Strategic Liver Allocation by Stochastic Game Models- Competition vs. Cooperation

描述（由申请人提供）：肝移植是终末期肝病和某些形式肝癌患者唯一确定和维持生命的治疗方法。器官短缺导致每年约2，000名等待名单上的病人死亡。当一个器官可用时，每个移植中心都会做出决定，主要受益于在其中心进行肝移植的患者。这种行为在资源稀缺的情况下是合理的，每个中心对自己的病人负有首要责任。然而，这种竞争策略可能会导致决定接受或拒绝器官提供，从而导致等待名单上的患者个体和整体受益减少，导致等待名单上的患者死亡率高于必要水平。本论文旨在探讨目前的做法，竞争器官移植中心与替代的合作策略，占病人的结果和经济目标的比较有效性。拟议调查的框架是博弈的数学理论，它已被用来模拟各种各样的社会，政治和经济环境中的竞争。该理论表明，竞争策略可能会落入一个均衡（纳什均衡），没有参与者（在这种情况下，没有中心）有动机单独偏离，即使在合作的基础上偏离可能是有益的。该提案的目标包括：1.1。构建多中心竞争行为的博弈论模型; 1.2确定纳什均衡; 2.研究中心间的合作策略，这可能会建议对器官分配系统进行潜在的改革，以改善患者的预后并降低医疗保健系统的成本。 公共卫生相关性：肝移植是终末期肝病和某些形式肝癌患者的唯一维持生命的治疗选择;不幸的是， 由于捐赠器官严重短缺，每年有近2，000名病人因等待肝脏移植而死亡。本论文旨在探讨目前的做法，竞争器官移植中心与替代的合作策略，占病人的结果和经济目标的比较有效性。此外，该提案旨在研究潜在的改革，这些改革将促进肝脏分配中的合作团队决策环境，这将改善个体和总体患者结局，并降低医疗保健系统的成本。

DESCRIPTION (provided by applicant): Liver transplantation is the only definitive and life-sustaining treatment for patients with end-stage liver disease and certain forms of liver cancers. The scarcity of organs leads to the death of approximately 2,000 waitlisted patients each year. When an organ becomes available, each transplant center makes decisions that primarily benefit the patients listed for liver transplantation at their center. This behavior is rational inthe setting of scarce resources and each center's primary obligation to their own patients. However, this competitive strategy may lead to a decision to accept or decline an organ offer that results in a decreased benefit to waitlisted patients both individually and overall, leading to a higher than necessary patient mortality on the waitlist. This thesis aims to explore the comparative effectiveness of the current practice of competition for organs across transplant centers versus alternative collaborative strategies, accounting for both patient outcomes and economic objectives. The framework for the proposed investigation is the mathematical theory of games, which has been used to model competition in a wide variety of social, political and economic settings. This theory suggests that competing strategies may fall into an equilibrium (the Nash equilibrium) from which no player (in this case, no center) has incentive to deviate individually, even though it may be of benefit to deviate on a collaborative basis. The proposal aims include: 1.1. construct game-theoretic models of multi-center competitive behavior; 1.2 identify the Nash equilibria; and 2. investigate inter-center collaborative strategies, which may suggest potential reforms to the organ allocation system that would improve patient outcomes and reduce costs to the healthcare system. PUBLIC HEALTH RELEVANCE: Liver transplantation is the only life-sustaining treatment option for patients with end-stage liver disease and certain forms of liver cancers; unfortunately, given the significant shortage of donated organs, nearly 2,000 patients die each year waiting for a liver transplant. This thesis aims to explore the comparative effectiveness of the current practice of competition for organs across transplant centers versus alternative collaborative strategies, accounting for both patient outcomes and economic objectives. Furthermore, this proposal aims to investigate potential reforms that will foster an environment of cooperative team decision-making in liver allocation, which will improve individual and aggregate patient outcomes and reduce costs to the healthcare system.