In 2009, almost 1,500 Americans died of end-stage liver disease (ESLD), which is the twelfth leading cause of death in the U.S. As liver transplantation is the only possible therapy for ESLD and there is a considerable difference between the number of donated organs and patients, it is important to manage donor-patient match and investigate alternative treatments to transplantation.
Every patient lists in at least one waiting list (OPO) in order to be eligible for a donated organ. However, patients may list in additional OPOs. This practice is called multiple listing. Currently, multiple listing is one of the most debated topics in organ allocation.
Although transplantation is a successful procedure, it may not be available on time due to the massive shortage of donated organs. Therefore, an alternative therapy to transplantation is needed. Liver Assist Devices (LADs) are an emerging therapy for ESLD that aim to stabilize a patient until transplantation or her own organ recovers.
In this dissertation, we discuss three models that are related to ESLD. In the first model, we optimize the three-stage decision process faced by a single patient. The patient decides her geographic location, in which OPOs to multiple list, and which organ offers to accept. This problem is formulated as a continuous-time Markov Decision Process (MDP). We derive structural properties of this model and solve it using clinical data.
The second model analyzes multiple listing from the societal perspective. Utilizing an existing simulation of the U.S. liver allocation system, we give every patient the flexibility to multiple list. Therefore, we evaluate the effects of multiple listing on every wait-listed patient, rather than on a single patient. We also study the same problem where multiple listing is a more widespread practice in the U.S.
The third model considers a hypothetical system in which an internal LAD is available.
So, in addition to the liver accept/reject decision, patients can decide to accept an LAD. This model aims to help manufacturers by estimating potential demand for an LAD. We model this problem as a discrete-time MDP and give sufficient conditions under which an LAD will be worthwhile.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-07282010-111803 |
| Date | 30 September 2010 |
| Creators | Saka, Gorkem |
| Contributors | Lisa M. Maillart, Mark S. Roberts, Andrew J. Schaefer, Oguzhan Alagoz, Laurens G. Debo |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-07282010-111803/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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