Using data envelopment analysis and the bootstrap method to evaluate organ transplantation efficiency in Brazil

Brazil has the most extensive public program for organ transplantation in the world, and the Brazilian National Health System (SUS) provides full coverage of all costs involved in organ donation, transplants, and post-transplant. Despite the relevance of the subject and the shortage of organs for transplants, transplantation process efficiency assessments are still uncommon in Brazil and abroad. This study aims to evaluate the efficiency of the Brazilian states and the Federal District in transforming potential organ donors into actual donations. We applied data envelopment analysis (DEA) in conjunction with the bootstrap technique, using organ transplantation data from 2018. The bootstrap methods applied (bootstrap technique, the bootstrap-biased scores of efficiency, and the bootstrap bias-corrected scores of efficiency) allow to obtain a confidence interval for DEA scores and provide greater robustness to studies based on DEA methodology. The bootstrap bias-corrected model indicates that there is significant room for improvement in terms of converting potential donors into actual donors. The mean corrected score is 0.55, signalizing that altogether the Brazilian states could maximize in 45% the number of transplanted organs without necessarily increasing the pool of potential donors. The study provides insights into the Brazilian processes of organ donation and transplantation, helping to identify locations in need of resource allocation improvements. Given the scarcity of studies with a joint application of DEA and bootstrap techniques in this crucial health activity, we also intend to methodologically contribute to this type of benchmark analysis, emphasizing the importance of considering measurement errors, randomness, and bias at DEA models.

Transportation of Donated Hearts by Drone in Comparison to Road-Bound Vehicles in Mexico City

Background:

Organ transportation between hospitals has many challenges since the harvested organ needs to be transplanted to the recipient within an optimal time frame. It is important to transfer the organ from the donor to the recipient site quickly and professionally.

Aim:

The aim of this research is to investigate whether the transportation of donated hearts by drones is more efficient than transportation using road-bound vehicles.

Methods:

A simulation using MatLab software was performed to calculate the heart transportation time between three different hospitals in Mexico City by road-bound vehicles and by drones. This simulation was performed to demonstrate how congestion and traffic in Mexico City prevent healthy hearts from being transplanted to patients on time. The 24-hour period was divided into four 5-hour periods and these were chosen to be: Period 1 (22:00-03:00), Period 2 (04:00-09:00), Period 3 (10:00-15:00) and Period 4 (16:00-21:00).

Results:

The time it took to travel between the hospitals by car within each of the 5-hour periods was calculated. It was observed that, in period 2, a high volume of traffic was present causing road-bound vehicles to take a longer time to deliver hearts to hospitals. All hospitals were within reach of each other if the hearts were to be transported by drone and the delivery time by drone in all cases was less than 1.88 hours, which is the optimum time for the harvested heart to be transported without risk from the donor to the recipient.

Conclusion:

Using drones will increase the safety of transplants, reduce the heart transplantation waiting list and eventually, heart transplantation may be possible in different areas of the city at rush hour times.

Evaluation on the Use of Italian High-Speed Rail to Support Transportation Network for Transplantation Activities

BACKGROUND

One of the main activities connected with transplantation is the rapid and timely transportation of patients, medical teams, and human organs from donation to transplantation centers under the compliance of national guidelines and principles of quality, performance, and safety. High-speed transportation on a railway network is becoming relevant both in terms of performance and extensiveness of the service.

METHODS AND OBJECTIVES

Our study explores the feasibility of adopting a high-speed rail network for the transportation of those organs with large cold ischemia time and those less influenced by transportation-related perturbations (ie, temperature, speed, vibrations), assessing savings and relative performance improvement. In this study, only kidneys have been considered; the transplantation database has been integrated with the national high-speed railway network and timetables. A function is implemented that allocates to air transportations those records with 1 of the 2 ends situated on islands, remote regions, and abroad, while rail transportation is preferred where constraints on capacity and compliance with cold ischemia time are met. Road transportation is still feasible for those records involving 2 adjacent regions and for intraregional transportation.

RESULTS

The opportunity of integrated road-rail transportation in place of air or all-road transportation allows users to lower generalized costs and reduce driven distance for personnel and vehicles allocated to a regional transplantation center's fleet and staff. Savings in fleet and staff usage can serve to improve the performances at the local level.

CONCLUSIONS

The knowledge and analysis of transportation alternatives for human organs with less stringent safety and preservation criteria allow a more efficient allocation of resources both at the local and national level-without compromising quality and reliability of the system.