Organ Transplantation: An Introduction to Game Theory.

T transplantation system serves as a shining example of ongoing quality assessment and performance improvement. This was facilitated by the creation of a federally mandated registry administered by the Organ Procurement and Transplantation Network. Subsequently, these data are analyzed by a separate federal contractor, the Scientific Registry for Transplant Recipients, generating program specific reports assessing the performance of transplant programs across the United States, which at the time was unprecedented in any field of health care. This infrastructure has provided a platform for the ongoing evaluation of the scientific and clinical status of organ transplantation. It has fostered transparency in risk communication and provided vital data used to inform patient, clinician, policy-maker, and payer decision making. It is these features which have characterized the transplantation system as perhaps a successful example of an early iteration of the Learning Healthcare System which has only more recently garnered attention as part of the ongoing debate over health care reform. The national data that are reported to the Organ Procurement and Transplantation Network and analyzed by the Scientific Registry for Transplant Recipients truly are an asset of the transplant community. These data are integral to the development and reform of national organ allocation policy. Moreover, registry data provide a foundation for the creation of transplant-specific quality metrics that are the focus of quality assurance program improvement initiatives, as well as fuel discussions surrounding refinement of value-based purchasing systems for the delivery of transplantation services. Although these aspects of transplantation have positively distinguished it from other areas of health care, there are issues which require attention if transplantation is to remain a leader. First, the use of aggregate national data to inform quality metrics, such as waiting time or length of stay in the absence of the context provided by location-specific and more granular covariates, such as organ quality/availability, candidate disease severity, and transplant center or patient decision-making