Department of Quantitative Health Sciences.
Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Curr Opin Organ Transplant. 2019 Jun;24(3):332-336. doi: 10.1097/MOT.0000000000000637.
Organ allocation is a highly complex process with significant impact on outcomes of donor organs and end-stage organ disease patients. Policies governing allocation must incorporate numerous factors to meet stated objective. There have been significant alterations and ongoing discussion about changes in allocation policy for all solid organs in the United States. As with any policy change, rigorous evaluation of the impact of changes is important.
This manuscript discusses metrics to consider to evaluate the impact of organ allocation policy that may be monitored on an ongoing basis including examples of research evaluating current policies. Potential metrics to evaluate allocation policy include the effectiveness, efficiency, equity, costs, donor rates, and transparency associated with the system.
Ultimately, policies will often need to adapt to secular changes in donor and patient characteristics, clinical and technological advances, and overarching healthcare polices. Providing objective empirical evaluation of the impact of policies is a critical component for assessing quality of the allocation system and informing the effect of changes. The foundation of organ transplantation is built upon public trust and the dependence on the gift of donor organs, as such the importance of the most appropriate organ allocation policies cannot be overstated.
器官分配是一个高度复杂的过程，对供体器官和终末期器官疾病患者的结局有重大影响。分配政策必须纳入众多因素，以满足既定目标。美国所有实体器官的分配政策都发生了重大变化，并正在持续讨论这些变化。与任何政策变化一样，对变化影响的严格评估都很重要。
本文讨论了用于评估器官分配政策影响的指标，这些指标可以在持续监测的基础上进行考虑，包括评估当前政策的研究示例。潜在的分配政策评估指标包括与系统相关的有效性、效率、公平性、成本、供体率和透明度。
最终，政策通常需要适应供体和患者特征、临床和技术进步以及总体医疗政策的长期变化。提供政策影响的客观经验评估是评估分配系统质量和告知变化影响的关键组成部分。器官移植的基础是建立在公众信任和对捐献者器官馈赠的依赖之上的，因此，最合适的器官分配政策的重要性怎么强调都不为过。
