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The Optimal Timing of Living-Donor Liver Transplantation

Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15261
Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio 44106
Departments of Industrial Engineering and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15261
Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
alagoz{at}ie.pitt.edu
lisa.maillart{at}case.edu
schaefer{at}ie.pitt.edu
robertsm{at}upmc.edu

Living donors are a significant and increasing source of livers for transplantation, mainly because of the insufficient supply of cadaveric organs. We consider the problem of optimally timing a living-donor liver transplant to maximize the patient's total reward, such as quality-adjusted life expectancy. We formulate a Markov decision process (MDP) model in which the state of the process is described by patient health. We derive structural properties of the MDP model, including a set of intuitive conditions that ensure the existence of a control-limit optimal policy. We use clinical data in our computational experiments, which show that the optimal policy is typically of control-limit type.

Key Words: medical decision making; Markov decision processes; control-limit policy; organ transplantation; liver transplantation; service operations
History: Received: September 1, 2003;

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