Making organ allocation fairer: How data and simulation can save lives
Hans de Ferrante developed simulation tools to uncover disparities in organ allocation, helping improve fairness and policy decisions.
Each year, more than one thousand patients across Europe die while waiting for an organ transplant. At the same time, over 6,000 transplant procedures are performed annually within Eurotransplant, the international organization responsible for coordinating organ allocation in eight European countries. This gap between availability and access highlights the urgent need to improve how organs are distributed.
PhD researcher Hans de Ferrante investigated how the current allocation system could be made more equitable and effective. His work, conducted in close collaboration with Eurotransplant, focuses on identifying existing disparities in access to transplantation and developing practical tools to support better decision-making. He defended his thesis on Thursday July 3.
Understanding the complexities of organ allocation
When a donor organ becomes available, must quickly determine which patient should receive it. This decision process is highly complex. Each case involves multiple medical, ethical, and logistical considerations. Decisions are guided by allocation rules embedded in algorithms, which assess factors such as medical urgency, donor-recipient compatibility, and expected outcomes.
These allocation rules are the result of decades of scientific, ethical, and legal discussions. They strive to be fair and based on evidence, but real-world outcomes reveal that some patient groups still experience structural disadvantages.
Identifying gaps in fairness
research identifies two patient groups that currently face unequal chances in receiving an organ.
The first group is women who are on the waiting list for a liver transplant. They are statistically more likely to experience poor outcomes compared to male patients.
His analysis shows that this disparity is not due to sex itself, but rather to differences in average body size. Smaller body size makes it more difficult to match organs under the current system, which does not fully correct for this issue.
The second group includes kidney patients who have been immunized, meaning they have developed antibodies due to events such as pregnancy, blood transfusions, or previous transplants.
These patients are harder to match and therefore have reduced access to transplantation, despite existing mechanisms that aim to support them.
These findings underscore the importance of regularly evaluating and adjusting allocation policies to ensure they align with the principle of equal opportunity.
New tools to support policy reform
Although Eurotransplant regularly updates its policies, the process of making changes is slow and complex.
One key reason is the lack of tools that allow stakeholders to predict the consequences of proposed policy changes. Without reliable evidence on how new rules would affect patients, it is difficult to build consensus or take action.
To address this gap, de Ferrante developed two simulation models that replicate the liver and kidney allocation systems used by Eurotransplant.
These simulators, known as discrete event simulators, use real-world data and closely replicate the actual allocation process. They enable policymakers, clinicians, and researchers to test and compare the effects of various allocation strategies in a virtual environment.
The liver simulator, for example, has already been used to support discussions around a new scoring system for liver allocation. Both simulators have been validated with historical data and are being adopted in ongoing policy discussions.
Allowing decisions to be more transparent and driven by data
Organ allocation involves unavoidable competing priorities. Some rules prioritize patients who are at the highest risk of dying without a transplant, while others focus on maximizing the number of years a recipient may live with a new organ.
At the same time, systems must remain fair to different patient groups, countries, and medical conditions.
Although simulation cannot solve these ethical dilemmas, it helps make their consequences clearer. By showing how various policies would affect outcomes on the waiting list, simulation tools support a more informed and constructive dialogue.
They make it easier for policymakers to balance competing priorities and consider the real impact of their choices.
PhD researcher Hans de Ferrante
Towards a more just allocation system
De Ferrante鈥檚 research contributes both to our understanding of inequality in organ allocation and to the development of practical tools that support better policymaking.
By identifying which patient groups are disadvantaged and by offering a way to test improvements before they are implemented, de Ferrante鈥檚 work lays the foundation for a more fair and effective system.
As Eurotransplant continues to evolve, simulation based approaches can play an essential role in ensuring that vital organs reach the patients who need them most in a way that is transparent, based on evidence, and aligned with the values of justice and medical responsibility.
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Supervisors
Frits Spieksma, Bart Smeulders
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