Equitable allocation of livers for orthotopic transplantation: An application of the Analytic Hierarchy Process

This paper discusses the use of the Analytic Hierarchy Process (AHP) to develop a rating system allocation of cadaver livers for orthotopic transplantation. Five major criteria for comparison were established, defined, and rated relative to one another: logistic considerations, tissue compatability, waiting time, financial considerations, and medical status. Subcriteria were also established and rated to one another in relative terms. Patients that met appropriate inclusion screening were then ranked for selection by assigning the appropriate rating to subcriteria in the major selection criteria. Final weighing can be used to develop an alternative to the rigid computerized multifactorial point system that now exists. This paper is meant to demonstrate the utility of the AHP process in complex medical decision making, rather than to necessarily document a final allocation system.