Sunday, March 4, 2018

Deceased kidney allocation in Australia

What does it mean for kidney allocation to be fair?  A recent paper asks that question in Australia, and supplies some background to the debate in the increasing age of both patients and donors there.

Fairness in Deceased Organ Matching
Nicholas Mattei, Abdallah Saffidine, Toby Walsh

Abstract: "As algorithms are given responsibility to make decisions that impact our lives, there is increasing awareness of the need to ensure the fairness of these decisions. One of the first challenges then is to decide what fairness means in a particular context. We consider here fairness in deciding how to match organs donated by deceased donors to patients. Due to the increasing age of patients on the waiting list, and of organs being donated, the current “first come, first served” mechanism used in Australia is under review to take account of age of patients and of organs. We consider how to revise the mechanism to take account of age fairly. We identify a number of different types of fairness, such as to patients, to regions and to blood types and consider how they can be achieved."

Introduction: "Kidney disease costs the Australian economy billions of dol-lars per year. Over ten thousand people in Australia are on dialysis,  each  costing  hundreds  of  thousands  of  dollars  in medical and welfare costs. Australia is especially challenged in this area as kidney disease is a major problem within the indigenous population. The incidence of end stage kidney disease in the indigenous population in remote areas of Australia is 18 to 20 times higher than that of comparable non-indigenous peoples.1

"A  significant  trend  in  Australia  (as  in  other  developed countries) is that age is now starting to play a major role in kidney disease. It is impacting both the demand and supply side of the kidney transplant market. On the demand side,the age of patients in Australia waiting to receive a kidney has increased significantly in recent years. In 2010, for example, just 11% of the waiting list were 65 years or older. In 2015, this had increased to 15%. Over the next 30 years, the proportion of the population of Australia aged over 65 years is predicted to double to around 25 per cent. This ageing demographic will likely further increase the age of people on the waiting list for a kidney transplant.

"On the supply side of the market, the age of donated kidneys has also increased significantly. In 1989, the mean age of  donated  kidneys  in  Australia  was  just  32  years  old.  In 2014, this had increased dramatically to 46 years old. Surgeons are now able and willing to transplant older kidneys into older patients. In 1989, the oldest transplanted kidney came from a donor aged 69 years. In 2014, this has increased to an 80 year old donated organ. A number of factors including  increasing  life  expectancy,  medical  advances,  and  improved road safety have been driving these changes on both sides of the market."

(The paper proposes a stability criterion that I'm not persuaded is well motivated in the present context, but the discussion is interesting...)

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