A regional analysis on the activity of transplantations in Italy: issues related to demand and supply

Presenter: Lara Gitto, University of Roma "Tor Vergata" & University of Messina

Abstract

Rationale:

Transplantation activity concerns many important economic issues (Machnicki et al. 2006), among which there are:

- scarcity of resources, due to the limited availability of organs;

- improvements in patients’ health conditions, that can be measured through economic evaluation techniques (Jacobbi et al., 1997).

Transplantation can be seen as a productive activity, compounded of different phases that start from patients’ diagnosis and arrive to post intervention therapies and rehabilitation: an effective organizational model should be set up and applied in such a context.

Objectives:

The purpose of the paper is that of analyzing demand and supply of transplantations in Italy, looking at mobility of patients across Regions.

Different flows of patients can be distinguished: outflows patients are those who decide to migrate to another Region; inflows patients per Region are, instead, those patients who arrive in a given Region for undergoing a transplantation; resident patients are those who choose to remain in their Region, and to undergo there the surgery.

By knowing the extent of inflow-outflow decision and the factors that may affect it, it might be possible to organize the activity of transplantation in a more effective way.
Methodology:

A descriptive statistical analysis has been carried out for demand and supply of transplantations in Italian Regions, according to type of organ transplanted.

The analysis of the factors determining the outflow decision has been performed by applying OLS. Data employed refer to waiting lists, number of donors, number of transplantation centers; for heart and liver transplantation it has been considered a complexity index as well. Data analyzed are of 2006.
Results:

Transplantation activity is mainly concentrated in Northern Italian Regions. Lombardy and Emilia-Romagna (Northern Italy) presents the highest inflow, while the greatest number of outflows come from Campania (Southern Italy).

Number of donors and number of transplantation centers have a positive impact in determining an increase in outflow decision. A positive coefficient, even if not significant, is associated to patients’ survival after complex interventions.

However, the number of patients enrolled in a waiting list depends on the criteria established for each organ. For example, patients needing kidney transplantation can enroll themselves in more than one waiting list and in more than one Region.
Conclusions:

The impact of some factors, mainly related to demand for transplantations, should be better investigated.

Moreover, in order to boost donations, a more detailed information related to risks and benefits of transplantations should be provided and, in order to facilitate patients' choice for transplantation center, the Information Transplantation System should be improved, especially in assessing the activity of each center.