I attended a fascinating session yesterday on using OR to improve equity in allocating donated organs for transplants, because the current policy results in severe geographic disparities. The country is divided into regions, but the supply and demand are greatly unequal between regions. Baris Ata of the University of Chicago highlighted this disparity by relating Steve Jobs’ own experience trying to get a liver in California, where the list was so long he’d never get one before his own liver was predicted to give out. He instead also “listed” in Tennessee, where his odds were much better and where his ability to be on the ground within eight hours was possible because of his own personal jet. Baris related this story to an entrepreneur (and OM professor) he knows, and the result was a quite disruptive new venture, OrganJet. Baris encouraged the crowd to consider other disruptive ways to address this issue.
This session was unique for INFORMS in that the speakers were roughly balanced between academics using their expertise (or engineers, as most of the doctors referred to OR professionals) and clinicians who are leaders in the transplant community.
Key lessons I took away:
- It is critical but also hard for clinicians and engineers to build relationships so they can understand each other because of the big gap that sometimes exists in what they value.
- The politics and ethical implications make agreeing on the constraints very hard. One person asked how you decide whether a newly available organ should go to an otherwise relatively healthy young person with greater chances of survival and opportunity to live a long life or a more critically ill older person at greater risk of dying. There’s no right answer to this question.
- Modeling is far from abstract when it determines who lives and dies. The clinicians said that as they attempt to make policy they argue a lot! One likened this question to the Titanic and lifeboats, because the difficult reality is that there are not enough boats. People will die, but how to you minimize death, maximize life, and preserve equity? The doctors present implored the OR community to help come up with a better way to allocate what one called “this precious gift,” the organs in question.
- Consulting with the end users of your models, when you are collaborating with practitioners, is critical. As Sommer Gentry of the Naval Academy said, “our endless models don’t necessarily provide the details the practitioners want.”
- Sommer also pointed out the tragedy of the commons as it applies to this question. One major challenge of these kinds of complex public policy decisions is that unlike many of the Edelman winners there is no unifying force like a CEO who can clarify the objective function, so clinicians set parameters for policy, argue, shift who is on the committees making the decisions, and then stalling tactics are used to change the parameters.
For all the challenges it was inspiring to hear the real efforts to make an impact on such a pressing problem. It was an amazing example of #data4good at #INFORMS2016.