Choosing Among Living-Donor and Cadaveric Livers
针对终末期肝病患者面临活体供肝时，是否立即移植以及选择活体还是尸体供肝的决策问题，构建离散时间无限期马尔可夫决策模型，用临床数据求解，并分析最优策略结构。
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.