Predicting Liver Transplant Capacity Using Discrete Event Simulation.
The number of liver transplants (LTs) performed in the US increased until 2006 but has since declined despite an ongoing increase in demand. This decline may be due in part to decreased donor liver quality and increasing discard of poor-quality livers. We constructed a discrete event simulation (DES) model informed by current donor characteristics to predict future LT trends through the year 2030. The data source for our model is the United Network for Organ Sharing database, which contains patient-level information on all organ transplants performed in the US. Previous analysis showed that liver discard is increasing and that discarded organs are more often from donors who are older, are obese, have diabetes, and donated after cardiac death. Given that the prevalence of these factors is increasing, the DES model quantifies the reduction in the number of LTs performed through 2030. In addition, the model estimatesthe total number of future donors needed to maintain the current volume of LTs and the effect of a hypothetical scenario of improved reperfusion technology.We also forecast the number of patients on the waiting list and compare this with the estimated number of LTs to illustrate the impact that decreased LTs will have on patients needing transplants. By altering assumptions about the future donor pool, this model can be used to develop policy interventions to prevent a further decline in this lifesaving therapy. To our knowledge, there are no similar predictive models of future LT use based on epidemiological trends.
Department of Industrial Engineering, Clemson University, SC (HTD)
Hector
H
Toro-Díaz
Department of Industrial & Systems Engineering, North Carolina State University, Raleigh, NC (MM)
Maria E
ME
Mayorga
Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC (ASB)
A Sidney
AS
Barritt
Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN (ESO)
Eric S
ES
Orman
Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC (SBW)
Stephanie B
SB
Wheeler
D003198:Computer Simulation; D005544:Forecasting; D006297:Health Services Accessibility / Q000706:statistics & numerical data* / Q000639:trends; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D016031:Liver Transplantation / Q000706:statistics & numerical data* / Q000639:trends; D014019:Tissue Donors / Q000600:supply & distribution; D014022:Tissue Survival; D014481:United States; D014850:Waiting Lists
forecast; liver transplantation; organ donors; simulation