Efficiency in lung transplant allocation strategies

DOI10.1214/20-AOAS1350MaRDI QIDQ2044231zbMATH OpenFDO

Authors Jingjing Zou, David J. Lederer, Daniel Rabinowitz

Publication date 4 August 2021

Published in The Annals of Applied Statistics (Search for Journal in Brave)

Full work available at URL https://arxiv.org/abs/1812.07691, https://projecteuclid.org/euclid.aoas/1600454858

zbMATH Keywords

allocation rulesHamilton-Jacobi-Bellman equationslung allocation score (LAS)lung transplantationMarkov decision modelssimulation studies

Mathematics Subject Classification ID

Compound decision problems in statistical decision theory (62C25) Applications of statistics to biology and medical sciences; meta analysis (62P10)

Abstract: Currently in the United States, lung transplantations are allocated to candidates according to the candidates' Lung Allocation Score (LAS). The LAS is an ad-hoc ranking system for patients' priorities of transplantation. The goal of this study is to develop a framework for improving patients' life expectancy over the LAS based on a comprehensive modeling of the lung transplantation waiting list. Patients and organs are modeled as arriving according to Poisson processes, patients' health status evolving a waiting time inhomogeneous Markov process until death or transplantation, with organ recipient's expected post-transplant residual life depending on waiting time and health status at transplantation. Under allocation rules satisfying minimal fairness requirements, the long-term average expected life converges, and its limit is a natural standard for comparing allocation strategies. Via the Hamilton-Jacobi-Bellman equations, upper bounds for the limiting average expected life are derived as a function of organ availability. Corresponding to each upper bound is an allocable set of (time, state) pairs at which patients would be optimally transplanted. The allocable set expands monotonically as organ availability increases, which motivates the development of an allocation strategy that leads to long-term expected life close to the upper bound. Simulation studies are conducted with model parameters estimated from national lung transplantation data. Results suggest that compared to the LAS, the proposed allocation strategy could provide a 7.7% increase in average total life. We further extended the results to the the allocation and matching of multiple organ types.

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Cites work

• A Broader View of Designing the Liver Allocation System
• A Resource Allocation Problem in a Random Environment
• A Sequential Stochastic Assignment Problem
• A Stochastic Sequential Allocation Model
• A survey of product-integration with a view toward application in survival analysis
• Assessing the causal effect of organ transplantation on the distribution of residual lifetime
• Asymptotic Optimal Policies for the Stochastic Sequential Assignment Problem
• Conservation Laws, Extended Polymatroids and Multiarmed Bandit Problems; A Polyhedral Approach to Indexable Systems
• Determining the Acceptance of Cadaveric Livers Using an Implicit Model of the Waiting List
• Fairness, efficiency, and flexibility in organ allocation for kidney transplantation
• scientific article; zbMATH DE number 4087408 (Why is no real title available?)
• scientific article; zbMATH DE number 3687126 (Why is no real title available?)
• scientific article; zbMATH DE number 194374 (Why is no real title available?)
• scientific article; zbMATH DE number 3443893 (Why is no real title available?)
• Involving Patients in the Cadaveric Kidney Transplant Allocation Process: A Decision-Theoretic Perspective
• Kidney Exchange
• Modeling the transplant waiting list: A queueing model with reneging
• On the Gittins index for multiarmed bandits
• Pairwise kidney exchange
• Patient Choice in Kidney Allocation: A Sequential Stochastic Assignment Model
• Recipient choice can address the efficiency-equity trade-off in kidney transplantation: a mechanism design model
• Restless Bandits, Linear Programming Relaxations, and a Primal-Dual Index Heuristic
• Restless bandits, partial conservation laws and indexability
• The kidney exchange problem: how hard is it to find a donor?
• The optimal timing of living-donor liver transplantation

Cited in

(1)

• Reshaping national organ allocation policy

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