Identification and Allocation of Increased-Risk Encephalitis Organs

Health/Infectious Diseases

We developed two decision-support tools to aid organ transplant physicians (and patients) in the identification and allocation of organs that carry the risk of infectious encephalitis. The Infectious Encephalitis Risk Calculator assesses whether a donor (and his/her organs) may have infectious versus non-infectious encephalitis, using statistical imputation, cross-validation, and several regression techniques. Compared to current practices used by physicians to distinguish between infectious and non-infectious encephalitis, the Infectious Encephalitis Risk Calculator improves the prediction accuracy from 70% to 92%. The Liver Transplant Decision Aid helps patients and physicians evaluate the trade-offs between accepting and rejecting an increased-risk encephalitis (IRE) liver, using Cox Proportional Hazards models. 53% of the patients who died on the waitlist in 2006 would have had a higher one-year survival probability if they had taken an IRE liver with an infection risk of 100% versus remaining on the waitlist. Thus, the Liver Transplant Decision Aid can enable a better allocation of high-risk organs and reduce the number of deaths on the waitlist. Finally, we also present descriptive models to provide wait times customized to patient characteristics.

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