Sistema de obtención de riñones en Colombia: un enfoque basado en la Dinámica de Sistemas
| Autor | Joan Paola Cruz, William J. Guerrero Rueda, Edna Rocío Pérez, David Leonardo Lizarazo Walteros, Paula Carolina Rico Ardila, Ana María Castillo, Laura Natalia Torres Tinjacá |
| Páginas | 1-26 |
Artículos
Kidney Procurement System in Colombia: A System Dynamics Approach*
Sistema de obtención de riñones en Colombia: un enfoque basado en la Dinámica de Sistemas
Sistema de obtenção de rins na Colômbia: uma abordagem baseada na Dinâmica de Sistemas
DOI: https://doi.org/10.11144/Javeriana.rgps18-36.kpsc
Redalyc: http://www.redalyc.org/articulo.oa?id=54559086011
Date received: 17 April 2017
Date accepted: 26 August 2017
Date published: 27 May 2019
Joan Paola Cruz
Escuela Colombiana de Ingeniería Julio Garavito,
Colombia
ORCID: http://orcid.org/ 0000-0002-5343-9055
William J. Guerrero
a
Universidad de la Sabana, Colombia
william.guerrero1@unisabana.edu.co
ORCID: http://orcid.org/0000-0002-9807-6593
Edna Rocío Pérez
Escuela Colombiana de Ingeniería Julio Garavito,
Colombia
ORCID: http://orcid.org/0000-0002-0659-2794
David L. Lizarazo
Escuela Colombiana de Ingeniería Julio Garavito,
Colombia
ORCID: http://orcid.org/0000-0002-4178-3617
Paula C Rico
Escuela Colombiana de Ingeniería Julio Garavito,
Colombia
ORCID: http://orcid.org/0000-0003-1260-1236
Ana María Castillo
Escuela Colombiana de Ingeniería Julio Garavito,
Colombia
ORCID: http://orcid.org/0000-0002-4166-8459
Laura N Torres
Escuela Colombiana de Ingeniería Julio Garavito,
Colombia, Colombia
ORCID: http://orcid.org/0000-0002-3734-8858
Abstract:
Objective: is paper presents an analysis of two regulatory proposals in response to the growing demand for kidney transplants in
Colombia. e results can be useful in evaluating these possible policy interventions once they have been implemented. Methods:
e proposed model uses System Dynamics as a tool to understand the behavior of this complex social system if two intervention
projects are executed. e rst is a bill of law seeking to expand the legal presumption of organ donation. e second one is to
implement a Kidney Exchange Program. e analysis is made in two parts. Firstly, a causal loop diagram is proposed. Secondly, the
simulation of the system using a stock and ow diagram is analyzed. Results: Results show that the projects can balance the system
and encourage donations. Conclusion: e implementation of a KEP is re commended since it achieves stability of the system
earlier than the amendment to the law, with a reduction in the waiting list size.
Keywords: kidney exchange program, System Dynamics modeling, healthcare, kidney transplantation, organ procurement
system.
Author notes:
a Corresponding author. E-mail: william.guerrero1@unisabana.edu.co
Revista Gerencia y Políticas de Salud, 2019, 18(36), ISSN: 1657-7027
Resumen:
Objetivo: Este artículo presenta un análisis de dos propuestas de regulación en respuesta a la creciente demanda de trasplantes
de riñón en Colombia. Los resultados pueden ser útiles al evaluar esas posibles intervenciones en las políticas una vez han
sido implementadas. Métodos: El modelo propuesto emplea la Dinámica de Sistemas como herramienta para entender el
comportamiento de este complejo sistema social cuando se ejecutan dos proyectos de intervención. El primero es un proyecto
de ley que buscan expandir la presunción legal de la donación del órgano. El segundo es la implementación de un Programa de
intercambio de riñones (KEP). El análisis se realiza en dos partes: primero se propone un diagrama causal; en segundo lugar, se
analiza la simulación del sistema usando un diagrama de existencias y ujos. Resultados: Los resultados muestran que los proyectos
pueden equilibrar el sistema y motivar las donaciones. Conclusión: Se recomienda la implementación de un programa KEP dado
que logra la estabilidad del sistema antes que la enmienda de las leyes, con una reducción en el tamaño de la lista de espera.
Palabras clave: programa de intercambio de riñón, modelos de Dinámica de Sistemas, atención médica, trasplante de riñón,
sistema de obtención de órganos.
Resumo:
Objetivo: Este artigo apresenta análise de duas propostas regulatórias em resposta à crescente demanda por transplantes renais na
Colômbia. Os resultados podem ser úteis na avaliação das possíveis intervenções nas políticas, uma vez implementadas. Métodos: O
modelo proposto usa a Dinâmica de Sistemas como uma ferramenta para compreender o comportamento desse complexo
sistema social quando executados dois projetos de intervenção. O primeiro é um projeto de lei visando expandir a presunção legal
da doação de órgãos. O segundo é a implementação de um Programa de troca de rins (KEP). A análise é realizada em duas
partes: primeiro propõe-se diagrama causal; segundo, analisa-se a simulação do sistema usando um diagrama de estoque e
uxo. Resultados: Os resultados mostram que os projetos podem equilibrar o sistema e motivar as doações. Conclusão:
Recomenda-se a implementação de um programa KEP uma vez que alcança a estabilidade do sistema antes da alteração das leis,
com uma redução no tamanho da lista de espera.
Palavras-chave: programa de troca de rins, modelos de Dinâmica de Sistemas, atendimento médico, transplante renal, sistema
de aquisição de órgãos.
Introduction
Kidneys are vital organs of the human body whose functions include producing hormones, removing waste
products from the blood, and regulating water uid levels that allow a chemical balance in the body. Kidneys
are healthy if they do not present a reduction of their renal function, which is the capacity of ltering blood.
Factors such as age, genetics, high blood pressure, and diabetes can permanently reduce renal function. is
is known as Chronic Kidney Disease (CKD). CKD is dened as the progressive loss of the rate of glomerular
ltration that oen results in uremia and death (1). Although its progression can be delayed, CKD does
not have a known cure. is disease is categorized into ve stages. In stages 1, 2 and 3, the objective of the
medical treatment is to preserve renal function. In stage 4, renal function is heavily reduced, and in stage 5,
hemodialysis and kidney transplant are the only options to keep the patient alive.
During 2015 in Colombia, the number of patients in stages 4 and 5 that were registered in the kidney
transplant waiting list was over 2000, and the number of performed transplants was 768 (2). About 17.3%
of these transplantations come from living donors. Donations from patients with asystole are not
practice
in Colombia. is shows the imbalance between kidney donors and the waiting list. On the other hand,
CKD deaths rise to 26.9 per 100,000 inhabitants (3. is behavior needs understanding, considering its
complexity.
A System Dynamics (SD model representing this situation is a helpful tool to determine the factors
and impacts that the changes in the system will cause in the future and allows studying the effect of the
implementation of strategies to improve its behavior. e developed model considers the bill 1805 of 2016
that aims to amend article 2 of Law 73 of 1988 of the Republic of Colombia, which extends the legal
Para continuar leyendo
Solicita tu prueba