Not every research question can be solved with a randomized control trial (RCT), which is held as the gold standard for producing the most valid and reliable results. But there are often ethical considerations or consequences that prevent their use. Researchers must instead construct other methods that can approximate an RCT.

Organ transplant policies, particularly in liver allocation, is one area where an RCT would be virtually impossible as organs represent limited resources that are allocated in a life-and-death context. But it is also an area where high demand and low supply raises questions about how best to allocate with so many factors involved. The question then of how best to construct an optimal and efficient policy structure is one that Tomohiro Tanaka, MD, MPH, has been considering.

Tanaka has received a K08 grant from the US Department of Health and Human Service’s Agency for Healthcare Research and Quality (AHRQ). His five-year, $738k award will allow him to establish a methodology via causal inference from real-world data to effectively evaluate US liver allocation policies, with a focus on how they impact underserved communities.

“Although the transplant community has made incremental changes to allocation policies over the years, disparities including, but not limited to, geographic region, age, and disease type persist,” Tanaka said. Given the high stakes for people and the limited resources, he added, “this is problematic.”

Two collaborators will work with Tanaka on this project. David Axelrod, MD, MBA, professor of surgery, whom Tanaka cites as a “nationally renowned expert in this research topic,” and Mark Vander Weg, PhD, professor of internal medicine, investigator in the Iowa City VA’s health services research consortium CADRE, and head of the Department of Community and Behavioral Health in the UI’s College of Public Health.