ESS - Collaborative Research: Modeling the Patient's Perspective on Organ Acceptance

ESS - 合作研究：模拟患者对器官接受的看法

• 批准号: 0222661
• 负责人: Lisa Maillart
• 金额: $ 2.38万
• 依托单位: Case Western Reserve University
• 依托单位国家: 美国
• 项目类别: Standard Grant
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-01 至 2005-02-28
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=0222661&HistoricalAwards=false
• 关键词: ESS; Collaborative; Research; Modeling; Patient

Funding for this research project is provided under the Exploratory Research on Engineering the Service Sector (ESS) program announcement. The United Network for Organ Sharing (UNOS) manages the national organ donation and allocation system. When UNOS offers an organ to a transplant patient, the patient decides to either accept it or to continue waiting. The research question at hand is therefore: if offered an organ, when should a patient decide to accept it? This question is of great practical importance, as it is a life-or-death decision faced by thousands of people per year, and growing. This research will focus only on livers, however the methodology used is applicable to other organs. The key issue in modeling this decision process is the assumption made regarding the information available to the patient. In all cases, the pertinent characteristics of the liver are known at the time an offer is made, as is the patient's health. What is uncertain is the ranking of the patient relative to the other patients on the waiting list, and the timing of future offers. The simplest version of this problem is the case in which a living donor exists. Typically, however, donors are cadaveric. In the latter situation, liver offerings occur randomly and patients "compete" with each other for livers without knowing their relative position on the waiting list. This research project will formulate mathematical models for the living-donor as well as the cadaveric-donor situation, in which the objective is to maximize, for instance, "quality-adjusted life expectancy" or some other objective. A model will be developed for the hypothetical situation in which the composition of the waiting list is public information. Specifically, the reach team will formulate these situations as Markov decision processes and engage in numerical and analytical study of the resulting optimal policies. Numerical study will make use of extensive clinical data, identify patterns that will guide the analytical study, and allow the researchers to explore the potential value in publishing the waiting list. Analytical study will determine conditions under which the optimal policies have appealing, consistent structure. It is interesting to note that most of the existing literature focuses on modeling the organ transplant problem from UNOS's perspective, rather than from the patient's perspective as considered here. Note, however, that the research may have an impact on this policy-perspective line of research, since one of the objectives is to study the policy change that involves the publication of the waiting list.

该研究项目的资金由服务业工程探索性研究 (ESS) 计划公告提供。 器官共享联合网络（UNOS）管理国家器官捐献和分配系统。 当 UNOS 向移植患者提供器官时，患者决定要么接受，要么继续等待。 因此，当前的研究问题是：如果提供器官，患者什么时候应该决定接受它？ 这个问题具有非常重要的现实意义，因为这是每年成千上万人面临的生死攸关的决定，而且这种情况还在不断增加。 这项研究将仅关注肝脏，但所使用的方法也适用于其他器官。 对该决策过程进行建模的关键问题是对患者可获得的信息做出的假设。 在所有情况下，肝脏的相关特征在提出报价时都是已知的，患者的健康状况也是如此。 不确定的是该患者相对于等待名单上其他患者的排名，以及未来提供服务的时间。 这个问题最简单的版本是存在活体捐赠者的情况。 然而，捐献者通常是尸体。 在后一种情况下，肝脏供应是随机发生的，患者在不知道自己在等待名单上的相对位置的情况下相互“竞争”肝脏。该研究项目将为活体捐赠者以及尸体捐赠者的情况制定数学模型，其中的目标是最大化“质量调整预期寿命”或其他一些目标。 将针对候补名单的组成是公开信息的假设情况开发一个模型。 具体来说，影响力团队将把这些情况表述为马尔可夫决策过程，并对由此产生的最优政策进行数值和分析研究。 数值研究将利用广泛的临床数据，确定指导分析研究的模式，并使研究人员能够探索发布等待名单的潜在价值。 分析研究将确定最佳政策具有有吸引力的、一致的结构的条件。 有趣的是，大多数现有文献都侧重于从 UNOS 的角度对器官移植问题进行建模，而不是从此处考虑的患者的角度进行建模。 但请注意，该研究可能会对这一政策视角的研究产生影响，因为目标之一是研究涉及等待名单公布的政策变化。