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

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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.