New research on kidney screening strategies shows encouraging signs
A new model devised by Canadian business professors is showing promising signs in lowering costs and reducing the likelihood of offering kidneys to patients with severe conditions that make them ineligible for a transplant.
Haskayne School of Business supply chain prof Alireza Sabouri and colleagues from the Sauder School of Business at UBC developed a framework that helps transplant centres with a common challenge in how to screen patients on kidney transplant waiting lists. According to the Kidney Foundation of Canada, 4,500 Canadians are on a waiting list for a transplant and 80 per cent of those are awaiting a new kidney.
The centres screen patients on the lists looking for conditions such as cardiovascular diseases, which makes them ineligible for a transplant. The more often centres screen the patients, the greater costs they incur. Further complicating the screening process is the fact that when a kidney becomes available, it must be transplanted quickly without sufficient time to screen. It's also not possible to know who is next on the list because the patient must be a match for that particular organ.
Using data from the waiting list in British Columbia, Sabouri and co-authors Woonghee Tim Huh and Steven M. Shechter developed a model that optimizes when to screen patients based on their characteristics and position on the waiting list.
"This problem came out of our discussions with transplant surgeons in the British Columbia Transplant Society. They suggested that having a decision support tool would significantly facilitate the screening process," says Sabouri, the lead researcher.
"Our study of the literature and current practice also revealed that the current guidelines are very simple and not evidence-based. Also, transplant centres usually deviate from these general guidelines and come up with their own policies for screening patients," he says.
The model they devised, based on simulation results, showed a 36-per-cent reduction in annual cost, a reduction of offering kidneys to patients with cardiovascular disease by 57 per cent and used only five-per-cent more screenings per year. Their findings were recently published in the journal of Operations Research in the article "Screening Strategies for Patients on the Kidney Transplant Waiting List."
"We expected our policy to outperform the current generic guidelines because they ignore the remaining time on the waiting list as a factor in making screening decisions," says Sabouri.
"However, many transplant centers use expert judgment and resource considerations to come up with their own policies that should perform better than the guidelines. In other words, when necessary, they deviate from the guidelines to consider factors such as the remaining waiting time. Our model helps with streamlining the screening process and provide more insights on how to make those judgement calls."
Sabouri says the researchers have shared their findings with the British Columbia Transplant Society and are currently preparing a next article aimed at medical practitioners and policy-makers.