[icegreentea2]

What does a non "one size fits all" approach for organ matching look like? What does a non-singular matching system work? Do you arbitrarily (randomly?) split up organs into different pools and let each pool match by a different algorithm?

[toast0]

So, from the article, it sounds like this current UK system for liver transplant matchibg was developed to replace the previous regional systems. It's not clear if all of those used the same process to determine matches, but it would be possible for them to have developed different processes.

It's also likely that a cross-regional system existed, that may have been ad-hoc. If you had a patient with an exceptional need, you might ask the other regions to be on the look out for an exceptional liver that works just right for your patient. That sort of thing is harder to do in a national system where livers are allocated based on scores.

Another thing that's helpful with multiple systems is it encourages reviewing and comparing results.

For a single system, reviewing results is even more important, but comparing is harder. But you might look at things like demographics of patients who died from liver disease while on the list including how long they were on the list; how long the current people have been waiting; demographics of people who recieve a transplant and how long they waited.

If there's a bias against young people, you would likely see more young people with long wait times, etc.

[steveBK123]

Yes, in the US it might look like state level / hospital system level vs 1 singular national level matching system.

US has its problems, but sometimes the "laboratory of ideas" that is federated system of 50 states prevents bad outcomes like this.

[RyanHamilton]

The lab of ideas = advantages the rich e.g. Steve Jobs. "In 2009, Steve Jobs received a liver transplant—not in northern California where he lived, but across the country in Memphis, Tennessee. Given the general complications of both travel and a transplant, Jobs’ decision may seem like an odd choice. But it was a strategic move that almost certainly got him a liver much more quickly than if Jobs had just waited for a liver to become available in California." https://arstechnica.com/science/2017/03/live-death-math-and-...

[icegreentea2]

The challenge is maintaining the multiple independent systems when faced with pressures like "hey, if we consolidated systems, the the % of waiting list patients who die within 6 months of enrolling goes from 8% to 4%, and the % who receive a transplant go from 60% to 65%".

The UK system undoubtedly had a bad outcome, but the reasoning behind consolidation was sound, and the benefits real and ACTUALLY achieved (just not dispersed justly). Maintaining independent systems would mitigate against some of these failures, but would long-term be out performed by a responsive consolidated system (which I think is ultimately what the article is arguing for - not against algorithms, but against black-box algorithms that are not responsive or amendable to public scrutiny and feedback).

There are definitely times and places with independent implementations provide a strong benefits, but I think this is a much more borderline scenario.

And btw, the US has a unified organ matching system.

[rangestransform]

I think the advantage of the laboratory of ideas these days is mostly that it prevents knuckledraggers in other states from hindering progress in mine, but with a strong federal govt it’s looking less and less realistic