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

Source: https://onco.cc/ideas/idea-reg-manufacturing-slot-exchange/  
OnCo record `idea-reg-manufacturing-slot-exchange` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- 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.
- Proposed 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

## Sources

- 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): https://doi.org/10.1001/jamaoncol.2018.0977

## Connected records

- technologies: [CAR-T cell therapy](https://onco.cc/technologies/car-t/)
- bottlenecks: [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Manufacturing cost and time for living and radioactive medicines](https://onco.cc/bottlenecks/b-manufacturing-cell-therapy/)
- key papers: [Total Costs of Chimeric Antigen Receptor T-Cell Immunotherapy](https://onco.cc/key-papers/paper-hernandez-jama-oncol/)

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