Informing the management of pediatric heart transplant waiting lists: complementary use of simulation and analytical modeling

A clinical intervention known as 'bridging to transplant', in which a patient is placed on life-sustaining support, can be used to increase the chance of an individual surviving until a donor heart becomes available. However, the impact of this on other patients on the waiting list and the wider implications for the resourcing of cardiac units remains unclear. Initial insights have previously been generated using a birth-death queuing model, but this model did not incorporate realistic donor-recipient assumptions regarding blood type and weight. Here we report on a complementary simulation study that examined how estimates from the analytical model might change if organ matching were better taken into account. Simulation results showed that system metrics changed substantially when recipient donor compatibility was modelled. However, the effects of blood type compatibility were countered by that of weight compatibility and when combined, these have a relatively small net effect on results.