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Identification and weighting of kidney allocation criteria: a novel multi-expert fuzzy method.

ABSTRACT: BACKGROUND:Kidney allocation is a multi-criteria and complex decision-making problem, which should also consider ethical issues in addition to the medical aspects. Leading countries in this field use a point scoring system to allocate kidneys. Hence, the purpose of this study is to identify and weight the kidney allocation criteria considering the balance between utility and equity. METHODS:To do this, a new fuzzy hybrid approach is proposed, which consists of two steps: In the first step, Fuzzy Delphi Method (FDM) is used to identify the effective criteria in the kidney allocation algorithm. In the second step, Intuitionistic Fuzzy Analytic Hierarchy Process (IF-AHP) is employed to determine the weight of the criteria. RESULTS:The results showed that the highest weight belongs to "Medical emergency" criterion and the lowest weight to "5 HLA mismatches", which is similar to Euro-transplant kidney allocation system (ETKAS). The developed method is evaluated in two steps. First, the proposed model is implemented using a real case study from the Iranian Kidney Allocation System. It was shown that the proposed model has the potential to improve allocation outcome. Second, the proposed model's superiority to the current model is approved by the experts using the results display in the profile matrix. Finally, sensitivity analysis is performed to check the robustness of the proposed model. CONCLUSIONS:This paper contributes to the kidney allocation literature by doing the following: (a) developing a comprehensive framework for identification and weightings of criteria for kidney allocation, (b) using, for the first time, the IF-AHP technique to consider hesitancy of decision makers and uncertainty in organ allocation, and (c) proposing an appropriate framework for the countries that intend to improve or modify their organ allocation system.

SUBMITTER: Taherkhani N

PROVIDER: S-EPMC6729045 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Identification and weighting of kidney allocation criteria: a novel multi-expert fuzzy method.

Taherkhani Nasrin N Sepehri Mohammad Mehdi MM Shafaghi Shadi S Khatibi Toktam T

BMC medical informatics and decision making 20190906 1

<h4>Background</h4>Kidney allocation is a multi-criteria and complex decision-making problem, which should also consider ethical issues in addition to the medical aspects. Leading countries in this field use a point scoring system to allocate kidneys. Hence, the purpose of this study is to identify and weight the kidney allocation criteria considering the balance between utility and equity.<h4>Methods</h4>To do this, a new fuzzy hybrid approach is proposed, which consists of two steps: In the fi ...[more]

PMID: 31492132

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Project description:BackgroundThere is an increased interest in the use of multi-criteria decision analysis (MCDA) to support regulatory and reimbursement decision making. The EVIDEM framework was developed to provide pragmatic multi-criteria decision support in health care, to estimate the value of healthcare interventions, and to aid in priority-setting. The objectives of this study were to test 1) the influence of different weighting techniques on the overall outcome of an MCDA exercise, 2) the discriminative power in weighting different criteria of such techniques, and 3) whether different techniques result in similar weights in weighting the criteria set proposed by the EVIDEM framework.MethodsA sample of 60 Dutch and Canadian students participated in the study. Each student used an online survey to provide weights for 14 criteria with two different techniques: a five-point rating scale and one of the following techniques selected randomly: ranking, point allocation, pairwise comparison and best worst scaling.ResultsThe results of this study indicate that there is no effect of differences in weights on value estimates at the group level. On an individual level, considerable differences in criteria weights and rank order occur as a result of the weight elicitation method used, and the ability of different techniques to discriminate in criteria importance. Of the five techniques tested, the pair-wise comparison of criteria has the highest ability to discriminate in weights when fourteen criteria are compared.ConclusionsWhen weights are intended to support group decisions, the choice of elicitation technique has negligible impact on criteria weights and the overall value of an innovation. However, when weights are used to support individual decisions, the choice of elicitation technique influences outcome and studies that use dissimilar techniques cannot be easily compared. Weight elicitation through pairwise comparison of criteria is preferred when taking into account its superior ability to discriminate between criteria and respondents' preferences.

Project description:BackgroundThe widening supply-demand imbalance for kidneys necessitates finding ways to reduce rejection and improve transplant outcomes. Human leukocyte antigen (HLA) epitope compatibility between donor and recipient may minimize premature graft loss and prolong survival, but incorporating this strategy to deceased donor allocation criteria prioritizes transplant outcomes over wait times. An online public deliberation was held to identify acceptable trade-offs when implementing epitope compatibility to guide Canadian policymakers and health professionals in deciding how best to allocate kidneys fairly.MethodsInvitations were mailed to 35,000 randomly-selected Canadian households, with over-sampling of rural/remote locations. Participants were selected for socio-demographic diversity and geographic representation. Five two-hour online sessions were held from November-December 2021. Participants received an information booklet and heard from expert speakers prior to deliberating on how to fairly implement epitope compatibility for transplant candidates and governance issues. Participants collectively generated and voted on recommendations. In the final session, kidney donation and allocation policymakers engaged with participants. Sessions were recorded and transcribed.ResultsThirty-two individuals participated and generated nine recommendations. There was consensus on adding epitope compatibility to the existing deceased donor kidney allocation criteria. However, participants recommended including safeguards/flexibility around this (e.g., mitigating declining health). They called for a transition period to epitope compatibility, including an ongoing comprehensive public education program. Participants unanimously recommended regular monitoring and public sharing of epitope-based transplant outcomes.ConclusionsParticipants supported adding epitope compatibility to kidney allocation criteria, but advised safeguards and flexibility around implementation. These recommendations provide guidance to policymakers about incorporating epitope-based deceased donor allocation criteria.

Dataset Information

Identification and weighting of kidney allocation criteria: a novel multi-expert fuzzy method.

Publications

Identification and weighting of kidney allocation criteria: a novel multi-expert fuzzy method.

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