The kidney distribution system for transplantation in Chile explained according to Game Theory: How theoretical generosity is transformed into real selfishness
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Abstract
Context: There is a huge mismatch between demand and supply of organs for transplantation, particularly kidneys. Their allocation system in Chile delivers one kidney to the procuring institution and the second to another national institution; policy designed seeking to stimulate procurement in transplant institutions.
Objectives: Evaluate whether this policy has been effective for increasing nationwide organ donation and procurement rates in procuring centers, whether their behavior is aligned with the local / pool kidney allocation system, and whether the policy has contributed to increasing equity in access to kidney transplantation.
Methods: We obtained the origin of all organ donors between 2010-2020 from public records, separating them by private or public institutions, and matched those organs with the corresponding information from the centers that implanted them, and used descriptive statistics, t-student tests, and linear regressions over time for analysis. We performed an economic analysis of the costs of procuring a kidney for transplantation, for which we gathered the public static prices, and a sample of the 5 largest private transplantation facilities’ prices.
Results: We found no significant increase in the total number of organ donors in the country during the studied period, and the mild increase observed was due to the addition of new public centers to the system. We observed that private institutions are increasing their participation in the transplant market and they do so at the expense of public institutions and without increasing their contribution of organs to the system, because of the high cost of procuring compared to the cost of transferring a kidney.
Conclusions: This behavior can be framed within the Game Theory, specifically the Tragedy of the Commons, describing that the players maximize their benefit at the expense of the rest without considering the subsequent consequences, which leads to an imbalance between demand and supply of organs for transplantation that worsens over time and lengthens waiting lists.
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References
2. Lewis A, Koukoura A, Tsianos GI, Gargavanis AA, Nielsen AA, Vassiliadis E. Organ donation in the US and Europe: The supply vs demand imbalance. Transplant Rev. 2021;35(2):100585. doi:10.1016/j.trre.2020.100585
3. Wu DA, Watson CJ, Bradley JA, Johnson RJ, Forsythe JL, Oniscu GC. Global trends and challenges in deceased donor kidney allocation. Kidney Int. 2017;91(6):1287-1299. doi:10.1016/j.kint.2016.09.054
4. Lee D, Kanellis J, Mulley WR. Allocation of deceased donor kidneys: A review of international practices. Nephrology. 2019;24(6):591-598. doi:10.1111/nep.13548
5. Stewart DE, Klassen DK. Early Experience with the New Kidney Allocation System: A Perspective from UNOS. Clin J Am Soc Nephrol. 2017;12(12):2063-2065. doi:10.2215/CJN.06380617
6. Watson CJE, Johnson RJ, Mumford L. Overview of the Evolution of the UK Kidney Allocation Schemes. Curr Transplant Rep. 2020;7(2):140-144. doi:10.1007/s40472-020-00270-6
7. Faitot F, Michard B, Artzner T. Organ allocation in the age of the algorithm: avoiding futile transplantation - utility in allocation. Curr Opin Organ Transplant. 2020;25(3):305-309. doi:10.1097/MOT.0000000000000752
8. Israni A, Wey A, Thompson B, et al. New Kidney and Pancreas Allocation Policy: Moving to a Circle as the First Unit of Allocation. J Am Soc Nephrol. 2021;32(7):1546. doi:10.1681/ASN.2020121679
9. Javier Domínguez C. Sistema de distribución de órganos en chile: propuestas para una modificación de la distribución de riñones de donantes cadavéricos para trasplante. Rev Médica Clínica Las Condes. 2010;21(2):179-185. doi:10.1016/S0716-8640(10)70522-8
10. INCUCAI A. Normas para la habilitación de establecimientos y autorización de equipos de profesionales para la práctica de ablación e implante de riñón y uréter y para la evaluación pre-trasplante y seguimiento post-trasplante. Accessed June 13, 2022. https://www.argentina.gob.ar/sites/default/files/norm-ren-reso-incucai_062_17.pdf
11. Alcaldía Mayor de Bogotá S de S. Lineamientos de distribucion y asignacion_ de riñon en la Coordiancion Regional N1 red de Donacion Trasplantes. 2016. Accessed June 17, 2022. http://saludcapital.gov.co/Lineamientos/2016-2020/44_SDS_PSS_LN_005_Distribucion_Asignacion__Ri%C3%B1onCoordiancion_Regional_N1_Red_Donacion_Trasplantes.pdf
12. Almeida Ubidia DHM. RESOLUCIÓN 012-INDOT-2015 EMÍTENSE LAS POLÍTICAS DE ASIGNACIÓN RENAL Y HEPÁTICA PARA TRANSPLANTES. 2015;Ministerio de Salud Pública:41.
13. Nieto EP. Reglamento de la Ley General de Salud en Materia de Trasplantes. :24.
14. Ministerio de Salud. Yo Dono Vida - Estadísticas. Ministerio de Salud - Estadísticas. Accessed March 26, 2019. https://yodonovida.minsal.cl/estadisticas/estadisticas.html
15. González Cohens F, González Fuenzalida F. The coronavirus pandemic did not impact Chilean organ donation system. Transpl Int. Published online September 1, 2021:10.1111/tri.13999. doi:10.1111/tri.13999
16. González Cohens F, Vera Cid F, Alcayaga Droguett R, González Fuenzalida F. Análisis crítico de la baja tasa de donación de órganos en Chile. Rev Med Chile. 2020;148(2):267-276. doi:10.4067/s0034-98872020000200242
17. Directorio de organismos regulados - Portal de Transparencia del Estado de Chile. Accessed October 14, 2024. https://www.portaltransparencia.cl/PortalPdT/buscador-directorio-de-organismos-regulados
18. Fonasa Chile 2022. Accessed June 6, 2023. https://www.fonasa.cl/sites/Satellite?c=Page&cid=1520002044318&pagename=Fonasa2019%2FPage%2FF2_ContenidoDerecha#aranceles-mai-2022
19. Clinica Las Condes. Aranceles 2021 y Honorarios Medicos. Accessed October 14, 2024. https://www.clinicalascondes.cl/Dev_CLC/media/Otros/pdfs/Aranceles2021-Honorarios-Medicos.pdf?gclid=CjwKCAiAtouOBhA6EiwA2nLKH2jtfVaYuU-8Vb1nyrNUbxiMqIradbBlmgsxyOVouBVZKzoMHs_yCRoCF1oQAvD_BwE
20. UC Christus R de S. Arancel de prestaciones 2021. Published online 2021. Accessed October 14, 2024. https://d328k6xhl3lmif.cloudfront.net/docs/default-source/default-document-library/arancel-2021-csc.pdf?sfvrsn=30d791f0_2
21. Arancel | Clínica Alemana de Santiago. Accessed October 14, 2024. https://www.alemana.cl/wls/arancel/
22. Aranceles. Accessed October 14, 2024. https://www.clinicasantamaria.cl/necesitas-atencion/pacientes/aranceles/
23. Aranceles Nuevo. Clínica Dávila. Accessed October 14, 2024. https://www.davila.cl/aranceles/
24. Palacios Junemann JM. Procuramiento de Órganos: el modelo chileno. Rev Chil Cir. Published online 2002:573-588.
25. Salaman JR, Ross WB. EXCHANGING KIDNEY TRANSPLANTS—IS IT WORTH IT? The Lancet. 1987;329(8548):1480-1481. doi:10.1016/S0140-6736(87)92220-3
26. Zuckoff M. Ponzi’s Scheme: The True Story of a Financial Legend. Random House Publishing Group; 2005.
27. Nash JF. Equilibrium points in n-person games. Proc Natl Acad Sci. 1950;36(1):48-49. doi:10.1073/pnas.36.1.48
28. Hardin G. The Tragedy of the Commons. Science. 1968;162(3859):1243-1248. doi:10.1126/science.162.3859.1243