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The Optimal Timing of Living-Donor Liver Transplantation

  • Oguzhan Alagoz

    ()

    (Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15261)

  • Lisa M. Maillart

    ()

    (Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio 44106)

  • Andrew J. Schaefer

    ()

    (Departments of Industrial Engineering and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15261)

  • Mark S. Roberts

    ()

    (Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213)

Registered author(s):

    Living donors are a significant and increasing source of livers for transplantation, mainly because of the insufficient supply of cadaveric organs. We consider the problem of optimally timing a living-donor liver transplant to maximize the patient's total reward, such as quality-adjusted life expectancy. We formulate a Markov decision process (MDP) model in which the state of the process is described by patient health. We derive structural properties of the MDP model, including a set of intuitive conditions that ensure the existence of a control-limit optimal policy. We use clinical data in our computational experiments, which show that the optimal policy is typically of control-limit type.

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    File URL: http://dx.doi.org/10.1287/mnsc.1040.0287
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    Article provided by INFORMS in its journal Management Science.

    Volume (Year): 50 (2004)
    Issue (Month): 10 (October)
    Pages: 1420-1430

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    Handle: RePEc:inm:ormnsc:v:50:y:2004:i:10:p:1420-1430
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    1. Jae-Hyeon Ahn & John C. Hornberger, 1996. "Involving Patients in the Cadaveric Kidney Transplant Allocation Process: A Decision-Theoretic Perspective," Management Science, INFORMS, vol. 42(5), pages 629-641, May.
    2. Howard, David H., 2002. "Why do transplant surgeons turn down organs?: A model of the accept/reject decision," Journal of Health Economics, Elsevier, vol. 21(6), pages 957-969, November.
    3. Chew, Soo Hong & Ho, Joanna L, 1994. "Hope: An Empirical Study of Attitude toward the Timing of Uncertainty Resolution," Journal of Risk and Uncertainty, Springer, vol. 8(3), pages 267-88, May.
    4. Howard J. Weiss, 1979. "The Computation of Optimal Control Limits for a Queue with Batch Services," Management Science, INFORMS, vol. 25(4), pages 320-328, April.
    5. Cyrus Derman, 1963. "Optimal Replacement and Maintenance Under Markovian Deterioration with Probability Bounds on Failure," Management Science, INFORMS, vol. 9(3), pages 478-481, April.
    6. Chen, Mingchih & Feldman, Richard M., 1997. "Optimal replacement policies with minimal repair and age-dependent costs," European Journal of Operational Research, Elsevier, vol. 98(1), pages 75-84, April.
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