Estimating the patient's price of privacy in liver transplantation

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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

41 Citations (Scopus)

Abstract

In the United States, patients with end-stage liver disease must join a waiting list to be eligible for cadaveric liver transplantation. Due to privacy concerns, the details of the composition of this waiting list are not publicly available. This paper considers the benefits associated with creating a more transparent waiting list. We study these benefits by modeling the organ accept/reject decision faced by these patients as a Markov decision process in which the state of the process is described, by patient health, quality of the offered liver, and a measure of the rank of the patient in the waiting list. We prove conditions under which there exist structured optimal solutions, such as monotone value functions and control-limit optimal policies. We define the concept of the patient's price of privacy, namely, the number of expected life days lost due to the lack of complete waiting list information. We conduct extensive numerical studies based on clinical data, which indicate that this price of privacy is typically on the order of 5% of the optimal solution value.

Original languageEnglish
Pages (from-to)1393-1410
Number of pages18
JournalOperations Research
Volume56
Issue number6
DOIs
Publication statusPublished - Nov 2008
Externally publishedYes

Keywords

  • Dynamic programming/optimal control: applications, markov
  • Health care: treatment

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