Choosing among living-donor and cadaveric livers

Oguzhan Alagoz*, Lisa M. Maillart, Andrew J. Schaefer, Mark S. Roberts

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

35 Scopus citations

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 languageEnglish (US)
Pages (from-to)1702-1715
Number of pages14
JournalManagement Science
Volume53
Issue number11
DOIs
StatePublished - Nov 2007
Externally publishedYes

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

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