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Abstract
Organ shortage is a major barrier in transplantation and rules guarding organ allocation decisions should be robust, transparent, ethical and fair. Whilst numerous allocation strategies have been proposed, it is often unrealistic to evaluate all of them in real-life settings. Hence, the capability of conducting simulations prior to deployment is important. Here, we developed a kidney allocation simulation framework (simKAP) that aims to evaluate the allocation process and the complex clinical decision-making process of organ acceptance in kidney transplantation. Our findings have shown that incorporation of both the clinical decision-making and a dynamic wait-listing process resulted in the best agreement between the actual and simulated data in almost all scenarios. Additionally, several hypothetical risk-based allocation strategies were generated, and we found that these strategies improved recipients’ long-term post-transplant patient survival and reduced wait time for transplantation. The importance of simKAP lies in its ability for policymakers in any transplant community to evaluate any proposed allocation algorithm using in-silico simulation.
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Details
1 The University of Sydney, School of Mathematics and Statistics, Sydney, Australia (GRID:grid.1013.3) (ISNI:0000 0004 1936 834X); The University of Sydney, Charles Perkins Centre, Sydney, Australia (GRID:grid.1013.3) (ISNI:0000 0004 1936 834X)
2 The University of Sydney, School of Mathematics and Statistics, Sydney, Australia (GRID:grid.1013.3) (ISNI:0000 0004 1936 834X); The University of Sydney, Sydney Law School, Sydney, Australia (GRID:grid.1013.3) (ISNI:0000 0004 1936 834X)
3 The University of Sydney, School of Mathematics and Statistics, Sydney, Australia (GRID:grid.1013.3) (ISNI:0000 0004 1936 834X); Macquarie University, School of Mathematical and Physical Sciences, Sydney, Australia (GRID:grid.1004.5) (ISNI:0000 0001 2158 5405)
4 The University of Sydney, Sydney School of Public Health, Sydney, Australia (GRID:grid.1013.3) (ISNI:0000 0004 1936 834X); The Children’s Hospital at Westmead, Centre for Kidney Research, Kids Research Institute, Sydney, Australia (GRID:grid.413973.b) (ISNI:0000 0000 9690 854X); Westmead Hospital, Centre for Transplant and Renal Research, Sydney, Australia (GRID:grid.413252.3) (ISNI:0000 0001 0180 6477)