How Should Lungs Be Allocated for Transplant?

2018 ◽  
Vol 39 (02) ◽  
pp. 126-137 ◽  
Author(s):  
Thomas Egan
Keyword(s):  
Waiting Time ◽  
Organ Procurement ◽  
Waiting Times ◽  
Organ Transplant ◽  
Health Resources ◽  
Organ Allocation ◽  
Final Rule ◽  
History Of ◽  
End Stage ◽  
The Impact

AbstractAs lung transplantation became established therapy for end-stage lung disease, there were not nearly enough suitable lungs from brain-dead organ donors to meet the need, leading to a focus on how lungs are allocated for transplant. Originally lungs were allocated by the United Network for Organ Sharing (UNOS) like hearts—by waiting time, first to listed recipients in the organ procurement organization of the donor, then to potential recipients in concentric 500 nautical mile circles. This resulted in long waiting times and increasing waitlist deaths. In 1999, the Health Resources and Services Administration published a Final Rule, requesting UNOS to review organ allocation algorithms to ensure that they complied with the desire to allocate organs based on urgency, avoiding futile transplants, and minimizing the role of waiting time in organ allocation. This led to development of the lung allocation score (LAS), which allocates lungs based on urgency and transplant benefit, introduced in 2005. The U.S. LAS system was adopted by Eurotransplant to allocate unused lungs between donor countries, and by both Germany and the Netherlands for lung allocation in their countries. This article will review the history of lung allocation, discuss the impact of LAS and its shortcomings, suggest recommendations to increase the number of lungs for transplant, and improve allocation of donated lungs. Ultimately, the goal of organ transplant research is to have so many organs to transplant that allocation systems are unnecessary.

scholarly journals High emergency organ allocation rule in lung transplantation: a simulation study

2017 ◽  
Vol 3 (4) ◽  
pp. 00020-2017 ◽  
Author(s):  
Julien Riou ◽  
Pierre-Yves Boëlle ◽  
Jason D. Christie ◽  
Gabriel Thabut
Keyword(s):  
Lung Transplantation ◽  
Waiting Time ◽  
Waiting Times ◽  
Organ Allocation ◽  
Waiting List ◽  
Allocation Rule ◽  
Long Term Effects ◽  
Term Survival ◽  
The Impact

The scarcity of suitable organ donors leads to protracted waiting times and mortality in patients awaiting lung transplantation. This study aims to assess the short- and long-term effects of a high emergency organ allocation policy on the outcome of lung transplantation.We developed a simulation model of lung transplantation waiting queues under two allocation strategies, based either on waiting time only or on additional criteria to prioritise the sickest patients. The model was informed by data from the United Network for Organ Sharing. We compared the impact of these strategies on waiting time, waiting list mortality and overall survival in various situations of organ scarcity.The impact of a high emergency allocation strategy depends largely on the organ supply. When organ supply is sufficient (>95 organs per 100 patients), it may prevent a small number of early deaths (1 year survival: 93.7% against 92.4% for waiting time only) without significant impact on waiting times or long-term survival. When the organ/recipient ratio is lower, the benefits in early mortality are larger but are counterbalanced by a dramatic increase of the size of the waiting list. Consequently, we observed a progressive increase of mortality on the waiting list (although still lower than with waiting time only), a deterioration of patients’ condition at transplant and a decrease of post-transplant survival times.High emergency organ allocation is an effective strategy to reduce mortality on the waiting list, but causes a disruption of the list equilibrium that may have detrimental long-term effects in situations of significant organ scarcity.

scholarly journals The Long Road from the Kidney Bazaar: A Commentary on Pakistan’s Progress Towards Self-sufficiency in Organ Transplantation

2011 ◽  
Vol 8 (2) ◽  
Author(s):  
Dominique E. Martin
Keyword(s):  
Organ Transplantation ◽  
Organ Procurement ◽  
Transplant Recipients ◽  
Transplant Tourism ◽  
Human Organs ◽  
Self Sufficiency ◽  
Social Inequities ◽  
History Of ◽  
Multiple Challenges ◽  
The Impact

The dark history of transplant tourism in Pakistan demonstrates the hazards of unregulated cross-border markets in human organs. Trading on existing national and international social inequities, ‘transplant tourism’ offers dubious benefits for transplant recipients and attractive profits to those facilitating the industry at the expense of the world’s poor. The impact of Pakistan’s 2007 Transplantation of Human Organs and Tissue Ordinance and the sustained efforts of transplant professionals and societal groups led by the Sindh Institute of Urology and Transplantation, show that organ trading can be effectively discouraged and equitable programs of organ procurement and transplantation pursued despite multiple challenges. In this paper, the factors that have contributed to Pakistan’s progress towards self-sufficiency in organ transplantation are identified and discussed. The case of Pakistan highlights the need for countries to protect their own organ and tissue providers who may be vulnerable in the global healthcare market. Pakistan provides an excellent example for other countries in the region and throughout the world to consider when regulating their own transplantation programs and considering the pursuit of national self-sufficiency.

Organ Transplantation: New Regulations to Alter Distribution of Organs

2000 ◽  
Vol 28 (1) ◽  
pp. 95-98
Author(s):  
Daniel Luke Geyser
Keyword(s):  
Organ Transplantation ◽  
Human Services ◽  
Organ Procurement ◽  
Organ Transplant ◽  
Non Profit ◽  
Health And Human Services ◽  
Legislative Action ◽  
Department Of Health ◽  
Final Rule ◽  
United Network

On December 17, 1999, President Clinton signed the Ticket to Work and Work Incentives Improvement Act of 1999, which instituted a 90-day comment period for the amended Organ Procurement and Transplantation Network (“OPTN”) Final Rule (“Final Rule”), a comprehensive set of guidelines that would affect how organs are allocated throughout the country. Barring further legislative action, the Final Rule, which has been over five years in the making, will be effective on March 16,2000.The Final Rule, issued by the Department of Health and Human Services (‘‘DHHS”) pursuant to the National Organ Transplant Act, was originally publishedApril 2, 1998. It provided a number of substantive changes to the process through which organs are allocated by the United Network for Organ Sharing (UNOS), a private, non-profit organization charged with administering the national organ transplantation network.

scholarly journals Mortality and its Determinants in Adult Patients with End-stage Liver Disease on Waiting List for Liver Transplantation: A Preliminary Report on Baseline Data

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Kamran Bagheri Lankarani ◽  
Behnam Honarvar ◽  
Mohammad Reza Rouhezamin ◽  
Hadi Raeisi Shahraki ◽  
Vahid Seifi ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Weight Loss ◽  
Liver Disease ◽  
Gallbladder Wall ◽  
Meld Score ◽  
Organ Allocation ◽  
Ca 125 ◽  
End Stage Liver Disease ◽  
History Of ◽  
End Stage

Background: Prevention of death in patients on the waiting list for liver transplantation (LT) is a major concern to prioritize organ allocation. Since the model for the end-stage liver disease (MELD) and its modifications have many shortages, there is a need for further refinement of the allocation strategy. Objectives: The current study aimed at assessing the predictors of mortality in LT candidates in a more comprehensive manner with the possible implications to improve the care of such patients and assist in developing better strategies for organ allocation. Methods: In the current cohort study, 544 adult LT candidates with end-stage liver disease were followed up for a mean of 12 months in three-month intervals. Data analysis was performed in Nutritionist, SPSS, and R software, using Kaplan-Meier, Cox proportional hazard (HRC), and LASSO Cox regression hazard (HRL) tests. Results: The mean age of the patients was 46.7 ± 13.7 years; the majority were male (n = 336, 61.7%). At the end of the study, 414 (76.1%) subjects were still alive and 130 (23.9%) dead. The cumulative percentages of death were 33.1%, 57.7%, and 79.2% after 3, 6, and 12 months of waiting for a donor, respectively. Although there was a strong association between having hepatopulmonary syndrome (HPS) (HRC = 4.7, HRL = 1.8), a history of myocardial infarction (MI) (HRC = 3.3, HRL = 1.6), low-carbohydrate (CHO) diet (HRC = 2.7, HRL = 1.5), and mortality, it was weak for MELD score. Moreover, a serum level of CA 125, high polymorphonuclear (PMN) count, weight loss, a high level of alanine aminotransferase (ALT), positive hepatitis B virus (HBV) markers, high mean corpuscular volume (MCV) of red blood cells, ascites, and edema of gallbladder wall had association with mortality in LT patients. Conclusions: In addition to MELD score, HPS, a history of MI, low CHO intake, weight loss, ascites, PMN, CA 125, ALT, hepatitis B surface antigen, MCV, blood urea nitrogen, and gallbladder wall thickness are predictors of mortality in LT candidates and need to be considered in the LT allocation system.

scholarly journals EP.WE.844Two-week bowel cancer referrals during the COVID pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ramez Antakia ◽  
Vladimir Popa-Nimigean ◽  
Thomas Athisayaraj
Keyword(s):  
Waiting Time ◽  
Waiting Times ◽  
Bowel Habit ◽  
Red Flags ◽  
National Guidelines ◽  
Mean Waiting Time ◽  
Significant Difference ◽  
Immunochemical Test ◽  
Red Flag ◽  
The Impact

Abstract Aims The aims were to assess the impact of the COVID-19 pandemic on the waiting times for patients referred via the two-week pathway for suspected colorectal cancer. We also examined the use of Faecal Immunochemical Test (FIT) alongside the presenting complaints in triaging/prioritising patients for further imaging and/or endoscopic investigations appropriately. Methods A list of all patients referred via the two-week pathway to the West Suffolk Hospital for suspected colorectal cancers from 30/01/2020 to 19/07/2020 was compiled. The main four red flag symptoms were change in bowel habit (CIBH), anorectal bleeding, anaemia and weight loss. A subset of 235 patients were closely examined regarding their presenting complaints, FIT, imaging and endoscopy results with analysis of outcomes. Results 127 male versus 108 female patients were included. 59.61% of patients who were eligible for the FIT test received one. Mean waiting time for FIT positive patients was 42.39 (95% CI) versus 61.10 (95% CI) for FIT negative patients. Patients with one or two red flags symptoms had a mean waiting time of 44.81 days (95% CI 35.79-53.82) and 47.91 days (95% CI 38.07-57.75) respectively. Patients with three red flag symptoms had a mean waiting time of 28.2 days (95% CI 17.94-38.39). There was a statistically significant difference in mean waiting time between patients having 1-2 symptoms and patients with three symptoms (p < 0.005). Conclusions Despite delays during the COVID pandemic particularly for endoscopy, high risk and FIT positive patients were prioritised. Waiting times were still higher than advised national guidelines.

Factors Associated with Nonattendance to a Geriatric Clinic among Mexican Older Adults

Gerontology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Juan Pablo Negrete-Najar ◽  
Yoselin Juárez-Carrillo ◽  
Jimena Gómez-Camacho ◽  
Nancy R. Mejía-Domínguez ◽  
Enrique Soto-Perez-de-Celis ◽  
...  
Keyword(s):  
Older Adults ◽  
Geriatric Medicine ◽  
Health Resources ◽  
Public Health Problem ◽  
Time Frame ◽  
Cross Sectional Study ◽  
Multinomial Regression ◽  
Cross Sectional ◽  
History Of ◽  
The Impact

<b><i>Introduction:</i></b> Outpatient appointment nonattendance (NA) represents a public health problem, increasing the risk of unfavorable health-related outcomes. Although NA is significant among older adults, little is known regarding its correlates. This study aimed to identify the correlates (including several domains from the geriatric assessment) of single and repeated NA episodes in a geriatric medicine outpatient clinic, in general and in the context of specific comorbidities. <b><i>Methods:</i></b> This is a cross-sectional study including data from 3,034 older adults aged ≥60 years with ≥1 scheduled appointments between January 1, 2016, and December 31, 2016. Appointment characteristics as well as sociodemographic, geographical, and environmental information were obtained. Univariate and multivariate multinomial regression analyses were carried out. <b><i>Results:</i></b> The mean age was 81.8 years (SD 7.19). Over a third (37.4%) of participants missed one scheduled appointment, and 14.4% missed ≥2. Participants with a history of stroke (OR 1.336, <i>p</i> = 0.041) and those with a greater number of scheduled appointments during the study time frame (OR 1.182, <i>p</i> &#x3c; 0.001) were more likely to miss one appointment, while those with Parkinson’s disease (OR 0.346, <i>p</i> &#x3c; 0.001), other pulmonary diseases (OR 0.686, <i>p</i> = 0.008), and better functioning for activities of daily living (ADL) (OR 0.883, <i>p</i> &#x3c; 0.001) were less likely to do so. High socioeconomic level (OR 2.235, <i>p</i> &#x3c; 0.001), not having a partner (OR 1.410, <i>p</i> = 0.006), a history of fractures (OR 1.492, <i>p</i> = 0.031), and a greater number of scheduled appointments (OR 1.668, <i>p</i> &#x3c; 0.001) increased the risk of repeated NA, while osteoarthritis (OR 0.599, <i>p</i> = 0.001) and hypertension (OR 0.680, <i>p</i> = 0.002) decreased it. In specific comorbidity populations (hypertension, type 2 diabetes mellitus, and cancer), better ADL functioning protected from a single NA, while better mobility functioning protected from repeated NA in older patients with hypertension and cancer. <b><i>Discussion/Conclusion:</i></b> Identifying geriatric factors linked to an increased probability of NA may allow one to anticipate its likelihood and lead to the design and implementation of preventive strategies and to an optimization of the use of available health resources. The impact of these factors on adherence to clinical visits requires further investigation.

scholarly journals P042 Five-year review of a tertiary paediatric sleep service for complex patients

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A35-A35
Author(s):  
A Griffiths ◽  
S Preston ◽  
A Adams ◽  
M Vandeleur
Keyword(s):  
Waiting Time ◽  
Waiting Times ◽  
Diagnostic Study ◽  
Sleep Study ◽  
Clinical Model ◽  
Home Study ◽  
Sleep Studies ◽  
Mean Waiting Time ◽  
Bed Capacity ◽  
The Impact

Abstract Introduction Our paediatric sleep unit commenced service for children with complex medical problems in July 2015. Service capacity includes 12 inpatient level 1 studies (two neonates) and one home study per week. FTE includes senior scientists 2.6, sleep technologists 1.7, administration 1.0, nursing 0.7 and medical 1.2. The primary aim of this study was to evaluate activity during the first 5-years. The secondary aim was to document the impact of the COVID-19 pandemic. Methods Sleep unit operational & diagnostic data were collected from sleep booking sheets, sleep study reports, electronic medical records. Descriptive statistics are presented. Results A total of 2186 sleep studies were performed (July 2015 to June 2020) with a range of 368–472 studies per annum. Overall, 61.7% were diagnostic studies, 20.8% titration studies (CPAP, oxygen, bi-level or invasive ventilation), 10% neonatal and 7.5% home studies. Between 2016–2020, the average waiting time (days) for a neonatal study was 16, a titration study was 106, a diagnostic study was 110 and a home study was 76. Further delays were caused by the COVID19 pandemic. Mean waiting time rose 229% from 108 days (Feb 2020) to 355 days (Feb 2021). Referrals for sleep studies have exceeded bed capacity since the beginning of the pandemic. Discussion This audit describes activity in a tertiary complex paediatric sleep service during the first 5 years. The service has struggled on current FTE and bed capacity to manage waiting times, exacerbated further by the COVID-19 pandemic. A new business and clinical model are warranted.

scholarly journals Managing Queues with Heterogeneous Servers

2011 ◽  
Vol 48 (2) ◽  
pp. 435-452 ◽  
Author(s):  
Jung Hyun Kim ◽  
Hyun-Soo Ahn ◽  
Rhonda Righter
Keyword(s):  
Waiting Time ◽  
Waiting Times ◽  
Structural Result ◽  
Batch Arrivals ◽  
Optimal Thresholds ◽  
Mean Waiting Time ◽  
Server Problem ◽  
The Mean ◽  
The Impact ◽  
Intuitive Proof

We consider several versions of the job assignment problem for an M/M/m queue with servers of different speeds. When there are two classes of customers, primary and secondary, the number of secondary customers is infinite, and idling is not permitted, we develop an intuitive proof that the optimal policy that minimizes the mean waiting time has a threshold structure. That is, for each server, there is a server-dependent threshold such that a primary customer will be assigned to that server if and only if the queue length of primary customers meets or exceeds the threshold. Our key argument can be generalized to extend the structural result to models with impatient customers, discounted waiting time, batch arrivals and services, geometrically distributed service times, and a random environment. We show how to compute the optimal thresholds, and study the impact of heterogeneity in server speeds on mean waiting times. We also apply the same machinery to the classical slow-server problem without secondary customers, and obtain more general results for the two-server case and strengthen existing results for more than two servers.

scholarly journals Differences in Perceived Waiting Time by Health Insurance Type in the Inpatient Sector: An Analysis of Patients With Breast Cancer in Germany

2019 ◽  
Vol 56 ◽  
pp. 004695801987589 ◽  
Author(s):  
Susan Lee ◽  
Sophie E. Gross ◽  
Holger Pfaff ◽  
Antje Dresen
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Health Insurance ◽  
Waiting Time ◽  
Care Center ◽  
Waiting Times ◽  
Breast Cancer Surgery ◽  
Cross Sectional ◽  
Insurance Type ◽  
The Impact

Although the relationship between health insurance and waiting time has been established in the ambulatory sector in Germany, research in the inpatient sector is limited. This study aims to contribute to previous work through analyzing differences in perceived waiting time by health insurance type during the inpatient stays of patients with breast cancer in Germany. This study utilizes cross-sectional data from 2017 of patients with breast cancer (N = 4626) who underwent primary breast cancer surgery in a certified breast care center in Germany. Results from multilevel logistic regression models indicate a significant effect of health insurance status on perceived waiting time, net of other relevant factors (patient’s sociodemographic background, Union for International Cancer Control stage, grading, self-reported and classified health, type of surgery, and chemotherapy). Patients with statutory insurance were significantly more likely than privately insured patients to report long waiting times for examinations/procedures, discharge, and to speak with the physician. There were no significant differences in waiting time for nursing staff between private and statutory insurance holders. Results align with previous findings in the ambulatory sector and suggest a private health insurance advantage, with private patients receiving priority to some health care services. Disparities in health care accessibility and quality need to continue to be addressed and discussed, as well as the impact of health insurance type on other indicators of health.

scholarly journals SP4.2.11 Access to emergency theatre during the COVID -19 pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Alexios Dosis ◽  
Jie Qi Lim ◽  
Dharsshini Reveendran ◽  
Kiara Paramjothy ◽  
Sonia Lockwood
Keyword(s):  
Statistical Analysis ◽  
Surgical Procedures ◽  
Waiting Time ◽  
Waiting Times ◽  
P Value ◽  
Surgical Emergencies ◽  
Time Periods ◽  
Spss Software ◽  
The Impact ◽  
Second Peak

Abstract Aims To investigate the impact of the COVID-19 pandemic on general surgical emergencies and access to theatre during the pandemic. Methods We retrospectively reviewed emergency theatre lists in three distinct time periods: October 2019 (pre-COVID-19 era), April 2020 (first peak) and October 2020 (regional second peak). We extracted and compared data from a prospectively maintained database to calculate patient waiting times. Statistical analysis was performed with SPSS software v21.0 to compare median waiting times between groups and significance was set to a p value of &lt; 0.05. Results Conclusions Despite the initial major drop in general surgical procedures and waiting times, the decreased availability of theatre lists due to staff redeployment and sickness, the introduction of routine pre-operative COVID-19 testing have all resulted in a significant increase in waiting time for urgent (CEPOD 2A) cases during the second peak.

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