title: Modeling the allocation system: principles for robust design before restructuring.
abstract: The United Network for Organ Sharing is poised to resolve geographic disparity in liver transplantation and promote allocation based on medical urgency. At the time of writing, United Network for Organ Sharing is considering redistricting the organ procurement and transplantation network so that patient model for end-stage liver disease scores at transplant is more uniform across regions.We review the proposal with a systems-engineering focus and find that although the proposal is promising, it currently lacks evidence that it would perform effectively under realistic departures from its underlying data and assumptions. Moreover, we caution against prematurely focusing on redistricting as the only method to mitigate disparity. We describe system modeling principles which, if followed, will ensure that the redesigned allocation system is effective and efficient in achieving the intended goals.
authors: 1 Industrial Engineering and Management Sciences, Northwestern University, Evanston, IL. 2 Center for Engineering and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. 3 Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL. 4 University of Kansas Medical Center, Kansas City, KS. 5 Baylor University, Annette C. and Harold C. Simmons Transplant Institute, Dallas, TX.
authors: Sanjay
authors: S
authors: Mehrotra
authors: Vikram
authors: V
authors: Kilambi
authors: Richard
authors: R
authors: Gilroy
authors: Daniela P
authors: DP
authors: Ladner
authors: Goran B
authors: GB
authors: Klintmalm
authors: Bruce
authors: B
authors: Kaplan
mesh_terms: D002391:Catchment Area, Health; D046148:Donor Selection / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration*; D054625:Healthcare Disparities / Q000458:organization & administration*; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis / Q000601:surgery*; D016031:Liver Transplantation; D017146:Models, Organizational; D009937:Organizational Objectives; D011050:Policy Making; D012040:Regional Health Planning / Q000458:organization & administration; D014019:Tissue Donors / Q000600:supply & distribution*