Allocating organs for transplantation has been controversial in the United States for decades. Two main allocation approaches developed in the past are (1) to allocate organs to patients with higher priority at the same locale; (2) to allocate organs to patients with the greatest medical need regardless of their locations. To balance these two allocation preferences, the U.S. organ transplantation and allocation network has lately implemented a three-tier hierarchical allocation system, dividing the U.S. into 11 regions, composed of 59 Organ Procurement Organizations (OPOs). At present, an procured organ is offered first at the local level, and then regionally and nationally. The purpose of allocating organs at the regional level is to increase the likelihood that a donor-recipient match exists, compared to the former allocation approach, and to increase the quality of the match, compared to the latter approach. However, the question of which regional configuration is the most efficient remains unanswered.
This dissertation develops several integer programming models to find the most efficient set of regions. Unlike previous efforts, our model addresses efficient region design for the entire hierarchical system given the existing allocation policy. To measure allocation efficiency, we use the intra-regional transplant cardinality. Two estimates are developed in this dissertation. One is a population-based estimate; the other is an estimate based on the situation where there is only one waiting list nationwide. The latter estimate is a refinement of the former one in that it captures the effect of national-level allocation and heterogeneity of clinical and demographic characteristics among donors and patients. To model national-level allocation, we apply a modeling technique similar to spill-and-recapture in the airline fleet assignment problem. A clinically based simulation model is used in this dissertation to estimate several necessary parameters in the analytic model and to verify the optimal regional configuration obtained from the analytic model.
The resulting optimal region design problem is a large-scale set-partitioning problem in which
there are too many columns to handle explicitly. Given this challenge, we adapt branch and price in this dissertation. We develop a mixed-integer programming pricing problem that is both theoretically and practically hard to solve. To alleviate this existing computational difficulty, we apply geographic decomposition to solve many smaller-scale pricing problems based on pre-specified subsets of OPOs instead of a big pricing problem. When solving each smaller-scale pricing problem, we also generate multiple ``promising' regions that are not necessarily optimal to the pricing problem. In addition, we attempt to develop more efficient solutions for the pricing problem by studying alternative formulations and developing strong valid inequalities.
The computational studies in this dissertation use clinical data and show that (1) regional reorganization is beneficial; (2) our branch-and-price application is effective in solving the optimal region design problem.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-12062005-001321 |
| Date | 02 June 2006 |
| Creators | Kong, Nan |
| Contributors | Brady Hunsaker, Andrew J. Schaefer, Mark S. Roberts, Jayant Rajgopal, Prakash Mirchandani |
| 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-12062005-001321/ |
| 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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