Accelerating kidney allocation: Simultaneously expiring offers

Michal A. Mankowski, Martin Kosztowski, Subramanian Raghavan, Jacqueline M. Garonzik-Wang, David Axelrod, Dorry L. Segev, Sommer E. Gentry

Research output: Contribution to journalArticle

Abstract

Using nonideal kidneys for transplant quickly might reduce the discard rate of kidney transplants. We studied changing kidney allocation to eliminate sequential offers, instead making offers to multiple centers for all nonlocally allocated kidneys, so that multiple centers must accept or decline within the same 1 hour. If more than 1 center accepted an offer, the kidney would go to the highest-priority accepting candidate. Using 2010 Kidney-Pancreas Simulated Allocation Model–Scientific Registry for Transplant Recipients data, we simulated the allocation of 12 933 kidneys, excluding locally allocated and zero-mismatch kidneys. We assumed that each hour of delay decreased the probability of acceptance by 5% and that kidneys would be discarded after 20 hours of offers beyond the local level. We simulated offering kidneys simultaneously to small, medium-size, and large batches of centers. Increasing the batch size increased the percentage of kidneys accepted and shortened allocation times. Going from small to large batches increased the number of kidneys accepted from 10 085 (92%) to 10 802 (98%) for low–Kidney Donor Risk Index kidneys and from 1257 (65%) to 1737 (89%) for high–Kidney Donor Risk Index kidneys. The average number of offers that a center received each week was 10.1 for small batches and 16.8 for large batches. Simultaneously expiring offers might allow faster allocation and decrease the number of discards, while still maintaining an acceptable screening burden.

Original languageEnglish (US)
Pages (from-to)3071-3078
Number of pages8
JournalAmerican Journal of Transplantation
Volume19
Issue number11
DOIs
StatePublished - Nov 1 2019

Fingerprint

Kidney
Tissue Donors
Transplants
Registries
Pancreas

Keywords

  • clinical research/practice
  • delayed graft function (DGF)
  • health services and outcomes research
  • kidney transplantation/nephrology
  • mathematical model
  • organ allocation
  • organ procurement and allocation
  • Scientific Registry for Transplant Recipients (SRTR)

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

Accelerating kidney allocation : Simultaneously expiring offers. / Mankowski, Michal A.; Kosztowski, Martin; Raghavan, Subramanian; Garonzik-Wang, Jacqueline M.; Axelrod, David; Segev, Dorry L.; Gentry, Sommer E.

In: American Journal of Transplantation, Vol. 19, No. 11, 01.11.2019, p. 3071-3078.

Research output: Contribution to journalArticle

Mankowski, Michal A. ; Kosztowski, Martin ; Raghavan, Subramanian ; Garonzik-Wang, Jacqueline M. ; Axelrod, David ; Segev, Dorry L. ; Gentry, Sommer E. / Accelerating kidney allocation : Simultaneously expiring offers. In: American Journal of Transplantation. 2019 ; Vol. 19, No. 11. pp. 3071-3078.
@article{34a419845e404b60996599a976adf256,
title = "Accelerating kidney allocation: Simultaneously expiring offers",
abstract = "Using nonideal kidneys for transplant quickly might reduce the discard rate of kidney transplants. We studied changing kidney allocation to eliminate sequential offers, instead making offers to multiple centers for all nonlocally allocated kidneys, so that multiple centers must accept or decline within the same 1 hour. If more than 1 center accepted an offer, the kidney would go to the highest-priority accepting candidate. Using 2010 Kidney-Pancreas Simulated Allocation Model–Scientific Registry for Transplant Recipients data, we simulated the allocation of 12 933 kidneys, excluding locally allocated and zero-mismatch kidneys. We assumed that each hour of delay decreased the probability of acceptance by 5{\%} and that kidneys would be discarded after 20 hours of offers beyond the local level. We simulated offering kidneys simultaneously to small, medium-size, and large batches of centers. Increasing the batch size increased the percentage of kidneys accepted and shortened allocation times. Going from small to large batches increased the number of kidneys accepted from 10 085 (92{\%}) to 10 802 (98{\%}) for low–Kidney Donor Risk Index kidneys and from 1257 (65{\%}) to 1737 (89{\%}) for high–Kidney Donor Risk Index kidneys. The average number of offers that a center received each week was 10.1 for small batches and 16.8 for large batches. Simultaneously expiring offers might allow faster allocation and decrease the number of discards, while still maintaining an acceptable screening burden.",
keywords = "clinical research/practice, delayed graft function (DGF), health services and outcomes research, kidney transplantation/nephrology, mathematical model, organ allocation, organ procurement and allocation, Scientific Registry for Transplant Recipients (SRTR)",
author = "Mankowski, {Michal A.} and Martin Kosztowski and Subramanian Raghavan and Garonzik-Wang, {Jacqueline M.} and David Axelrod and Segev, {Dorry L.} and Gentry, {Sommer E.}",
year = "2019",
month = "11",
day = "1",
doi = "10.1111/ajt.15396",
language = "English (US)",
volume = "19",
pages = "3071--3078",
journal = "American Journal of Transplantation",
issn = "1600-6135",
publisher = "Wiley-Blackwell",
number = "11",

}

TY - JOUR

T1 - Accelerating kidney allocation

T2 - Simultaneously expiring offers

AU - Mankowski, Michal A.

AU - Kosztowski, Martin

AU - Raghavan, Subramanian

AU - Garonzik-Wang, Jacqueline M.

AU - Axelrod, David

AU - Segev, Dorry L.

AU - Gentry, Sommer E.

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Using nonideal kidneys for transplant quickly might reduce the discard rate of kidney transplants. We studied changing kidney allocation to eliminate sequential offers, instead making offers to multiple centers for all nonlocally allocated kidneys, so that multiple centers must accept or decline within the same 1 hour. If more than 1 center accepted an offer, the kidney would go to the highest-priority accepting candidate. Using 2010 Kidney-Pancreas Simulated Allocation Model–Scientific Registry for Transplant Recipients data, we simulated the allocation of 12 933 kidneys, excluding locally allocated and zero-mismatch kidneys. We assumed that each hour of delay decreased the probability of acceptance by 5% and that kidneys would be discarded after 20 hours of offers beyond the local level. We simulated offering kidneys simultaneously to small, medium-size, and large batches of centers. Increasing the batch size increased the percentage of kidneys accepted and shortened allocation times. Going from small to large batches increased the number of kidneys accepted from 10 085 (92%) to 10 802 (98%) for low–Kidney Donor Risk Index kidneys and from 1257 (65%) to 1737 (89%) for high–Kidney Donor Risk Index kidneys. The average number of offers that a center received each week was 10.1 for small batches and 16.8 for large batches. Simultaneously expiring offers might allow faster allocation and decrease the number of discards, while still maintaining an acceptable screening burden.

AB - Using nonideal kidneys for transplant quickly might reduce the discard rate of kidney transplants. We studied changing kidney allocation to eliminate sequential offers, instead making offers to multiple centers for all nonlocally allocated kidneys, so that multiple centers must accept or decline within the same 1 hour. If more than 1 center accepted an offer, the kidney would go to the highest-priority accepting candidate. Using 2010 Kidney-Pancreas Simulated Allocation Model–Scientific Registry for Transplant Recipients data, we simulated the allocation of 12 933 kidneys, excluding locally allocated and zero-mismatch kidneys. We assumed that each hour of delay decreased the probability of acceptance by 5% and that kidneys would be discarded after 20 hours of offers beyond the local level. We simulated offering kidneys simultaneously to small, medium-size, and large batches of centers. Increasing the batch size increased the percentage of kidneys accepted and shortened allocation times. Going from small to large batches increased the number of kidneys accepted from 10 085 (92%) to 10 802 (98%) for low–Kidney Donor Risk Index kidneys and from 1257 (65%) to 1737 (89%) for high–Kidney Donor Risk Index kidneys. The average number of offers that a center received each week was 10.1 for small batches and 16.8 for large batches. Simultaneously expiring offers might allow faster allocation and decrease the number of discards, while still maintaining an acceptable screening burden.

KW - clinical research/practice

KW - delayed graft function (DGF)

KW - health services and outcomes research

KW - kidney transplantation/nephrology

KW - mathematical model

KW - organ allocation

KW - organ procurement and allocation

KW - Scientific Registry for Transplant Recipients (SRTR)

UR - http://www.scopus.com/inward/record.url?scp=85068035737&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068035737&partnerID=8YFLogxK

U2 - 10.1111/ajt.15396

DO - 10.1111/ajt.15396

M3 - Article

C2 - 31012528

AN - SCOPUS:85068035737

VL - 19

SP - 3071

EP - 3078

JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

IS - 11

ER -