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Choosing Among Living-Donor and Cadaveric Livers

Department of Industrial and Systems Engineering, University of Wisconsin–Madison, Madison, Wisconsin 53706
Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15261
Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15261
Section of Decision Sciences and Clinical Systems Modeling, Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
alagoz{at}engr.wisc.edu
lisa.maillart{at}engr.pitt.edu
schaefer{at}ie.pitt.edu
robertsm{at}upmc.edu

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.

Key Words: medical decision making; Markov decision processes; control-limit policy; health-care applications; organ transplantation; service operations; optimal stopping; dynamic programming
History: Received: April 3, 2006;

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