A Hybrid Liver‐Candidate Transportation System to Improve Accessibility and Extend Organ Life in Liver Transplantation

Abstract

In the USA, access to liver transplant is determined by the geographical organ allocation boundaries. The current allocation system involves a three‐tier hierarchical boundary system consisting of Organ Procurement Organization (OPO), the United Network for Organ Sharing (UNOS), and the National (USA) boundary. The search for a matching candidate when a liver is available begins within OPOs and moves up to the UNOS and National levels. The boundary‐based allocation system results in several issues such as geographical disparity in access, long system waiting times, liver wastages, high post‐graft failure, and prioritization of less severe candidates that live close to a transplant center over more needy ones from farther away. The paper investigates the conflict between attempts that reduce geographical disparity and those that optimize organ life (results in geographical disparity) through the application of Modeling and Simulation (M&S) to System Engineering. To resolve the above conflict, the paper presents the system architecture of a new hybrid liver‐candidate transport system instead of a liver‐only transport system, and uses discrete event simulation to model and validate the new system.