Abstract
Background: Lung transplantation is a specialized procedure used to treat chronic end-stage respiratory diseases. Due to the scarcity of lung donors, constructing fair and equitable lung transplant allocation methods is an issue that has been addressed with different strategies worldwide. This work aims to describe how Italy’s “national protocol for the management of surplus organs in all transplant programs” functions through an online app to allocate lung transplants. We have developed two probability models to describe the allocation process among the various transplant centers. An online app was then created. The first model considers conditional probabilities based on a protocol flowchart to compute the probability for each area and transplant center to receive each n-th organ in the period considered. The second probability model is based on the generalization of the binomial distribution to correlated binary variables, which is based on Bahadur’s representation, to compute the cumulative probability for each transplant center to receive at least nth organs. Our results show that the impact of the allocation of a surplus organ depends mostly on the region where the organ was donated. The discrepancies shown by our model may be explained by a discrepancy between the northern and southern regions in relation to the number of organs donated.
Highlights
Since the first successful lung transplants were performed in the 1968, lung transplantation has become an established surgical treatment for chronic end-stage respiratory diseases [1]
The Italian transplant system is coordinated by the Centro Nazionale Trapianti (CNT), which directly responds to the Ministry of Health
The tool we developed is intended as a practical instrument to monitor the impact of the current allocation system of surplus organs
Summary
Since the first successful lung transplants were performed in the 1968, lung transplantation has become an established surgical treatment for chronic end-stage respiratory diseases [1]. In the United States the number of lungs transplanted has reached its highest level in 2019, with reduced waitlist mortality as reported by the Organ Procurement. In Italy the trend of lung transplants has increased until 2019 [3]. Given the scarcity of lung donors, their allocation is an issue that has been addressed with different strategies worldwide. Optimizing the allocation of donated organs is crucial to reduce the number of patients dying on the waiting list for lung transplantations (LTx) and to improve post-transplant outcomes [4]. Organ allocations rules are different across the world, as reported by the International Society for Heart and Lung Transplantation (ISHLT) [5]. Several countries have introduced the use of a scoring system to maximize the clinical matches between the tissue type of the donor and that of the recipient.
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