PT  - JOURNAL ARTICLE
AU  - Andrew Hantel
AU  - Gregory A Abel
AU  - Mark Siegler
TI  - Practical allocation system for the distribution of specialised care during cellular therapy access scarcity
AID  - 10.1136/medethics-2018-105339
DP  - 2019 Aug 01
TA  - Journal of Medical Ethics
PG  - 532--537
VI  - 45
IP  - 8
4099  - http://jme.bmj.com/content/45/8/532.short
4100  - http://jme.bmj.com/content/45/8/532.full
SO  - J Med Ethics2019 Aug 01; 45
AB  - Novel cellular therapy techniques promise to cure many haematology patients refractory to other treatment modalities. These therapies are intensive and require referral to and care from specialised providers. In the USA, this pool of providers is not expanding at a rate necessary to meet expected demand; therefore, access scarcity appears forthcoming and is likely to be widespread. To maintain fair access to these scarce and curative therapies, we must prospectively create a just and practical system to distribute care. In this article, we first review previously implemented medical product and personnel allocation systems, examining their applicability to cellular therapy provider shortages to demonstrate that this problem requires a novel approach. We then present an innovative system for allocating cellular therapy access, which accounts for the constraints of distribution during real-world oncology practice by using a combination of the following principles: (1) maximising life-years per personnel time, (2) youngest and robust first, (3) sickest first, (4) first come/first served and (5) instrumental value. We conclude with justifications for the incorporation of these principles and the omission of others, discuss how access can be distributed using this combination, consider cost and review fundamental factors necessary for the practical implementation and maintenance of this system.