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Efficient and Fair Heart Allocation Policies for Transplantation.

ABSTRACT: Background: The optimal allocation of limited donated hearts to patients on the waiting list is one of the top priorities in heart transplantation management. We developed a simulation model of the US waiting list for heart transplantation to investigate the potential impacts of allocation policies on several outcomes such as pre- and posttransplant mortality. Methods: We used data from the United Network for Organ Sharing (UNOS) and the Scientific Registry of Transplant Recipient (SRTR) to simulate the heart allocation system. The model is validated by comparing the outcomes of the simulation with historical data. We also adapted fairness schemes studied in welfare economics to provide a framework to assess the fairness of allocation policies for transplantation. We considered three allocation policies, each a modification to the current UNOS allocation policy, and analyzed their performance via simulation. The first policy broadens the geographical allocation zones, the second modifies the health status order for receiving hearts, and the third prioritizes patients according to their waiting time. Results: Our results showed that the allocation policy similar to the current UNOS practice except that it aggregates the three immediate geographical allocation zones, improves the health outcomes, and is "closer" to an optimal fair policy compared to all other policies considered in this study. Specifically, this policy could have saved 319 total deaths (out of 3738 deaths) during the 2006 to 2014 time horizon, in average. This policy slightly differs from the current UNOS allocation policy and allows for easy implementation. Conclusion: We developed a model to compare the outcomes of heart allocation policies. Combining the three immediate geographical zones in the current allocation algorithm could potentially reduce mortality rate and is closer to an optimal fair policy.

SUBMITTER: Hasankhani F

PROVIDER: S-EPMC6125046 | biostudies-literature | 2017 Jan-Jun

REPOSITORIES: biostudies-literature

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Efficient and Fair Heart Allocation Policies for Transplantation.

Hasankhani Farhad F Khademi Amin A

MDM policy & practice 20170101 1

<b>Background:</b> The optimal allocation of limited donated hearts to patients on the waiting list is one of the top priorities in heart transplantation management. We developed a simulation model of the US waiting list for heart transplantation to investigate the potential impacts of allocation policies on several outcomes such as pre- and posttransplant mortality. <b>Methods:</b> We used data from the United Network for Organ Sharing (UNOS) and the Scientific Registry of Transplant Recipient ...[more]

PMID: 30288421

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Project description:The allocation strategies during challenging situations among the different social groups is based on 9 principles which can be considered either individually: sickest first, waiting list, prognosis, youngest first, instrumental values, lottery, monetary contribution, reciprocity, and individual behavior, or in combination; youngest first and prognosis, for example. In this study, we aim to look into the most important prioritization principles amongst different groups in the Jordanian population, in order to facilitate the decision-making process for any potential medical crisis. We conducted an online survey that tackled how individuals would deal with three different scenarios of medical scarcity: (1) organ donation, (2) limited hospital beds during an influenza epidemic, and (3) allocation of novel therapeutics for lung cancer. In addition, a free-comment option was included at the end of the survey if respondents wished to contribute further. Seven hundred and fifty-four survey responses were gathered, including 372 males (49.3%), and 382 females (50.7%). Five groups of individuals were represented including religion scholars, physicians, medical students, allied health practitioners, and lay people. Of the five surveyed groups, four found "sickest-first" to be the most important prioritization principle in all three scenarios, and only the physicians group documented a disagreement. In the first scenario, physicians regarded "sickest-first" and "combined-criteria" to be of equal importance. In general, no differences were documented between the examined groups in comparison with lay people in the preference of options in all three scenarios; however, physicians were more likely to choose "combination" in both the second and third scenarios (OR 3.70, 95% CI 1.62-8.44, and 2.62, 95% CI 1.48-4.59; p < 0.01), and were less likely to choose "sickest-first" as the single most important prioritization principle (OR 0.57, CI 0.37-0.88, and 0.57; 95% CI 0.36-0.88; p < 0.01). Out of 100 free comments, 27 (27.0%) thought that the "social-value" of patients should also be considered, adding the 10th potential allocation principle. Our findings are concordant with literature in terms of allocating scarce medical resources. However, "social-value" appeared as an important principle that should be addressed when prioritizing scarce medical resources in Jordan.

Project description:BackgroundThis study aimed to investigate the distribution of European Union (EU) healthcare research grants across EU countries, and to study the effect of the potential influencing factors on grant allocation.MethodsWe analysed publicly available data on healthcare research grants from the 7th Framework Programme and the Horizon 2020 Programme allocated to beneficiaries between 2007 and 2016. Grant allocation was analysed at the beneficiary-, country-, and country group-level (EU-15 versus newer Member States, defined as EU-13). The investigated country-level explanatory variables included GDP per capita, population size, overall disease burden, and healthcare research excellence. Grant amounts per 100,000 inhabitants were used as an outcome variable in the regression analyses.ResultsResearch funds were disproportionally allocated to EU-15 versus the EU-13, as 96.9% of total healthcare grants were assigned to EU-15 countries. At the beneficiary level, EU funding was positively influenced by participating in previous grants. The average grant amount per beneficiary was higher for EU-15 organizations. In the multiple regression analysis GDP per capita (p = 0.002) and research excellence (p<0.001) had a significant positive association with EU funding. Population size had an inverted U-shaped relationship with EU funding for healthcare research, having the largest per capita funding in second and the third quartiles (p = 0.03 and p = 0.02).ConclusionThe uneven allocation of healthcare research funds across EU countries was influenced by GDP per capita, medical research excellence and population size. Wealthier countries with an average population size and strong research excellence in healthcare had more EU funding for healthcare research. Higher disease burden apparently was not associated with more EU research funding. While our findings are in line with analyses on previous periods, they suggest that the EU did not implement any effective policy measures to improve the unfair allocation of research grants.

Project description:BACKGROUND:Infectious complications are a major cause of morbidity and mortality after heart transplantation (HT). However, the epidemiology and outcomes of these infections in the recent population of adult heart transplant recipients have not been investigated. METHODS:We conducted a single-center retrospective study on infectious complications occurring within 180 days following HT on consecutive heart transplant recipients, from January 2011 to June 2015 at Bichat University Hospital in Paris, France. Risk factors for non-viral infections occurring within 8, 30 and 180 days after HT were investigated using competing risk analysis. RESULTS:Overall, 113 patients were included. Fifty-eight (51%) HTs were high-priority allocations. Twenty-eight (25%) patients had an extracorporeal membrane oxygenation (ECMO) support at the time of transplantation. Ninety-two (81%) patients developed at least one infection within 180 days after HT. Bacterial and fungal infections (n = 181 episodes) occurred in 80 (71%) patients. The most common bacterial and fungal infections were pneumonia (n = 95/181 episodes, 52%), followed by skin and soft tissue infections (n = 26/181, 14%). Multi-drug-resistant bacteria were responsible for infections in 21 (19%) patients. Viral infections were diagnosed in 44 (34%) patients, mostly Cytomegalovirus infection (n = 39, 34%). In multivariate subdistribution hazard model, prior cardiac surgery (subdistribution hazard ratio sHR = 2.7 [95% CI 1.5-4.6] p < 0.01) and epinephrine or norepinephrine at the time of HT (sHR = 2.3 [95% CI 1.1-5.2] p = 0.04) were significantly associated with non-viral infections within 8 days after HT. Prior cardiac surgery (sHR = 2.5 [95% CI 1.4-4.4] p < 0.01), recipient age over 60 years (sHR = 2.0 [95% CI 1.2-3.3] p < 0.01) and ECMO following HT (sHR = 1.7 [95% CI 1.0-2.8] p = 0.04) were significantly associated with non-viral infection within 30 days after HT, as well as within 180 days after HT. CONCLUSION:This study confirmed the high rate of infections following HT. Recipient age, prior cardiac surgery and ECMO following HT were independent risk factors for early and late bacterial and fungal infections.

Project description:BackgroundIn Europe, progress in the development of health policies that address the needs of migrants and ethnic minorities has been slow. This is partly due to the absence of a strategic commitment by the health authorities. The Ministry of Public Health commissioned the ETHEALTH (EThnicity &HEALTH) group to formulate relevant recommendations to the public authorities with a view to reducing health inequalities among ethnic minorities. This paper describes the political process and the outcomes of the ETHEALTH expert group.ResultsAfter ten meetings, the ETHEALTH group came up with 46 recommendations, which were presented at a national press conference in December 2011. Target groups concerned by these recommendations covered both irregular migrants and migrants entitled to the national insurance coverage. Recommendations were supported by the need of combining universal approaches to health care with more specific approaches. The scope of the recommendations concerned health care as well as prevention, health promotion and access to health care. When analysing the content of the recommendations, some ETHEALTH recommendations were not fully measurable, and time-related; they were, however, quite specific and realistic within the Belgian context. The weak political commitment of an executive agency was identified as a major obstacle to the implementation of the recommendations.ConclusionsThe ETHEALTH group was an example of scientific advice on a global health issue. It also demonstrated the feasibility of coming up with a comprehensive strategy to decrease ethnic health inequalities, even in a political context where migration issues are sensitive. Two final lessons may be highlighted at the end of the first phase of the ETHEALTH project: firstly, the combination of scientific knowledge and practical expertise makes recommendations SMART; and, secondly, the low level of commitment on the part of policymakers might jeopardise the effective implementation of the recommendations.

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Efficient and Fair Heart Allocation Policies for Transplantation.

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Efficient and Fair Heart Allocation Policies for Transplantation.

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