OnCo
ideasIdea

A neutral slot exchange so unused CAR-T manufacturing slots go to the next patient

Patients wait weeks for a manufacturing slot while other slots go unused when a patient drops out. A shared booking system would match spare slots to waiting patients.

CAR-T manufacturing slots are allocated per product and per treatment centre, and cancellations (patient deterioration, failed apheresis) leave slots empty while patients at other centres wait. The proposal is a neutral, regulator-sanctioned exchange, run by a registry organisation, where manufacturers post real-time slot availability and treatment centres release and claim slots across products and sites, with priority rules agreed by clinicians. It resembles organ allocation and airline seat inventory systems.

Hypothesis
An exchange reduces median time from referral to apheresis by at least a week and increases slot utilisation above 90%, reducing the proportion of eligible patients who never reach infusion.
Rationale
The queue is a matching problem; the current fragmentation means aggregate capacity exceeds aggregate demand in many months while individual patients still wait. Slot utilisation data are already collected by manufacturers.
What would test it
Pilot the exchange in one country with two manufacturers and ten centres for a year; compare referral-to-apheresis interval and slot utilisation with the prior year.
Maturity
speculative
Who has to act
data
Cost to try
Small (under $1M)
Years to first evidence
2
Bottlenecks it attacks

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