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Is the UK's liver transplant matching algorithm biased against younger patients?

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Re: Is the UK's liver transplant matching algorithm biased against younger patients?

#51

Post by pkaye »

jl6 wrote: post #47

It’s worth noting that the algorithm in question is not any kind of AI or ML as we might know it from the tech industry. Underneath, it is plain old statistical modelling. The article doesn’t make this clear, and the name of the blog doesn’t help.

I got my kidney transplant last years. Here are some of the allocation calculators used in the US. https://optn.transplant.hrsa.gov/data/allocation-calculators

For kidney transplants, for example the EPTS score, compatibility, time on the list, geographic distance and antibody levels are used to generate the wait list ranking. For scale, you accrue 1/365 points for each day waiting on the list. Kids under 10 get 2 extra points. Kids under 20 get 1 extra point. Those with high antibody levels can get up to 20 extra points to increase their chance of getting a match.

The KDPI score is an estimate of how risk of graft failure of the donor organ. The lower the number the better the odds. Those with low EPTS (<20%) will get those with KDPI <20%. Age and diabetes heavily factor in an EPTS score. The donor KDPI is something they will tell you when you get a call. You can always pass on any donor organ.

Re: Is the UK's liver transplant matching algorithm biased against younger patients?

#52

Post by refurb »

ipnon wrote: post #5

Similarly the main calculator used in the US to calculate 10-year risk of cardiovascular incident literally cannot compute scores for people under 40.[0] There are two consequences to this. The first is that if you are under 40 you will never encounter a physician who believes you are at risk of heart attack or stroke, even though over 100,000 Americans under 40 will experience such an incident each year. The second…

> The second is that even if you get a heart attack or stroke due to their negligence they will never be liable because that calculator is considered the standard of care in malpractice law!

I think you misunderstand how the risk calculator is used.

Physicians are still expected to use their clinical judgement and information from patient conversation to determine the appropriate intervention.

If a 30 year old patient comes in with high blood pressure, but no existing cardiovascular disease (so the calculator could be used except for the age), it would clearly be malpractice for the doctor to say "sorry! you're too young to use the calculator so I'm going to give you a stamp of approval for health!"

Re: Is the UK's liver transplant matching algorithm biased against younger patients?

#53

Post by lazyasciiart »

rscho wrote: post #36
lazyasciiart wrote: post #20

Earlier quoted context omitted.

I had a heart attack at 35, despite not really having other risks. A sibling who had a heart attack is the biggest risk factor, but later my sister did not qualify for a study on heart attack risk because she was only 39. My ER notes literally say “can’t be a heart attack but that’s what it looks like, so we’ll treat it as one for now”, which is a little unnerving.

> is a little unnerving Why so? You were lucky! You had a low probability for the diagnosis, but the doc made the right decision. That's to be celebrated. > did not qualify for a study on heart attack risk because she was only 39. Criteria for studies are designed to test a specific hypothesis. There are many possible reasons why your sister was not eligible, and not all of them bad.

Yes. It is unnerving to see how strong a role “luck” played in getting me treated.

She did not qualify because she was not have any risk factors, defined as being over 40, overweight, high cholesterol, or metabolic disorder. If she had been 41 she would have qualified.

Re: Is the UK's liver transplant matching algorithm biased against younger patients?

#55

Post by rainforest »

binary132 wrote: post #27

So, if I as a 38-year-old had a mild liver impairment which could reduce my life expectancy to 60 (22 years from now) I should get priority over a 60-year-old with a debilitating, excruciating condition which will end his life in six months, merely because his life expectancy with the transplant may only be 70? That’s an outrageous and obscene utility calculation to propose and it should be obviously so to just about…

The NHS does this calculus routinely using Quality Adjusted Life Years. Treatments that get more are favoured which is also how NICE decides what drugs the NHS should offer. There's obviously some utilitarianism in the decision to use QALYs but to some (including me) it seems a reasonable proxy metric to maximise.

Ultimately a sacrifice must be chosen, but I am not sure a discussion about how that should be made is necessarily fit for HN (though I'd be interested in how you'd resolve your proposed scenario).

Re: Is the UK's liver transplant matching algorithm biased against younger patients?

#56

Post by defrost »

binary132 wrote: post #27

So, if I as a 38-year-old had a mild liver impairment which could reduce my life expectancy to 60 (22 years from now) I should get priority over a 60-year-old with a debilitating, excruciating condition which will end his life in six months, merely because his life expectancy with the transplant may only be 70? That’s an outrageous and obscene utility calculation to propose and it should be obviously so to just about…

> That’s an outrageous and obscene utility calculation to propose

Welcome to the reality of triage .. all decisions are bad from some PoV or another, some are arguably less bad.

Oh, to live in a world of infinite matching organs and unlimited theatre slots on demand.

Re: Is the UK's liver transplant matching algorithm biased against younger patients?

#57

Post by adastra22 »

zamadatix wrote: post #43
adastra22 wrote: post #32

Earlier quoted context omitted.

Any ER would check for a concussion in that circumstance, as I can attest from experience.

Almost certainly. That's why not doing so is used as a clear example of malpractice and negligence - the standard of care says to check for those kinds of issues given the situation and that's what nearly every doctor will therefore do.

Concussion isn’t age related though, so the circumstance isn’t comparable.

Re: Is the UK's liver transplant matching algorithm biased against younger patients?

#58

Post by rangestransform »

steveBK123 wrote: post #8
icegreentea2 wrote: post #7

Earlier quoted context omitted.

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?

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.

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

Re: Is the UK's liver transplant matching algorithm biased against younger patients?

#59

Post by yieldcrv »

mannykannot wrote: post #46
yieldcrv wrote: post #17

Earlier quoted context omitted.

Then the entire medical industry is failing at communicating that The relatability of OP’s shared experience has us wanting to replace most medical professionals with genAI language models as soon as the regulations allow

> Then the entire medical industry is failing at communicating that. Rebutting hypobolic extrapolations from literally one datum is still not something that the entire medical industry - or just my PCP and cardiologist, for that matter - should be prioritizing (unless they have a patient doing just that), even if the prevalence of such claims has increased over the last decade or so. The afforementioned professionals…

many demographics have well studied issues of being validated at all

It’s not hyperbolic, it’s a relatable shared experience, which are the words I used for a reason. as its not a single datum, while also avoids any attempt to quantify it at all

Re: Is the UK's liver transplant matching algorithm biased against younger patients?

#60

Post by rcxdude »

adastra22 wrote: post #57
zamadatix wrote: post #43

Earlier quoted context omitted.

Almost certainly. That's why not doing so is used as a clear example of malpractice and negligence - the standard of care says to check for those kinds of issues given the situation and that's what nearly every doctor will therefore do.

Concussion isn’t age related though, so the circumstance isn’t comparable.

Falling certainly carries more health risks as you're older, but young people aren't immune, and the same is true for heart attacks. That's the point of the analogy. The skater concussion scenario is obviously ridiculous to highlight how the heart attack scenario is also ridiculous.
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