Health Care Management Science

, Volume 9, Issue 2, pp 125–142

A new organ transplantation location–allocation policy: a case study of Italy

  • Maria Elena Bruni
  • Domenico Conforti
  • Nicola Sicilia
  • Sandro Trotta
Article

Abstract

In this paper, we propose a location model for the optimal organization of transplant system. Instead of simulation approach, which is typical when facing many health care applications, our approach is distinctively based on a mathematical programming formulation of the relevant problem. In particular, we focus on the critical role of time in transplantation process as well as on a spatial distribution of transplant centers. The allocation of transplantable organs across regions with the objective of attaining regional equity in health care, is the aim of this paper. Our model differs from previous modeling approaches in that it considers the nationwide reorganization of the transplant system, identifying system barriers that may impair equity and efficiency. The demolition of these barriers may leads on a reduction of waiting lists and of wasted organs. We provide the basic structure and the properties of the model, and validate it on a real case study. The experimental validation of the model demonstrates the effectiveness and robustness of our proposal.

Keywords

Organ transplantation Facilities location Optimal allocation Prioritization rule Mathematical programming 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ubel PA, Loewenstein G (1996) Public perceptions of the importance of prognosis in allocating transplantable livers to children. Med Decis Mak 16(3):234–241Google Scholar
  2. 2.
    McMaster P (2000) Transplantation for alcoholic liver disease in an era of organ shortage. Lancet 355(202):424–425CrossRefGoogle Scholar
  3. 3.
    Macinko JA, Starfield B (2002) Annotated bibliography on equity in health, 1980–2001. International Journal for Equity in Health 1:1CrossRefGoogle Scholar
  4. 4.
    Zenios SA, Chertow GM, Wein LM (2000) Dynamic allocation of kidneys to candidates on the transplant waiting list. Oper Res 48(4):549–569CrossRefGoogle Scholar
  5. 5.
    Kennedy I, Sells RA et al (1998) The case for ‘presumed consent’ in organ donation. Lancet 351:1650–1652CrossRefGoogle Scholar
  6. 6.
    Wilbert B, Smits JMA, Deng MC, Hummel M, Schoendube F, Scheld H, Persijn G, Laufer G (2003) The heart allocation simulation model: a tool for comparison of transplantation allocation policies. Transplantation 6(10):1492–1497Google Scholar
  7. 7.
    Taranto SE, Harper AM, Edwards EB, Rosendale JD, McBride MA, Patrick Daily O, Murphy D, Poos B, Reust J, Schmeiser B (2000) Developing a national allocation model for cadaveric kidneys. Proceedings of the 2000 Winter Simulation ConferenceGoogle Scholar
  8. 8.
    Ozcan YA, Begun JW, McKinney M (1999) Benchmarking organ procurement organization: a national study. Health Serv Res 34(4):853–872Google Scholar
  9. 9.
    Kreke J, Schaefer J, Angus DC (2002) Incorporating biology into discrete event simulation models or organ allocation. Proceedings of the 2002 Winter Simulation ConferenceGoogle Scholar
  10. 10.
    Su X, Zenios SA (2005) Patient choice in kidney allocation: a sequential stochastic assignment model. Operation Research 53(3):443–455CrossRefGoogle Scholar
  11. 11.
    Hornberger J, Ahn JH (1997) Deciding eligibility for transplantation when a donor kidney becomes available. Med Decis Mak 17(2):160–170Google Scholar
  12. 12.
    Brand DA (1998) Perfect timing, no remorse, and kidney. Transplantation Medical Decision Making 18:249–255Google Scholar
  13. 13.
    Kong N, Shechter S, Schaefer A, Stahl JE (2002 May 19–22) Organ transplantation regions: the need for optimization. IIE 2002 IERC, Orlando, FloridaGoogle Scholar
  14. 14.
    Shechter SM, Bryce CL, Alagoz O, Kreke JE, Stahl JE, Schaefer AJ, Angus DC, Roberts MS (2005) A clinically based discrete-event simulation of end-stage liver disease and the organ allocation process. Med Decis Mak 25(2):199–209CrossRefGoogle Scholar
  15. 15.
    Hakimi SL (1964) Optimum locations of switching centres and the absolute centres and medians of a graph. Oper Res 12:450–459CrossRefGoogle Scholar
  16. 16.
    Balinski ML (1965) Integer programming: methods, uses and computation. Manage Sci 12:253–313Google Scholar
  17. 17.
    ReVelle CS, Swain RW (1970) Central facilities location. Geogr Anal 2:30–42CrossRefGoogle Scholar
  18. 18.
    Vladimir Marianov, Daniel Serra (2004) New trends in public facility location modeling, economics Working Papers 755, Department of Economics and Business, Universitat Pompeu FabraGoogle Scholar
  19. 19.
    Eken-Chaine M, Pliskin J (1992) Incorporating travel times in decisions about size and location of dialysis facilities. Med Decis Mak 12(1):44–51Google Scholar
  20. 20.
    Rahman Shams-ur, Smith David K (2000) Use of location–allocation models in health service development planning in developing nations. Eur J Oper Res 123:437–452CrossRefGoogle Scholar
  21. 21.
    ReVelle CS, Marks D, Liebman JC (1970) An analysis of private and public sector location models. Manage Sci 16:692–707Google Scholar
  22. 22.
    Rushton G (1987) Selecting the objective function in location–allocation analyses. In: Ghosh and Rushton (eds) Spatial analysis and location–allocation models. Van Nostrand Reinhold, New YorkGoogle Scholar
  23. 23.
    Toregas C, ReVelle C Optimal location under time or distance constraints. Papers of regional science association 28:133–143Google Scholar
  24. 24.
    https://trapianti.sanita.it/statistiche/, http://www.ministerosalute.it/servizio/datisit.jspGoogle Scholar
  25. 25.
    Optimization Modeling with Lingo, Lindo System Inc., 1415 North Dayton Street, ChicagoGoogle Scholar
  26. 26.
    Rushton G, Krishnamurthi A (1983) Locational effciency of health care services in an Indian district, Paper delivered at the Meetings of The Association of American Geographers, Denver, ColoradoGoogle Scholar
  27. 27.
    Rahman S, Smith DK (1996) The efficiency of inefficiency: the deployment of health facilities in rural Bangladesh. In: Alauddin M, Hasan S (eds) Economy, people, and the environment. Department of Economics, University of Queensland, Brisbane, Bangladesh, pp 197–209Google Scholar
  28. 28.
    Mehrez A, Sinuany-Stern Z, Arad-Geva T, Binyamin S (1996) On the implementation of quantitative facility location models: the case of a hospital in a rural region. J Oper Res Soc 47:612–625CrossRefGoogle Scholar
  29. 29.
    Marsh MT, Schilling DA (1994) Equity measurement in facility location analysis: a review and framework. Eur J Oper Res 74(1):1–17CrossRefGoogle Scholar
  30. 30.
    Daskin MS, Dean LK (2004) Location of health care facilities. In: Brandeau ML, Sainfort F, Pierskalla WP (eds) Operations research and health care. Kluwer’s International SeriesGoogle Scholar

Copyright information

© Springer Science + Business Media, Inc. 2006

Authors and Affiliations

  • Maria Elena Bruni
    • 1
  • Domenico Conforti
    • 1
  • Nicola Sicilia
    • 1
  • Sandro Trotta
    • 1
  1. 1.Dipartimento di Elettronica, Informatica, SistemisticaUniversità della CalabriaRende (CS)Italy

Personalised recommendations