Determining the Acceptance of Cadaveric Livers Using an Implicit Model of the Waiting List

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: Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio 44106
Andrew J. Schaefer: Departments of Industrial Engineering and Medicine, 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

Operations Research, 2007, vol. 55, issue 1, 24-36

Abstract: The only available therapy for patients with end-stage liver disease is organ transplantation. In the United States, patients with end-stage liver disease are placed on a waiting list and offered livers based on location and waiting time, as well as current and past health. Although there is a shortage of cadaveric livers, 45% of all cadaveric liver offers are declined by the first transplant surgeon and/or patient to whom they are offered. We consider the decision problem faced by these patients: Should an offered organ of a given quality be accepted or declined? We formulate a Markov decision process model in which the state of the process is described by patient state and organ quality. We use a detailed model of patient health to estimate the parameters of our decision model and implicitly consider the effects of the waiting list through our patient-state-dependent definition of the organ arrival probabilities. We derive structural properties of the model, including a set of intuitive conditions that ensure the existence of control-limit optimal policies. We use clinical data in our computational experiments, which confirm that the optimal policy is typically of control-limit type.

Keywords: dynamic programming/optimal control; applications and Markov; infinite horizon; health care; treatment (search for similar items in EconPapers)
Date: 2007
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Citations: View citations in EconPapers (23)

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