ABSTRACT
One of the most visible and contentious issues regarding the fairness of the original system of organ procurement and allocation is the argument that it resulted in great disparities in the total amount of time a patient waited for an organ (i.e. the time from registration at a transplantation center to transplant), depending on where he or she lived. In an attempt to resolve this debate, Congress charged the National Academy of Sciences, Institute of Medicine to perform an independent study of the original system and proposed rule changes. In an analysis of approximately 68,000 transplant waiting list records, the committee developed several conclusions and recommendations largely specific to liver transplantation policies. The purpose of this paper is to describe both the results of the study and the statistical foundations of the mixed-effects multinomial logistic regression model that led to the committee's conclusions.
Subject(s)
Health Care Rationing , Organ Transplantation , Statistics as Topic/methods , Waiting Lists , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Liver Diseases/mortality , Liver Diseases/surgery , Liver Transplantation , Male , Middle Aged , National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division , Patient Selection , Sex Factors , Treatment Outcome , United StatesABSTRACT
This article is based on the closing address given by Dr. Mitchell Spellman on behalf of Harvard Medical International at the third biennial Asan Medical Center-Harvard Medical International Symposium titled "Genetics and Proteomics: Impact on Medicine and Health" that took place at the Asan Medical Center in Seoul, Korea, July 3-4, 2001. Dr. Spellman's remarks were addressed to a distinguished gathering that included President Changgi D. Hong and President Emeritus Pyung Chul Min of Asan Medical Center; President Emeritus Mun Ho Lee of Asan Medical Center, who is currently President, Korea Cancer Research Foundation; Secretary General Chul Lee of the Organizing Committee for the Symposium; Dr. Won Jong Kim, Dean of the University of Ulsan College of Medicine; Dr. Je Guen Chi, President of the Korean Academy of Medical Sciences; and the Faculty of the Symposium, together with colleagues, guests, and friends. First, Dr. Spellman reminds participants of the breadth of topics presented during the third biennial symposium. He then discourses on the inestimable worth of the sequencing of the human genome and how such knowledge provides us with the opportunity to consider the meaning and dimensions of humanity-biological, social, and ethical.
