in Michigan would have on the waiting list of potential kidney transplant recipients in the state. The model represents the process of matching donated kidneys to people on the waiting list, taking into account the compatibility of the donor with the potential recipient's blood type and the tissue compatibility of the recipient to the donor as estimated by cytotoxicity. We describe the structure and data needs of the model and we discuss the results obtained for Michigan. It was found that under the current conditions, the waiting list would continue to grow rapidly. The number of donors needed to compensate for this growth would have to be disproportionately large: as the number of donations increases the effect of each donation in reducing the waiting list is less. The approach is applicable to other regions and it should also be adaptable to other types of organ transplants that require tissue compatibility once such transplants become common enough to warrant regional coordination of the matching of recipients with donors. (Reprinted by Permission of Publisher.)

Medicine, Surgery, Demand, Simulation, United States, Health Care, Supply, Donation, Michigan, Kidney, Parts of Body

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Involving patients in the cadaveric kidney transplant allocation process: a decision-theoretic perspective

Article Abstract:

A new framework for selecting kidneys that can maximize patients' duration and quality of life is proposed. The model improves on the United Network for Organ Sharing system of allocating cadaveric kidneys for transplantation, which focuses more on achieving high-level immunologic compatibility between the donor kidney and the recipient. The model allows patients to participate in the process of deciding which kidneys would be acceptable or unacceptable for transplantation. Holistic descriptions of health states are used to design the model. Use of the model shows that patients vary in the criteria they employ for accepting a donor kidney. The model is expected to be widely implemented in clinical practice through the use of desktop computers. The adoption of such a system will in turn lead to the development of an allocation system more responsive to patient preferences.

Decision-making, Decision making, Planning, Transplantation of organs, tissues, etc., Organ transplantation, Tissue transplantation, Transplantation

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Kidney transplantation: a simulation model for examining demand and supply

Article Abstract:

Throughout much of the United States, the number of kidneys donated for transplantation is not sufficient to provide transplants to all kidney patients evidencing a need, and the disparity between the number of potential recipients and donors is increasing. To identify the best strategy for increasing the number of kidney donators in the State of Michigan, a simulation model was constructed to assess the impact of changes in the number of cadaveric kidneys on the waiting list of kidney recipients. Results obtained from the model indicate that, under the current conditions, the waiting list will continue to grow, while the number of donors needed to compensate for this growth would have to be disproportionately large. The structure and data needs of the model are discussed, as well as its applicability to other regions.

Methods, Donation of organs, tissues, etc., Tissue donation

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