Reshaping National Organ Allocation Policy

Theodore Papalexopoulos (), James Alcorn (), Dimitris Bertsimas (), Rebecca Goff (), Darren Stewart () and Nikolaos Trichakis ()
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Theodore Papalexopoulos: Operations Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
James Alcorn: United Network for Organ Sharing, Richmond, Virginia 23219
Dimitris Bertsimas: Operations Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
Rebecca Goff: United Network for Organ Sharing, Richmond, Virginia 23219
Darren Stewart: NYU Grossman School of Medicine, New York, New York 10016
Nikolaos Trichakis: Operations Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139

Operations Research, 2024, vol. 72, issue 4, 1475-1486

Abstract: The Organ Procurement & Transplantation Network (OPTN) initiated in 2018 a major overhaul of all U.S. deceased-donor organ allocation policies, aiming to gradually migrate them to a so-called continuous distribution model, with the goal of creating an allocation system that is more efficient, more equitable, and more inclusive. Development of policies within this model, however, represents a major challenge because multiple efficiency and fairness objectives need to be delicately balanced. We introduce a novel analytical framework that leverages machine learning, simulation, and optimization to illuminate policy tradeoffs and enable dynamic exploration of the efficient frontier of policy options. In collaboration with the OPTN, we applied the framework to design a new national allocation policy for lungs. Since March 9, 2023, all deceased-donor lungs in the United States have been allocated according to this policy that we helped design, projected to reduce waitlist mortality by approximately 20% compared with current policy based on simulations. We discuss how we extended our collaboration with the OPTN to the redesign of kidney, pancreas, heart, and liver allocation and how our framework can be applied to other application domains, such as school choice or public housing allocation systems.

Keywords: OR Practice; fairness; policy design; multi-objective optimization; resource allocation; fairness and efficiency tradeoff; organ allocation (search for similar items in EconPapers)
Date: 2024
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