{"entity":{"id":"idea-reg-manufacturing-slot-exchange","kind":"idea","name":"A neutral slot exchange so unused CAR-T manufacturing slots go to the next patient","aka":[],"tldr":"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.","summary":"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.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Manufacturing cost and time for living and radioactive medicines): Hernandez, Prasad & Gellad, Total costs of chimeric antigen receptor T-cell immunotherapy (JAMA Oncology 2018)","url":"https://doi.org/10.1001/jamaoncol.2018.0977"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":["car-t"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-manufacturing-cell-therapy","b-care-fragmentation"],"keyPapers":["paper-hernandez-jama-oncol"],"journals":[],"dependsOn":[],"notes":[],"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.","test":"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","actor":"data","cost":"small","horizonYears":2},"route":"/ideas/idea-reg-manufacturing-slot-exchange/","neighbours":{"technology":[{"id":"car-t","kind":"technology","name":"CAR-T cell therapy","route":"/technologies/car-t/"}],"bottleneck":[{"id":"b-care-fragmentation","kind":"bottleneck","name":"Fragmented care and guideline gaps","route":"/bottlenecks/b-care-fragmentation/"},{"id":"b-manufacturing-cell-therapy","kind":"bottleneck","name":"Manufacturing cost and time for living and radioactive medicines","route":"/bottlenecks/b-manufacturing-cell-therapy/"}],"paper":[{"id":"paper-hernandez-jama-oncol","kind":"paper","name":"Total Costs of Chimeric Antigen Receptor T-Cell Immunotherapy","route":"/key-papers/paper-hernandez-jama-oncol/"}]}}