Pivo Elijah, Alcorn James, Bertsimas Dimitris, Booker Sarah E, Bradbrook Keighly, Dolan Thomas G, Larkin Lindsay V, Temple Kayla R, Trichakis Nikolaos
Institute for Data, Systems and Society, Massachusetts Institute of Technology, Cambridge, MA.
United Network for Organ Sharing, Richmond, VA.
Transplant Direct. 2025 Aug 22;11(9):e1780. doi: 10.1097/TXD.0000000000001780. eCollection 2025 Sep.
The allocation of a limited supply of donor organs remains a critical challenge for organ transplantation. The analytical tools that policymakers rely upon for improving allocation policy have seen little advancement since the introduction of computer simulation in 1995. In recent years, simulation has increasingly become a bottleneck in the policy design process. Partnering with the Organ Procurement and Transplantation Network Kidney Transplantation Committee, our team introduced new analytical techniques into the policy design process.
A new simulation algorithm was developed that reduces the time required to simulate 1 y of allocation from >6 h down to about 15 s while using the same simulation model as the preexisting simulator used by the Organ Procurement and Transplantation Network. This improvement enabled the simulation of thousands of allocation policies, allowing the introduction of multiobjective optimization as a primary method for policy design. An interactive website was created for committee members to analyze results and perform policy optimization.
These techniques were applied to the development of new continuous distribution allocation policies for kidneys. We detail the policy design process, present graphical results from 50 000 policy simulations, and highlight 4 policies optimized to balance between multiple objectives differently.
Advances in analytical tools offer a path to improving organ transplantation through more effective and equitable organ allocation policies.
供体器官供应有限，其分配仍是器官移植面临的一项严峻挑战。自1995年引入计算机模拟以来，政策制定者用以改进分配政策的分析工具几乎没有进展。近年来，模拟日益成为政策设计过程中的一个瓶颈。我们的团队与器官获取与移植网络肾移植委员会合作，将新的分析技术引入了政策设计过程。
开发了一种新的模拟算法，在使用与器官获取与移植网络之前使用的模拟器相同的模拟模型的情况下，将模拟1年分配所需的时间从超过6小时减少到约15秒。这一改进使得能够模拟数千种分配政策，从而将多目标优化作为政策设计的主要方法引入。创建了一个交互式网站，供委员会成员分析结果并进行政策优化。
这些技术被应用于制定新的肾脏连续分配政策。我们详细介绍了政策设计过程，展示了50000次政策模拟的图形结果，并重点介绍了4种针对不同目标进行优化平衡的政策。
分析工具的进步为通过更有效、公平的器官分配政策改善器官移植提供了一条途径。
