Article ID: | iaor20083962 |
Country: | United States |
Volume: | 53 |
Issue: | 11 |
Start Page Number: | 1702 |
End Page Number: | 1715 |
Publication Date: | Nov 2007 |
Journal: | Management Science |
Authors: | Schaefer Andrew J., Maillart Lisa M., Alagoz Oguzhan, Roberts Mark S. |
Keywords: | health services, markov processes, programming: dynamic |
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.