EURO 2024 Copenhagen
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4194. Evaluating policy changes to Eurotransplant’s kidney allocation rules with Discrete Event Simulation

Invited abstract in session TD-10: Kidney Exchange II, stream OR in Health Services (ORAHS).

Tuesday, 14:30-16:00
Room: 11 (building: 116)

Authors (first author is the speaker)

1. Hans de Ferrante
Mathematics & Operations Research, Eindhoven University of Technology
2. Bart Smeulders
Mathematics and Computer Science, Eindhoven University of Technology
3. Frits Spieksma
Mathematics and Computer Science, Eindhoven University of Technology

Abstract

Eurotransplant (ET) prioritizes candidates for deceased-donor kidney transplantation with the ET Kidney Allocation System (ETKAS) algorithm. ETKAS is a points-based system which awards points for patient and donor attributes, including dialysis time, HLA match quality, candidate age, relative location of the candidate w.r.t. the donor, and chances of finding a donor with at most 1 HLA mismatch in the ET donor pool.

The ET Kidney Advisory Committee (ETKAC) regularly points out that ETKAS is outdated. For instance, ETKAS still assigns equal priority to matches on HLA-A, -B and -DR loci, ETKAS does not include age matching, and ETKAS inadequately compensates immunized candidates for having a restricted donor pool. Despite recognition of such issues, the weights assigned to ETKAS attributes has changed little since ETKAS was introduced in 1996.

To facilitate ETKAC discussions on revising ETKAS, we developed the ETKAS simulator, which is a discrete event simulator based on ET registry data simulating ET kidney allocation. We find that the simulator accurately describes candidate dialysis times at transplant, mortality rates, and transplantation rates in ET member countries. To demonstrate utility of the ETKAS simulator for policy evaluation, we map the impact of assigning extra points to HLA-DR matching relative to HLA-A and HLA-B matching, as well as directly prioritizing immunized candidates by assigning points for virtual Panel Reactive Antibodies (vPRA).

Keywords

Status: accepted

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