The optimal timing of living-donor liver transplantation

• 成果类型: Article
• 署名作者: Alagoz, O; Maillart, LM; Schaefer, AJ; Roberts, MS
• 署名单位: Pennsylvania Commonwealth System of Higher Education (PCSHE); University of Pittsburgh; University System of Ohio; Case Western Reserve University; Pennsylvania Commonwealth System of Higher Education (PCSHE); University of Pittsburgh; Pennsylvania Commonwealth System of Higher Education (PCSHE); University of Pittsburgh
• 刊物名称: MANAGEMENT SCIENCE
• ISSN/ISSBN: 0025-1909
• DOI: 10.1287/mnsc.1040.0287
• 发表日期: 2004
• 页码: 1420-1430
• 关键词: medical decision making; Markov decision processes; control-limit policy; organ transplantation; liver transplantation; service operations

摘要

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.