Choosing Among Living-Donor and Cadaveric Livers

Oguzhan Alagoz (), Lisa M. Maillart (), Andrew J. Schaefer () and Mark S. Roberts ()
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Oguzhan Alagoz: Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin 53706
Lisa M. Maillart: Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15261
Andrew J. Schaefer: Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15261
Mark S. Roberts: Section of Decision Sciences and Clinical Systems Modeling, Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213

Management Science, 2007, vol. 53, issue 11, 1702-1715

Abstract: The only therapy for a patient with end-stage liver disease (ESLD) is liver transplantation, which is performed by using either a cadaveric liver from a deceased donor or a portion of a living-donor's liver. This study addresses the following decision problem for an ESLD patient with an available living donor. Should she have a transplantation now or wait? If she decides to have the transplantation now, should she use her living-donor liver or a cadaveric liver for transplantation? We formulate this problem as a discrete-time, infinite-horizon Markov decision process model and solve it using clinical data. Because living donors are typically related to the recipient, we incorporate a disutility associated with using the living-donor liver as opposed to using a cadaveric liver. We perform a structural analysis of the model, including a set of intuitive conditions that ensure the existence of structured policies such as an at-most-three-region (AM3R) optimal policy. Our computational experiments confirm that the optimal policy is typically of AM3R type.

Keywords: medical decision making; Markov decision processes; control-limit policy; health-care applications; organ transplantation; service operations; optimal stopping; dynamic programming (search for similar items in EconPapers)
Date: 2007
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Citations: View citations in EconPapers (13)

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