Sistema de obtención de riñones en Colombia: un enfoque basado en la Dinámica de Sistemas
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may 23, 2019
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Joan Paola Cruz
https://orcid.org/0000-0002-5343-9055
William J. Guerrero Rueda
https://orcid.org/0000-0002-9807-6593
Edna Rocío Pérez
https://orcid.org/0000-0002-0659-2794
David Leonardo Lizarazo Walteros
https://orcid.org/0000-0002-4178-3617
Paula Carolina Rico Ardila
https://orcid.org/0000-0003-1260-1236
Ana María Castillo
https://orcid.org/0000-0002-4166-8459
Laura Natalia Torres Tinjacá
https://orcid.org/0000-0002-3734-8858
https://orcid.org/0000-0002-5343-9055
William J. Guerrero Rueda
https://orcid.org/0000-0002-9807-6593
Edna Rocío Pérez
https://orcid.org/0000-0002-0659-2794
David Leonardo Lizarazo Walteros
https://orcid.org/0000-0002-4178-3617
Paula Carolina Rico Ardila
https://orcid.org/0000-0003-1260-1236
Ana María Castillo
https://orcid.org/0000-0002-4166-8459
Laura Natalia Torres Tinjacá
https://orcid.org/0000-0002-3734-8858
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Resumen
Objetivo: Este artículo presenta un análisis de dos propuestas de regulación en respuesta a la creciente demanda de trasplantes de riñón en Colombia. Los resultados pueden ser útiles al evaluar esas posibles intervenciones en las políticas una vez han sido implementadas. Métodos: El modelo propuesto emplea la Dinámica de Sistemas como herramienta para entender el comportamiento de este complejo sistema social cuando se ejecutan dos proyectos de intervención. El primero es un proyecto de ley que buscan expandir la presunción legal de la donación del órgano. El segundo es la implementación de un Programa de intercambio de riñones (KEP). El análisis se realiza en dos partes: primero se propone un diagrama causal; en segundo lugar, se analiza la simulación del sistema usando un diagrama de existencias y flujos. Resultados: Los resultados muestran que los proyectos pueden equilibrar el sistema y motivar las donaciones. Conclusión: Se recomienda la implementación de un programa KEP dado que logra la estabilidad del sistema antes que la enmienda de las leyes, con una reducción en el tamaño de la lista de espera.
Keywords
kidney exchange program, System Dynamics modeling, healthcare, kidney transplantation, organ procurement systemprograma de troca de rins, modelos de Dinâmica de Sistemas, atendimento médico, transplante renal, sistema de aquisição de órgãosprograma de intercambio de riñón, , modelos de Dinámica de Sistemas, atención médica, trasplante de riñón, sistema de obtención de órganos
References
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7. Thiel G, Vogelbach P, Gurke L, Gasser T, Lehmann K, Voegele T, Kiss A, Kirste G. Crossover renal transplantation: hurdles to be cleared! Transplant Proc. 2001; 33(1):811-816. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11267078
8. Abraham DJ, Blum A, Sandholm T. Clearing algorithms for barter exchange markets: Enabling nationwide kidney exchanges. In Proceedings of the 8th ACM conference on Electronic commerce. 2007 Jun 11-15; San Diego, California. 2007 p. 295-304. Available from: https://www.cs.cmu.edu/~sandholm/kidneyExchange.EC07.withGrantInfo.pdf
9. Saidman SL, Roth AE, Sonmez T, Utku M, Ünver, Delmonico FL. Increasing the opportunity of live kidney donation by matching for two-and three-way exchanges. Transplantation. 2006; 81(5):773-782. Available from: https://doi.org/10.1097/01.tp.0000195775.77081.25
10. Veale J, Hil G. National kidney registry: 213 transplants in three years. Clin Transpl. 2010; 333-344.
11. Gurkan A, Kacar SH, Varilsuha C, Tilif S, Coker I, Karaca C, Karaoglan M. Exchange kidney transplantation: a good solution in living kidney transplantation. Transplant Proc. 2004. 36(10): 2952-2953. Available from http://hdl.handle.net/10822/986410
12. Lucan M. Five years of single-center experience with paired kidney exchange transplantation. Transplant Proc. 2007 39(5):1371-1375. Available from: https://doi.org/10.1016/j.transproceed.2007.02.081
13. Klerk MD, Keizer KM, Claas FHJ, Witvliet M, Haase-Kromwijk BJJM, Weimar W. The Dutch national living donor kidney exchange program. American Journal of Transplantation. 2005; 5(9):2302-2305. Available from: https://doi.org/10.1111/j.1600-6143.2005.01024.x
14. Klerk M, Witvliet MD, Haase-Kromwijk BJJM, Claas FHJ, Weimar W. A highly efficient living donor kidney exchange program for both blood type and crossmatch incompatible donor-recipient combinations. Transplantation. 2006; 82(12):1616-1620. Available from: https://doi.org/10.1097/01.tp.0000250906.66728.8d
15. Kranenburg L, Zuidema W, Weimar W, Hilhorst M, Ijzermans J, Passchier J, Busschbach J. Strategies to advance living kidney donation: a single center's experience. Progress in Transplantation. 2009;19(1):71-75. Available from: https://doi.org/10.1177/152692480901900110
16. Biro P, Manlove DF, Rizzi R. Maximum weight cycle packing in directed graphs, with application to kidney exchange programs. Discrete Mathematics, Algorithms and Applications. 2009;1(04):499-517. Available from: http://eprints.gla.ac.uk/25732/
17. Johnson RJ, Allen JE, Fuggle SV, Bradley JA, Rudge C, et al. Early experience of paired living kidney donation in the United Kingdom. Transplantation. 2008;86(12):1672-1677. Available from: https://doi.org/10.1097/TP.0b013e3181901a3d.
18. Manlove DF, Omalley G. Paired and altruistic kidney donation in the UK: Algorithms and experimentation. J of Experimental Algorithmics. 2015; 19:2-6. Available from 10.1145/2670129
19. Ellison B. A systematic review of kidney paired donation: Applying lessons from historic and contemporary case studies to improve the U.S. model. Wharton Research Scholars. 2014. Available from: https://repository.upenn.edu/wharton_research_scholars/107/
20. Fakkert S, Schwarz P, Pruyt E. Kidney transplantations in the United States: A system dynamics approach to reduce the waiting list and illegal tracking. In Proceedings of the 33rd International Conference of the System Dynamics Society. 2015; 1-13.
21. Roth AE. What have we learned from market design? The Economic Journal. 2008; 118(527):285-310. Available from: https://doi.org/10.1111/j.1468-0297.2007.02121.x
22. Paricio I, Figal J. A system dynamics model of the kidney transplants in the U.S. In Proceedings of the 33rd International Conference of the System Dynamics Society. 2015;1-23. Available from: https://www.systemdynamics.org/assets/conferences/2015/proceed/papers/P1171.pdf
23. Bruni ME, Conforti D, Sicilia N, Trotta S. A new organ transplantation location-allocation policy: a case study of Italy. Health Care Management Science. 2006; 9(2):125-142.
24. Fajardo-Vallejo E. Emparejamiento voluntario de riñón: Una propuesta para incrementar el número de trasplantes en Colombia. Bachelor thesis, Universidad de los Andes, 2013.
25. Villa S, Patrone F. Incentive compatibility in kidney exchange problems. Health Care Management Science. 2008; 12(4):351-362. Available from: https://doi.org/10.1007/s10729-008-9089-0
26. Ahmadvand S, Pishvaee MS. An efficient method for kidney allocation problem: a credibility-based fuzzy common weights data envelopment analysis approach. Health Care Manag Sci. 2017; 1-17. https://doi.org/10.1007/s10729-017-9414-6
27. Ünver MU. Dynamic kidney exchange. The Review of Economic Studies. 2010; 77(1): 372-414. https://doi.org/10.1111/j.1467-937X.2009.00575.x
28. Zenios SA. Optimal control of a paired-kidney exchange program. Management Science. 2002; 48(3):328-342. Available from: https://www.jstor.org/stable/822569
29. Thompson D, Waisanen L, Wolfe R, Merion RM, McCullough K, Rodgers A. Simulating the allocation of organs for transplantation. Health Care Manag Sci. 2004; 7(4):331-338. Available from: https://doi.org/10.1016/j.socscimed.2017.09.005
30. Sterman JD. Business dynamics: systems thinking and modeling for a complex world. Number HD30. 2 S7835 2000. McGraw-Hill, 2000.
31. Chang AY, Ogbuoji O, Atun R, and Verguet S. Dynamic modeling approaches to characterize the functioning of health systems: A systematic review of the literature. Soc Sci Med.. 2017; 194(1) 160-167. https://doi.org/10.1016/j.socscimed.2017.09.005
32. Acuña-Merchán L, Sánchez-Quintero P, Soler LA, Piñeros L. Situación de la enfermedad renal crónica, hipertensión arterial y diabetes mellitus en Colombia. Technical report, Fondo Colombiano de Enfermedades de Alto Costo, Bogotá, D.C., 2015. Available from: https://cuentadealtocosto.org/site/images/Publicaciones/Situacion_ERC_HA_DM_Colombia_2016.pdf
33. Ojo AO, Hanson JA, Meier-Kriesche H-U, Okechukwu CN, Wolfe RA, Leichtman AB, et al. Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. J Am Soc Nephrol. 2001; 12(3):589-597. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11181808
34. Acosta Roldán Y, Arias-Murillo YR, García S, Salinas Nova MA, Torres Aunta, E et al. Informe Anual Red De Donación Y Trasplantes Colombia Año 2015. Technical Report. Instituto Nacional De Salud Coordinación Nacional Red Donación Y Trasplantes. Bogotá, D.C., Colombia, 2015. Online edition: ISSN 2256-408X. Available from: https://www.ins.gov.co/Direcciones/RedesSaludPublica/DonacionOrganosYTejidos/Estadisticas/Informe%20Red%20de%20Donaci%C3%B3n%20y%20Trasplante%202015.pdf
35. Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, et al. Prevalence of chronic kidney disease in the United States. Jama. 2007; 298(17):2038-2047.
2. Instituto Nacional de Salud. Informe ejecutivo red de donación y trasplantes [Internet].Bogotá, D.C.; 2015. Available from: https://www.ins.gov.co/Direcciones/RedesSaludPublica/DonacionOrganosYTejidos/Estadisticas/Informe%20Ejecutivo%20Donaci%C3%B3n%20y%20Trasplantes%202016.pdf
3. Acuña-Merchán L, Sánchez-Quintero P, Soler LA. Situación de la enfermedad renal crónica [Internet]. Fondo Colombiano de Enfermedades de Alto Costo, Bogotá, D.C., 2014. Available from: https://cuentadealtocosto.org/site/images/Publicaciones/Situacion%20de%20la%20ERC%20Colombia%202014.pdf
4. Huang S-K, Lin MT, Chen HC, Huang SC, Wu SH. Epidemiology of Kawasaki disease: Prevalence from national database and future trends projection by system dynamics modeling. J Pediatr. 2013; 163(1):126-131. Available from: https://doi.org/10.1016/j.jpeds.2012.12.011
5. Shin N, Kwag T, Park S, Kim SY. Effects of operational } on the diffusion of epidemic disease: A system dynamics modeling of the merscov outbreak in South Korea. J Theor Biol. 2017; 421 (Supplement C), 39-50. Available from https://doi.org/10.1016/j.jtbi.2017.03.020
6. Kwak JY, Kwon OJ, Lee KS, Kang CM, Park HY, Kim JH. Exchange-donor program in renal transplantation: a single-center experience. Transplant Proc. 1999; 31(1):344-345. Available from: https://www.ncbi.nlm.nih.gov/pubmed/10083136
7. Thiel G, Vogelbach P, Gurke L, Gasser T, Lehmann K, Voegele T, Kiss A, Kirste G. Crossover renal transplantation: hurdles to be cleared! Transplant Proc. 2001; 33(1):811-816. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11267078
8. Abraham DJ, Blum A, Sandholm T. Clearing algorithms for barter exchange markets: Enabling nationwide kidney exchanges. In Proceedings of the 8th ACM conference on Electronic commerce. 2007 Jun 11-15; San Diego, California. 2007 p. 295-304. Available from: https://www.cs.cmu.edu/~sandholm/kidneyExchange.EC07.withGrantInfo.pdf
9. Saidman SL, Roth AE, Sonmez T, Utku M, Ünver, Delmonico FL. Increasing the opportunity of live kidney donation by matching for two-and three-way exchanges. Transplantation. 2006; 81(5):773-782. Available from: https://doi.org/10.1097/01.tp.0000195775.77081.25
10. Veale J, Hil G. National kidney registry: 213 transplants in three years. Clin Transpl. 2010; 333-344.
11. Gurkan A, Kacar SH, Varilsuha C, Tilif S, Coker I, Karaca C, Karaoglan M. Exchange kidney transplantation: a good solution in living kidney transplantation. Transplant Proc. 2004. 36(10): 2952-2953. Available from http://hdl.handle.net/10822/986410
12. Lucan M. Five years of single-center experience with paired kidney exchange transplantation. Transplant Proc. 2007 39(5):1371-1375. Available from: https://doi.org/10.1016/j.transproceed.2007.02.081
13. Klerk MD, Keizer KM, Claas FHJ, Witvliet M, Haase-Kromwijk BJJM, Weimar W. The Dutch national living donor kidney exchange program. American Journal of Transplantation. 2005; 5(9):2302-2305. Available from: https://doi.org/10.1111/j.1600-6143.2005.01024.x
14. Klerk M, Witvliet MD, Haase-Kromwijk BJJM, Claas FHJ, Weimar W. A highly efficient living donor kidney exchange program for both blood type and crossmatch incompatible donor-recipient combinations. Transplantation. 2006; 82(12):1616-1620. Available from: https://doi.org/10.1097/01.tp.0000250906.66728.8d
15. Kranenburg L, Zuidema W, Weimar W, Hilhorst M, Ijzermans J, Passchier J, Busschbach J. Strategies to advance living kidney donation: a single center's experience. Progress in Transplantation. 2009;19(1):71-75. Available from: https://doi.org/10.1177/152692480901900110
16. Biro P, Manlove DF, Rizzi R. Maximum weight cycle packing in directed graphs, with application to kidney exchange programs. Discrete Mathematics, Algorithms and Applications. 2009;1(04):499-517. Available from: http://eprints.gla.ac.uk/25732/
17. Johnson RJ, Allen JE, Fuggle SV, Bradley JA, Rudge C, et al. Early experience of paired living kidney donation in the United Kingdom. Transplantation. 2008;86(12):1672-1677. Available from: https://doi.org/10.1097/TP.0b013e3181901a3d.
18. Manlove DF, Omalley G. Paired and altruistic kidney donation in the UK: Algorithms and experimentation. J of Experimental Algorithmics. 2015; 19:2-6. Available from 10.1145/2670129
19. Ellison B. A systematic review of kidney paired donation: Applying lessons from historic and contemporary case studies to improve the U.S. model. Wharton Research Scholars. 2014. Available from: https://repository.upenn.edu/wharton_research_scholars/107/
20. Fakkert S, Schwarz P, Pruyt E. Kidney transplantations in the United States: A system dynamics approach to reduce the waiting list and illegal tracking. In Proceedings of the 33rd International Conference of the System Dynamics Society. 2015; 1-13.
21. Roth AE. What have we learned from market design? The Economic Journal. 2008; 118(527):285-310. Available from: https://doi.org/10.1111/j.1468-0297.2007.02121.x
22. Paricio I, Figal J. A system dynamics model of the kidney transplants in the U.S. In Proceedings of the 33rd International Conference of the System Dynamics Society. 2015;1-23. Available from: https://www.systemdynamics.org/assets/conferences/2015/proceed/papers/P1171.pdf
23. Bruni ME, Conforti D, Sicilia N, Trotta S. A new organ transplantation location-allocation policy: a case study of Italy. Health Care Management Science. 2006; 9(2):125-142.
24. Fajardo-Vallejo E. Emparejamiento voluntario de riñón: Una propuesta para incrementar el número de trasplantes en Colombia. Bachelor thesis, Universidad de los Andes, 2013.
25. Villa S, Patrone F. Incentive compatibility in kidney exchange problems. Health Care Management Science. 2008; 12(4):351-362. Available from: https://doi.org/10.1007/s10729-008-9089-0
26. Ahmadvand S, Pishvaee MS. An efficient method for kidney allocation problem: a credibility-based fuzzy common weights data envelopment analysis approach. Health Care Manag Sci. 2017; 1-17. https://doi.org/10.1007/s10729-017-9414-6
27. Ünver MU. Dynamic kidney exchange. The Review of Economic Studies. 2010; 77(1): 372-414. https://doi.org/10.1111/j.1467-937X.2009.00575.x
28. Zenios SA. Optimal control of a paired-kidney exchange program. Management Science. 2002; 48(3):328-342. Available from: https://www.jstor.org/stable/822569
29. Thompson D, Waisanen L, Wolfe R, Merion RM, McCullough K, Rodgers A. Simulating the allocation of organs for transplantation. Health Care Manag Sci. 2004; 7(4):331-338. Available from: https://doi.org/10.1016/j.socscimed.2017.09.005
30. Sterman JD. Business dynamics: systems thinking and modeling for a complex world. Number HD30. 2 S7835 2000. McGraw-Hill, 2000.
31. Chang AY, Ogbuoji O, Atun R, and Verguet S. Dynamic modeling approaches to characterize the functioning of health systems: A systematic review of the literature. Soc Sci Med.. 2017; 194(1) 160-167. https://doi.org/10.1016/j.socscimed.2017.09.005
32. Acuña-Merchán L, Sánchez-Quintero P, Soler LA, Piñeros L. Situación de la enfermedad renal crónica, hipertensión arterial y diabetes mellitus en Colombia. Technical report, Fondo Colombiano de Enfermedades de Alto Costo, Bogotá, D.C., 2015. Available from: https://cuentadealtocosto.org/site/images/Publicaciones/Situacion_ERC_HA_DM_Colombia_2016.pdf
33. Ojo AO, Hanson JA, Meier-Kriesche H-U, Okechukwu CN, Wolfe RA, Leichtman AB, et al. Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. J Am Soc Nephrol. 2001; 12(3):589-597. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11181808
34. Acosta Roldán Y, Arias-Murillo YR, García S, Salinas Nova MA, Torres Aunta, E et al. Informe Anual Red De Donación Y Trasplantes Colombia Año 2015. Technical Report. Instituto Nacional De Salud Coordinación Nacional Red Donación Y Trasplantes. Bogotá, D.C., Colombia, 2015. Online edition: ISSN 2256-408X. Available from: https://www.ins.gov.co/Direcciones/RedesSaludPublica/DonacionOrganosYTejidos/Estadisticas/Informe%20Red%20de%20Donaci%C3%B3n%20y%20Trasplante%202015.pdf
35. Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, et al. Prevalence of chronic kidney disease in the United States. Jama. 2007; 298(17):2038-2047.
Cómo citar
Cruz, J. P., Guerrero Rueda, W. J., Pérez, E. R., Lizarazo Walteros, D. L., Rico Ardila, P. C., Castillo, A. M., & Torres Tinjacá, L. N. (2019). Sistema de obtención de riñones en Colombia: un enfoque basado en la Dinámica de Sistemas. Gerencia Y Políticas De Salud, 18(36), 1–26. https://doi.org/10.11144/Javeriana.rgps18-36.kpsc
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