Research

The lab studies organ allocation systems for deceased donors, addressing the critical shortage of available organs against high patient demand. The current heart transplant allocation system relies on treatment intensity rather than objective illness severity markers, creating perverse incentives where some transplant centers escalate care to artificially increase patient priority.

Analysis of data from the Scientific Registry of Transplant Recipients found that high-benefit centers prioritize truly sick candidates and maximize lives saved, while low-benefit centers over-treat stable patients. OPTN's 2018 reforms increased status levels from 3 to 6, restricting top priority to cardiogenic shock patients.

The lab develops evidence-based policies for allocating scarce therapeutic resources, with emphasis on vaccine distribution during COVID-19. Research addresses proactive outreach strategies, place-based allocation approaches, and the potential benefits of delaying second doses to extend initial coverage.

A study of 2.7 million residents found that Non-Hispanic Black residents comprised 80% of the least vaccinated zip codes. Modeling indicated that equal vaccination rates could have prevented 119 Alpha wave deaths and 108 Delta wave deaths. Analysis also identified gaps between the CDC's three ethical principles and actual vaccine allocation policies.

This work has been featured in the New York Times, Washington Post, USA Today, and Chicago Tribune.

Crisis standards of care provide ethical guidance for healthcare systems during public health emergencies. They enable resource prioritization when demand exceeds supply, directing allocation decisions toward patients with highest survival likelihood.

A review found that 92% of 26 state guidelines recommended objective scoring systems for ventilator allocation. Retrospective analysis revealed that while Black and White patients had similar SOFA scores, Black patients demonstrated lower in-hospital mortality at equivalent scores, creating a systemic disadvantage in allocation systems that rely on SOFA-based triage.

The CLIF Consortium standardizes critical care data across 17 institutions and 46 hospitals, enabling large-scale research on equitable allocation and outcomes in intensive care settings.