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

描述(申请人提供)：对于终末期肝病和某些形式的肝癌患者，肝移植是唯一确定的和维持生命的治疗方法。器官的匮乏每年导致大约2000名等待治疗的病人死亡。当一个器官可用时，每个移植中心做出的决定主要是让他们中心列出的肝移植患者受益。在资源稀缺和每个中心对自己的病人负有主要义务的情况下，这种行为是合理的。然而，这种竞争策略可能会导致决定接受或拒绝器官捐赠，从而导致等待名单上的患者个人和整体受益减少，导致等待名单上的患者死亡率高于必要的水平。这篇论文旨在探索当前跨移植中心器官竞争的实践与替代合作策略的比较有效性，同时考虑到患者的结果和经济目标。拟议调查的框架是博弈论的数学理论，该理论已被用来模拟各种社会、政治和经济环境中的竞争。这一理论表明，竞争策略可能陷入一种均衡(纳什均衡)，没有任何参与者(在这种情况下，没有中锋)有动力单独偏离，即使在合作的基础上偏离可能是有利的。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；以及2.研究中心间的协作策略，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的肝癌患者的唯一维持生命的治疗选择；不幸的是， 鉴于捐赠器官的严重短缺，每年有近2000名患者在等待肝脏移植时死亡。这篇论文旨在探索当前跨移植中心器官竞争的实践与替代合作策略的比较有效性，同时考虑到患者的结果和经济目标。此外，这项提案旨在调查潜在的改革，这些改革将在肝脏分配方面营造一个合作团队决策的环境，这将改善个人和总体患者的结果，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.