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Medical Decision Making
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A Methodological Framework for Optimally Reorganizing Liver Transplant Regions

James E. Stahl, MD, CM, MPH

Department of Radiology & Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston

Nan Kong, MS

Department of Industrial Engineering, University of Pittsburgh, Pennsylvania

Steven M. Shechter, MS

Department of Industrial Engineering, University of Pittsburgh, Pennsylvania

Andrew J. Schaefer, PhD

Department of Industrial Engineering, University of Pittsburgh, Pennsylvania, Department of Medicine, University of Pittsburgh Medical Center, Pennsylvania

Mark S. Roberts, MD, MPP

Department of Industrial Engineering, University of Pittsburgh, Pennsylvania, Department of Medicine, University of Pittsburgh Medical Center, Pennsylvania

Background. The United States is divided currently into 11 transplant regions, which vary in area and number of organ procurement organizations (OPOs). Region size affects organ travel time and organ viability at transplant. Purpose. To develop a methodologic framework for determining optimal configurations of regions maximizing transplant allocation efficiency and geographic parity. Methods. An integer program was designed to maximize a weighted combination of 2 objectives: 1) intraregional transplants, 2) geographic parity—maximizing the lowest intraregional transplant rate across all OPOs. Two classes of functions relating liver travel time to liver viability were also examined as part of the sensitivity analyses. Results. Preliminary results indicate that reorganizing regions, while constraining their number to 11, resulted in up to 17 additional transplants/year depending on the travel-viability function; when not constrained, it resulted in up to 18/year of increase. Conclusion. Our analysis indicates that liver transplantation may benefit through region reorganization. The analytic method developed here should be applicable to other organs and sets of organs.

Key Words: transplant regions • organ procurement organizations • liver transplants

Medical Decision Making, Vol. 25, No. 1, 35-46 (2005)
DOI: 10.1177/0272989X04273137
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This article has been cited by other articles:


Home page
 Med Decis MakingHome page
M. L. Volk, A. S. F. Lok, P. A. Ubel, and S. Vijan
Beyond Utilitarianism: A Method for Analyzing Competing Ethical Principles in a Decision Analysis of Liver Transplantation
Med Decis Making, September 1, 2008; 28(5): 763 - 772.
[Abstract] [PDF]