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.
Original language | English (US) |
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Pages (from-to) | 1702-1715 |
Number of pages | 14 |
Journal | Management Science |
Volume | 53 |
Issue number | 11 |
DOIs | |
State | Published - Nov 2007 |
Externally published | Yes |
Keywords
- Control-limit policy
- Dynamic programming
- Health-care applications
- Markov decision processes
- Medical decision making
- Optimal stopping
- Organ transplantation
- Service operations
ASJC Scopus subject areas
- Strategy and Management
- Management Science and Operations Research