Determining the Acceptance of Cadaveric Livers Using an Implicit Model of the Waiting List
نویسندگان
چکیده
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 patientstate-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.
منابع مشابه
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Transplantation is the only viable therapy for end-stage liver diseases (ESLD) such as hepatitis B. In the United States, patients with ESLD are placed on a waiting list. When organs become available, they are offered to the patients on this waiting list. This dissertation fo-cuses on the decision problem faced by these patients: which offer to accept and which to refuse? This decision depends ...
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ورودعنوان ژورنال:
- Operations Research
دوره 55 شماره
صفحات -
تاریخ انتشار 2007