Moving Toward Continuous Organ Distribution

Beyond donation to organ utilization in the USA

“…In a novel analysis of kidney offer timing data, Barah et al [43 ▪▪ ] found that an additional 2 h of cold time reduces the odds of high KDPI offer acceptance by approximately 40%. The migration of organ allocation policies to the continuous distribution framework [44] provides an opportunity to tune the system towards efficiency by prioritizing candidates and hospitals most likely to accept hard-to-place organs [45]. Advanced approaches to developing continuous distribution systems, such as goal-driven optimization [46 ▪ ], and bold policy ideas for combating organ nonusage [9,47 ▪▪ ,48], should continue to be explored.…”

Connecting the dots: uncovering the relationships between challenges confronting Africa's organ transplant supply chain systems

“…However, evidence suggests inefficiencies in kidney allocation (Ross and Thistlethwaite, 2008), cadaveric organ procurement (Beard et al, 2006) and circle-based liver allocation (Wood et al, 2022). This issue has increased the rate at which organs are discarded and wasted in transplant centres (Stewart, 2021). To ensure allocation efficiency, an organ procurement organisation must collaborate with the National Transplant Programme to create a database of potential donors with strict medical evaluation requirements for matching organs to recipients based on various factors such as blood group, waiting period and donor hospital location (Beyar, 2011).…”

“…For example, in the USA, the current organ transportation system cannot handle the increased demand from new allocation policies (Pullen, 2019). Furthermore, as organ transportation is closely related to organ acceptance (Stewart et al , 2016), difficulties encountered during transportation may impede the acceptance and transplantation of an organ, especially when imported organs such as kidneys and livers are involved (Wey et al , 2018).…”

Oversimplification and Misplaced Blame Will Not Solve the Complex Kidney Underutilization Problem

“…Altering how waiting time is used to prioritize patients across the donor quality (e.g., KDPI) spectrum, according to a paradigm coined as "dealing from the bottom of the deck", 33,34 may be a more effective approach to consider as the OPTN migrates to the continuous distribution framework. 35,36 If a patient just added to the list with little or no waiting time priority for the best kidneys was given first dibs on a higher KDPI kidney, the incentive equation may change in a way that fosters securing offer acceptance earlier in the placement process. 37 Given the drastic differences in kidney utilization practices among kidney programs 38 , the OPTN is implementing a new monitoring framework designed to exert upward pressure on and reduce variability in offer acceptance rates.…”

“…Reducing patients’ options by segmenting the allocation system and forcing a choice between a shorter wait for a shorter longevity kidney and vice versa is not the only (or necessarily best) way to tune the decision-making calculus toward acceptance. Altering how waiting time is used to prioritize patients across the donor quality (e.g., KDPI) spectrum, according to a paradigm coined as “dealing from the bottom of the deck” (33,34), may be a more effective approach to consider as OPTN migrates to the continuous distribution framework (35,36). If a patient just added to the list with little or no waiting time priority for the best kidneys was given first dibs on a higher KDPI kidney, the incentive equation may change in a way that fosters securing offer acceptance earlier in the placement process (37).…”