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Allocation Policies (allocation + policy)
Kinds of Allocation Policies Selected AbstractsDeveloping a New Kidney Allocation Policy: The Rationale for Including Life Years from TransplantAMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2009M. D. Stegall The viewpoint outlines the rationale for using LYFT as the major utility metric in kidney allocation and describes a compromise proposal in which recent public feedback is incorporated into the OPTN draft proposal. [source] Changes in Pediatric Renal Transplantation After Implementation of the Revised Deceased Donor Kidney Allocation PolicyAMERICAN JOURNAL OF TRANSPLANTATION, Issue 5 2009S. Agarwal In October 2005, the United Network for Organ Sharing (UNOS) implemented a revised allocation policy requiring that renal allografts from young deceased donors (DDs) (<35 years old) be offered preferentially to pediatric patients (<18 years old). In this study, we compare the pre- and postpolicy quarterly pediatric transplant statistics from 2000 to 2008. The mean number of pediatric renal transplants with young DDs increased after policy implementation from 62.8 to 133 per quarter (p < 0.001), reflecting a change in the proportion of all transplants from young DDs during the study period from 0.33 to 0.63 (p < 0.001). The mean number of pediatric renal transplants from old DDs (,35 years old) decreased from 22.4 to 2.6 per quarter (p < 0.001). The proportion of all pediatric renal transplants from living donors decreased from 0.55 to 0.35 (p < 0.001). The proportion from young DDs with five or six mismatched human leukocyte antigen (HLA) loci increased from 0.16 to 0.36 (p < 0.001) while those with 0 to 4 HLA mismatches increased from 0.18 to 0.27 (p < 0.001). Revision of UNOS policy has increased the number of pediatric renal transplants with allografts from young DDs, while increasing HLA-mismatched allografts and decreasing the number from living donors. [source] Predictability of Survival Models for Waiting List and Transplant Patients: Calculating LYFTAMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2009R. A. Wolfe ,Life years from transplant' (LYFT) is the extra years of life that a candidate can expect to achieve with a kidney transplant as compared to never receiving a kidney transplant at all. The LYFT component survival models (patient lifetimes with and without transplant, and graft lifetime) are comparable to or better predictors of long-term survival than are other predictive equations currently in use for organ allocation. Furthermore, these models are progressively more successful at predicting which of two patients will live longer as their medical characteristics (and thus predicted lifetimes) diverge. The C-statistics and the correlations for the three LYFT component equations have been validated using independent, nonoverlapping split-half random samples. Allocation policies based on these survival models could lead to substantial increases in the number of life years gained from the current donor pool. [source] Preventable Death: Children on the Transplant Waiting ListAMERICAN JOURNAL OF TRANSPLANTATION, Issue 12 2008S. V. McDiarmid Children, especially those under 5 years of age, have the highest death rate on the transplant waiting list compared to any other age range. This article discusses the concept, supported by OPTN data, that there is an age range of small pediatric donors, which are almost exclusively transplanted into small pediatric transplant candidates. Allocation policies that allow broader sharing of small pediatric donors into small pediatric candidates are likely to decrease death rates of children on the waiting list. As well, although the number of pediatric deceased donors continues to decline, improving consent rates for eligible pediatric donors, and judicious use of pediatric donors after cardiac death, can enhance the pediatric deceased donor supply. [source] VIOLENCE AMONG ADOLESCENTS LIVING IN PUBLIC HOUSING: A TWO-SITE ANALYSIS,CRIMINOLOGY AND PUBLIC POLICY, Issue 1 2003TIMOTHY O. IRELAND Research Summary: Current knowledge about violence among public housing residents is extremely limited. Much of what we know about violence in and around public housing is derived from analysis of Uniform Crime Report (UCR) data or victimization surveys of public housing residents. The results of these studies suggest that fear of crime among public housing residents is high and that violent offense rates may be higher in areas that contain public housing compared with similar areas without public housing. Yet, "[r]ecorded crime rates (and victimization rates) are an index not of the rate of participation in crime by residents of an area, but of the rate of crime (or victimization) that occurs in an area whether committed by residents or non-residents" (Weatherburn et al., 1999:259). Therefore, neither UCR nor victimization data measurement strategies address whether crime in and around public housing emanates from those who reside in public housing. Additionally, much of this research focuses on atypical public housing,large developments with high-rise buildings located in major metropolitan areas. To complement the existing literature, we compare rates of self-reported crime and violence among adolescents who reside in public housing in Rochester, N.Y., and Pittsburgh, Pa., with adolescents from the same cities who do not live in public housing. In Rochester, property crime and violence participation rates during adolescence and early adulthood among those in public housing are statistically equivalent to participation rates among those not in public housing. In Pittsburgh, living in public housing during late adolescence and early adulthood, particularly in large housing developments,increases the risk for violent offending, but not for property offending. The current study relies on a relatively small number of subjects in public housing at any single point in time and is based on cross-sectional analyses. Even so, there are several important policy implications that can be derived from this study, given that it moves down a path heretofore largely unexplored. Policy Implications: If replicated, our findings indicate that not all public housing is inhabited disproportionately by those involved in crime; that to develop appropriate responses, it is essential to discover if the perpetrators of violence are residents or trespassers; that policy should target reducing violence specifically and not crime in general; that a modification to housing allocation policies that limits, to the extent possible, placing families with children in late adolescence into large developments might reduce violence perpetrated by residents; that limited resources directed at reducing violence among residents should be targeted at those developments or buildings that actually have high rates of participation in violence among the residents; and that best practices may be derived from developments where violence is not a problem. [source] Mixed tree-vegetative barrier designs: experiences from project works in northern VietnamLAND DEGRADATION AND DEVELOPMENT, Issue 4 2002A. Fahlén Abstract There has been an increased interest in the use of vegetative barriers in acid-infertile upland management systems in Southeast Asia. This paper analyses the experimental designs and policies in early-1990s of using vetiver grass barriers (Vetiveria zizanioides L.) in microwatersheds with short-rotation tree plantations in Vinh Phu Province, Vietnam. Four different mixed tree-vetiver models on degraded Ferric-Plinthic Acrisols are discussed. It is concluded that the institutional approach of demonstrating vetiver barriers as a model had a poor cost-wise performance, and that the model itself did not address the underlying issues of land degradation due to uncontrolled harvest of organic matter from the forest floors. The institutional approach was tainted with price distortions and ,disbursement-oriented' actions. Alternative and more flexible on-farm approaches, using V. zizanioides or the indigenous leguminous shrub Tephrosia candida (Roxb.) DC as vegetative barriers, were found to be more cost-effective and likely to have a higher rate of adoption among farmers. The institutional changes in land allocation policies (securing long-term usufruct users and transfer rights of agricultural and forest land) that took place in Vietnam in the early 1990s, in combination with a reorientation of programme policies to support needs of individuals and farmers' households, are hypothesized to have contributed more to the ,regreening' of the hills, than any single approaches of technical barrier designs by the Swedish-Vietnamese Forestry Co-operation Programme (FCP) in northern Vietnam. Copyright © 2002 John Wiley & Sons, Ltd. [source] Extended right liver grafts obtained by an ex situ split can be used safely for primary and secondary transplantation with acceptable biliary morbidityLIVER TRANSPLANTATION, Issue 7 2009Atsushi Takebe Split liver transplantation (SLT) is clearly beneficial for pediatric recipients. However, the increased risk of biliary complications in adult recipients of SLT in comparison with whole liver transplantation (WLT) remains controversial. The objective of this study was to investigate the incidence and clinical outcome of biliary complications in an SLT group using split extended right grafts (ERGs) after ex situ splitting in comparison with WLT in adults. The retrospectively collected data for 80 consecutive liver transplants using ERGs after ex situ splitting between 1998 and 2007 were compared with the data for 80 liver transplants using whole liver grafts in a matched-pair analysis paired by the donor age, recipient age, indications, Model for End-Stage Liver Disease score, and high-urgency status. The cold ischemic time was significantly longer in the SLT group (P = 0.006). As expected, bile leakage from the transected surface occurred only in the SLT group (15%) without any mortality or graft loss. The incidence of all other early or late biliary complications (eg, anastomotic leakage and stenosis) was not different between SLT and WLT. The 1- and 5-year patient and graft survival rates showed no statistical difference between SLT and WLT [83.2% and 82.0% versus 88.5% and 79.8% (P = 0.92) and 70.8% and 67.5% versus 83.6% and 70.0% (P = 0.16), respectively]. In conclusion, ERGs can be used safely without any increased mortality and with acceptable morbidity, and they should also be considered for retransplantation. The significantly longer cold ischemic time in the SLT group indicates the potential for improved results and should thus be considered in the design of allocation policies. Liver Transpl 15:730,737, 2009. © 2009 AASLD. [source] Combined orthotopic heart and liver transplantation: The need for exception status listing1,LIVER TRANSPLANTATION, Issue 12 2004Paige M. Porrett Through May 2004, 33 combined orthotopic heart-liver transplants (OHT/OLT) have been performed nationwide. No published data exist to date regarding outcomes of patients awaiting such transplants, although progression of two organ disease processes may contribute to premature death for waiting patients. Retrospective data were collected on patients listed for combined OHT/OLT from both an individual tertiary care transplant center and the national UNOS registry to delineate listing criteria and evaluate patient outcomes in both the pre- and post-MELD eras. All patients who survived to transplantation or died on the waiting list were included in the analysis. Results show that 29.6% of patients registered nationally and 42% of patients listed institutionally survived to transplantation. Survival to transplantation was associated with less severe liver disease, though patients with MELD scores ranging from 19 to 26 had significantly higher wait list mortality than expected when compared to single-organ liver transplants. Following combined orthotopic heart-liver transplantation, 80% and 70% of patients survive 1 and 3 years, respectively. In conclusion, combined OHT/OLT is a successful therapy, but current organ allocation policies may not ensure expeditious transplantation in critically ill patients with dual vital organ failure. Providing exception status listing to these patients would ensure more expeditious transplantation and potentially contribute to improved survival. (Liver Transpl 2004;10:1539,1544.) [source] A general strategic capacity planning model under demand uncertaintyNAVAL RESEARCH LOGISTICS: AN INTERNATIONAL JOURNAL, Issue 2 2006Woonghee Tim Huh Abstract Capacity planning decisions affect a significant portion of future revenue. In equipment intensive industries, these decisions usually need to be made in the presence of both highly volatile demand and long capacity installation lead times. For a multiple product case, we present a continuous-time capacity planning model that addresses problems of realistic size and complexity found in current practice. Each product requires specific operations that can be performed by one or more tool groups. We consider a number of capacity allocation policies. We allow tool retirements in addition to purchases because the stochastic demand forecast for each product can be decreasing. We present a cluster-based heuristic algorithm that can incorporate both variance reduction techniques from the simulation literature and the principles of a generalized maximum flow algorithm from the network optimization literature. © 2005 Wiley Periodicals, Inc. Naval Research Logistics, 2006 [source] A welfare analysis of spectrum allocation policiesTHE RAND JOURNAL OF ECONOMICS, Issue 3 2009Thomas W. Hazlett Economic analysis of spectrum policy focuses on government revenues derived via competitive bidding for licenses. Auctions generating high bids are identified as "successful" and those with lower receipts as "fiascoes." Yet spectrum policies that create rents impose social costs. Most obviously, rules favoring monopoly predictably increase license values but reduce welfare. This article attempts to shift analytical focus to efficiency in output markets. In performance metrics derived by comparing 28 mobile telephone markets, countries allocating greater bandwidth to licensed operators and achieving more competitive market structures are estimated to realize efficiencies that generally dominate those associated with license sales. Policies intended to increase auction receipts (e.g., reserve prices and subsidies for weak bidders) should be evaluated in this light. [source] Development of the New Lung Allocation System in the United StatesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 5p2 2006T. M. Egan This article reviews the development of the new U.S. lung allocation system that took effect in spring 2005. In 1998, the Health Resources and Services Administration of the U.S. Department of Health and Human Services published the Organ Procurement and Transplantation Network (OPTN) Final Rule. Under the rule, which became effective in 2000, the OPTN had to demonstrate that existing allocation policies met certain conditions or change the policies to meet a range of criteria, including broader geographic sharing of organs, reducing the use of waiting time as an allocation criterion and creating equitable organ allocation systems using objective medical criteria and medical urgency to allocate donor organs for transplant. This mandate resulted in reviews of all organ allocation policies, and led to the creation of the Lung Allocation Subcommittee of the OPTN Thoracic Organ Transplantation Committee. This paper reviews the deliberations of the Subcommittee in identifying priorities for a new lung allocation system, the analyses undertaken by the OPTN and the Scientific Registry for Transplant Recipients and the evolution of a new lung allocation system that ranks candidates for lungs based on a Lung Allocation Score, incorporating waiting list and posttransplant survival probabilities. [source] Analytical approaches for transplant research, 2004AMERICAN JOURNAL OF TRANSPLANTATION, Issue 4p2 2005Douglas E. Schaubel This article provides detailed explanations of the methods frequently employed in outcomes analyses performed by the Scientific Registry of Transplant Recipients (SRTR). All aspects of the analytical process are discussed, including cohort selection, post-transplant follow-up analysis, outcome definition, ascertainment of events, censoring, and adjustments. The methods employed for descriptive analyses are described, such as unadjusted mortality rates and survival probabilities, and the estimation of covariant effects through regression modeling. A section on transplant waiting time focuses on the kidney and liver waiting lists, pointing out the different considerations each list requires and the larger questions that such analyses raise. Additionally, this article describes specialized modeling strategies recently designed by the SRTR and aimed at specific organ allocation issues. The article concludes with a description of simulated allocation modeling (SAM), which has been developed by the SRTR for three organ systems: liver, thoracic organs, and kidney-pancreas. SAMs are particularly useful for comparing outcomes for proposed national allocation policies. The use of SAMs has already helped in the development and implementation of a new policy for liver candidates with high MELD scores to be offered organs regionally before the organs are offered to candidates with low MELD scores locally. [source] INDUCTIVE RISK AND JUSTICE IN KIDNEY ALLOCATIONBIOETHICS, Issue 8 2010ANDREA SCARANTINO ABSTRACT How should UNOS deal with the presence of scientific controversies on the risk factors for organ rejection when designing its allocation policies? The answer I defend in this paper is that the more undesirable the consequences of making a mistake in accepting a scientific hypothesis, the higher the degree of confirmation required for its acceptance. I argue that the application of this principle should lead to the rejection of the hypothesis that ,less than perfect' Human Leucocyte Antigen (HLA) matches are an important determinant of kidney graft survival. The scientific community has been divided all along on the significance of partial antigen matches. Yet reliance on partial matches has emerged as one of the primary factors leading blacks to spend a much longer time than whites on the waiting list for kidneys, thereby potentially impacting the justice of the kidney allocation policy. My case study illustrates one of the legitimate roles non-epistemic values can play in science and calls into question the ideal of a value-free science. [source] An optimal multimedia object allocation solution in multi-powermode storage systemsCONCURRENCY AND COMPUTATION: PRACTICE & EXPERIENCE, Issue 13 2010Yingwei Jin Abstract Given a set of multimedia objects R={o1, o2, ,, ok} each of which has a set of multiple versions oi.v={Ai.0, Ai.1, ,, Ai.m}, i=1, 2, ,, k, there is a problem of distributing these objects in a server system so that user requests for accessing specified multimedia objects can be fulfilled with the minimum energy consumption and without significant degrading of the system performance. This paper considers the allocation problem of multimedia objects in multi-powermode storage systems, where the objects are distributed among multi-powermode storages based on the access pattern to the objects. We design an underlying infrastructure of storage system and propose a dynamic multimedia object allocation policy based on the designed infrastructure, which integrate and prove the optimality of the proposed policy. Copyright © 2010 John Wiley & Sons, Ltd. [source] MELD,Moving steadily towards equality, equity, and fairnessLIVER TRANSPLANTATION, Issue 5 2005James Neuberger Background and aims: A consensus has been reached that liver donor allocation should be based primarily on liver disease severity and that waiting time should not be a major determining factor. Our aim was to assess the capability of the Model for End-Stage Liver Disease (MELD) score to correctly rank potential liver recipients according to their severity of liver disease and mortality risk on the OPTN liver waiting list. Methods: The MELD model predicts liver disease severity based on serum creatinine, serum total bilirubin, and INR and has been shown to be useful in predicting mortality in patients with compensated and decompensated cirrhosis. In this study, we prospectively applied the MELD score to estimate 3-month mortality to 3437 adult liver transplant candidates with chronic liver disease who were added to the OPTN waiting list at 2A or 2B status between November, 1999, and December, 2001. Results: In this study cohort with chronic liver disease, 412 (12%) died during the 3-month follow-up period. Waiting list mortality increased directly in proportion to the listing MELD score. Patients having a MELD score <9 experienced a 1.9% mortality, whereas patients having a MELD score > or =40 had a mortality rate of 71.3%. Using the c-statistic with 3-month mortality as the end point, the area under the receiver operating characteristic (ROC) curve for the MELD score was 0.83 compared with 0.76 for the Child-Turcotte-Pugh (CTP) score (P < 0.001). Conclusions: These data suggest that the MELD score is able to accurately predict 3-month mortality among patients with chronic liver disease on the liver waiting list and can be applied for allocation of donor livers.(Gastroenterology 2003;124:91,96.) Context: The Model for Endstage Liver Disease (MELD) score serves as the basis for the distribution of deceased-donor (DD) livers and was developed in response to "the final rule" mandate, whose stated principle is to allocate livers according to a patient's medical need, with less emphasis on keeping organs in the local procurement area. However, in selected areas of the United States, organs are kept in organ procurement organizations (OPOs) with small waiting lists and transplanted into less-sick patients instead of being allocated to sicker patients in nearby transplant centers in OPOs with large waiting lists. Objective: To determine whether there is a difference in MELD scores for liver transplant recipients receiving transplants in small vs large OPOs. Design and setting: Retrospective review of the US Scientific Registry of Transplant Recipients between February 28, 2002, and March 31, 2003. Transplant recipients (N = 4798) had end-stage liver disease and received DD livers. Main outcome measures: MELD score distribution (range, 6,40), graft survival, and patient survival for liver transplant recipients in small (<100) and large (> or =100 on the waiting list) OPOs. RESULTS: The distribution of MELD scores was the same in large and small OPOs; 92% had a MELD score of 18 or less, 7% had a MELD score between 19 and 24, and only 2% of listed patients had a MELD score higher than 24 (P = .85). The proportion of patients receiving transplants in small OPOs and with a MELD score higher than 24 was significantly lower than that in large OPOs (19% vs 49%; P<.001). Patient survival rates at 1 year after transplantation for small OPOs (86.4%) and large OPOs (86.6%) were not statistically different (P = .59), and neither were graft survival rates in small OPOs (80.1%) and large OPOs (81.3%) (P = .80). Conclusions: There is a significant disparity in MELD scores in liver transplant recipients in small vs large OPOs; fewer transplant recipients in small OPOs have severe liver disease (MELD score >24). This disparity does not reflect the stated goals of the current allocation policy, which is to distribute livers according to a patient's medical need, with less emphasis on keeping organs in the local procurement area. (JAMA 2004;291:1871,1874.) [source] Marked Variation of the Association of ESRD Duration Before and After Wait Listing on Kidney Transplant OutcomesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2010J. D. Schold Numerous studies report a strong association between pretransplant end-stage renal disease (ESRD) duration and diminished transplant outcomes. However, cumulative waiting time may reflect distinct phases and processes related to patients' physiological condition as well as pre-existing morbidity and access to care. The relative impact of pre- and postlisting ESRD durations on transplant outcomes is unknown. We examined the impact of these intervals from a national cohort of kidney transplant recipients from 1999 to 2008 (n = 112 249). Primary factors explaining prelisting ESRD duration were insurance and race, while primary factors explaining postlisting ESRD duration were blood type, PRA% and variation between centers. Extended time from ESRD to waitlisting had significant dose,response association with overall graft loss (AHR = 1.26 for deceased donors [DD], AHR = 1.32 for living donors [LD], p values < 0.001). Contrarily, time from waitlisting (after ESRD) to transplantation had negligible effects (p = 0.10[DD], p = 0.57[LD]). There were significant associations between pre- and postlisting ESRD time with posttransplant patient survival, however prelisting time had over sixfold greater effect. Prelisting ESRD time predominately explains the association of waiting time with transplant outcomes suggesting that factors associated with this interval should be prioritized for interventions and allocation policy. The degree to which the effect of prelisting ESRD time is a proxy for comorbid conditions, socioeconomic status or access to care requires further study. [source] Liver Transplantation in the United States, 1999,2008AMERICAN JOURNAL OF TRANSPLANTATION, Issue 4p2 2010P. J. Thuluvath Changes in organ allocation policy in 2002 reduced the number of adult patients on the liver transplant waiting list, changed the characteristics of transplant recipients and increased the number of patients receiving simultaneous liver,kidney transplantation (SLK). The number of liver transplants peaked in 2006 and declined marginally in 2007 and 2008. During this period, there was an increase in donor age, the Donor Risk Index, the number of candidates receiving MELD exception scores and the number of recipients with hepatocellular carcinoma. In contrast, there was a decrease in retransplantation rates, and the number of patients receiving grafts from either a living donor or from donation after cardiac death. The proportion of patients with severe obesity, diabetes and renal insufficiency increased during this period. Despite increases in donor and recipient risk factors, there was a trend towards better 1-year graft and patient survival between 1998 and 2007. Of major concern, however, were considerable regional variations in waiting time and posttransplant survival. The current status of liver transplantation in the United States between 1999 and 2008 was analyzed using SRTR data. In addition to a general summary, we have included a more detailed analysis of liver transplantation for hepatitis C, retransplantation and SLK transplantation. [source] Moving Kidney Allocation Forward: The ASTS PerspectiveAMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2009R. B. Freeman In 2008, the United Network for Organ Sharing issued a request for information regarding a proposed revision to kidney allocation policy. This plan described combining dialysis time, donor characteristics and the estimated life years from transplant (LYFT) each candidate would gain in an allocation score that would rank waiting candidates. Though there were some advantages of this plan, the inclusion of LYFT raised many questions. Foremost, there was no clear agreement that LYFT should be the main criterion by which patients should be ranked. Moreover, to rank waiting candidates with this metric, long-term survival models were required in which there was no incorporation of patient preference or discounting for long survival times and for which the predictive accuracy did not achieve accepted standards. The American Society of Transplant Surgeons was pleased to participate in the evaluation of the proposal. Ultimately, the membership did not favor this proposal, because we felt that it was too complicated and that the projected slight increase in overall utility was not justified by the compromise in individual justice that was required. We offer alternative policy options to address some of the unmet needs and issues that were brought to light during this interesting process. [source] The Broad Spectrum of Quality in Deceased Donor KidneysAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2005Jesse D. Schold The quality of the deceased donor organ clearly is one of the most crucial factors in determining graft survival and function in recipients of a kidney transplant. There has been considerable effort made towards evaluating these organs culminating in an amendment to allocation policy with the introduction of the expanded criteria donor (ECD) policy. Our study, from first solitary adult deceased donor transplant recipients from 1996 to 2002 in the National Scientific Transplant Registry database, presents a donor kidney risk grade based on significant donor characteristics, donor,recipient matches and cold ischemia time, generated directly from their risk for graft loss. We investigated the impact of our donor risk grade in a naïve cohort on short- and long-term graft survival, as well as in subgroups of the population. The projected half-lives for overall graft survival in recipients by donor risk grade were I (10.7 years), II (10.0 years), III (7.9 years), IV (5.7 years) and V (4.5 years). This study indicates that there is great variability in the quality of deceased donor kidneys and that the assessment of risk might be enhanced by this scoring system as compared to the simple two-tiered system of the current ECD classification. [source] Pediatric Heart Transplant Candidates With Failed Donor Heart Allocation After Eurotransplant Urgency Listing Profit From Pretransplant Mechanical Circulatory Support BridgingARTIFICIAL ORGANS, Issue 4 2009Takeshi Komoda Abstract:, Due to the Eurotransplant organ allocation policy, urgency listing for heart transplantation (HTx) remains in force until ventricular assist device (VAD) implantation in Germany. We studied the prognosis of HTx candidates after failed donor heart allocation in urgent status. We studied all adult and pediatric (<18 years) HTx candidates who underwent primary HTx after Eurotransplant urgency listing between January 2001 and December 2006 (Group A-uHTx [A-"u"rgent status "HTx"], n = 99; Group P-uHTx [P-"u"rgent status "HTx"], n = 24) and those to whom donor heart was not urgently allocated before VAD implantation or death in the same period (Group A-fHA [A-"f"ailed "H"eart "A"llocation], n = 21, Group P-fHA [P-"f"ailed "H"eart "A"llocation], n = 10). Mortality rate after urgency listing or primary VAD implantation was studied in each group. In adult patients, 1-year mortality rate after urgency listing in Group A-fHA was 56.8% and significantly higher than in Group A-uHTx (30.6%, P < 0.001, log-rank test). After failed urgent heart allocation, 15 out of 21 patients in Group A-fHA had VAD implantation and two patients (9.5%) underwent HTx after VAD implantation. In pediatric patients, 1-year mortality rate in Group P-fHA was 40.0% and significantly higher than in Group P-uHTx (8.5%, P < 0.05). In Group P-fHA, all 10 patients underwent VAD implantation after failed urgent heart allocation and six patients (60.0%, P < 0.01 vs. Group A-fHA, Fisher's exact test) underwent HTx after VAD implantation. After failed urgent donor heart allocation, pediatric HTx candidates seem to profit more from mechanical circulatory support than adults. [source] INDUCTIVE RISK AND JUSTICE IN KIDNEY ALLOCATIONBIOETHICS, Issue 8 2010ANDREA SCARANTINO ABSTRACT How should UNOS deal with the presence of scientific controversies on the risk factors for organ rejection when designing its allocation policies? The answer I defend in this paper is that the more undesirable the consequences of making a mistake in accepting a scientific hypothesis, the higher the degree of confirmation required for its acceptance. I argue that the application of this principle should lead to the rejection of the hypothesis that ,less than perfect' Human Leucocyte Antigen (HLA) matches are an important determinant of kidney graft survival. The scientific community has been divided all along on the significance of partial antigen matches. Yet reliance on partial matches has emerged as one of the primary factors leading blacks to spend a much longer time than whites on the waiting list for kidneys, thereby potentially impacting the justice of the kidney allocation policy. My case study illustrates one of the legitimate roles non-epistemic values can play in science and calls into question the ideal of a value-free science. [source] | |||||||||||||