HIP/Georgia CTSA Seed Grant will Fund Proposal to Improve the Match of Organ-Donor Pairs
AUGUST 2019
Every year, thousands of people either die waiting for an organ transplant or are removed from the waitlist because they become too sick to withstand the procedure. As the shortage of donor organs continues to worsen and waitlists grow longer, nearly 20% of the organs that are procured are discarded each year in the U.S., with much variability by region. With each discard, an opportunity to save a life could be lost.
Rachel Patzer, PhD, MPH, director of the Emory Health Services Research Center, is Co-PI of a pilot project led by PI Pinar Pinar Keskinocak, PhD, William W. George Chair and Professor and director of the Center for Health and Humanitarian Systems, Georgia Institute of Technology, that plans to begin alleviating this problem. The project team, which includes Co-PIs Hannah Smalley, PhD, research engineer at Georgia Tech, and Joel Sokol, PhD, professor in Georgia Tech's Stewart School of Industrial and Systems Engineering, have received a two-year seed grant from the Emory-Georgia Tech Healthcare Innovation Program (HIP) in partnership with the Georgia Clinical & Translational Science Alliance (Georgia CTSA), to develop protocols and tools that will reduce the number of discarded organs, allow more patients on the waiting list to receive a transplant, and increase informed decision-making at various levels in the transplant process.
Organs, including kidneys, liver, lung, and heart, can be declined if the patient and their physician prefer waiting for a more desirable organ, such as one from a younger donor. Organs from donors at increased risk of hepatitis B, hepatitis C, or HIV are also often denied, even though the risk of infectious disease presence in the donor or transmission to the recipient may be low. Meanwhile, depending on circumstances and individual factors, a successful transplant of such an organ or one that is undesirable for other reasons could significantly improve the quality and span of a patient's life compared to remaining on the waitlist, particularly when deteriorating health status is considered.
To assist doctors and patients in navigating the dilemmas posed by these issues, the research team has built interactive, decision-aid prototype tools that perform such functions as displaying the probability of surviving to certain time periods for a potential recipient either receiving an organ transplant (possibly from an increased-risk donor) or waiting for a different kidney, liver, heart, or lung. In this project, they will test these tools among patients and clinicians to evaluate their design and functionality. Based on the feedback they receive, the team will update and improve the prototype designs to prepare the tools for more comprehensive, subsequent testing.
The research team is also seeking to improve patient and physician decision-making through individualized wait-time estimation. For each organ, the team is defining patient clusters that share medical characteristics and general time to transplant with data gathered from UNOS and OPTN. The final goal is to create a decision aid which predicts the wait time for an organ offer of a desired quality, helping patients and physicians make more informed decisions when accepting or declining an organ offered for transplant.
The team's final aim is to develop methods for improving identification and allocation of so-called marginal organs, which are often repeatedly declined and either discarded or transplanted to patients ranked very low in the waitlist. In fact, these organs should be viewed as having lifesaving potential and the possibility of giving patients a better quality of life compared to remaining on the waitlist. However, the process for identifying which patients could be good candidates for receiving such organs is not standardized, and often based on subjectivity rather than any type of formula.
The team will work to characterize such organs and identify those patients who could benefit from receiving them for transplant by considering patient and organ characteristics, patients' estimated time on the waitlist, patients' post-operation care options, and other factors. Using transplant data provided by OPTN, the team plans to determine specific characteristics of transplant candidates most likely to benefit from marginal organs. Furthermore, they will also develop an unequivocal model to identify organs which fall into the marginal category.