The role of waiting list information in liver transplant decision making
In the United States, patients in need of a liver transplant receive deceased-donor organ offers through joining a waiting list. Accepting or rejecting an offered organ is largely influenced by the patient’s prospects for future offers, which can be ascertained most accurately by knowing the entire composition of the waiting list. We present two stochastic models to help individual patients make optimal accept/reject decisions when faced with an offer. The first model assumes perfect information about the composition of waiting list, whereas the second model contends with partially observable waiting list as available in the current US system. In addition to modeling novelties, we present structural analyses of these models to characterize the optimal decision rule and a detailed numerical study investigating the impact of waiting list information on patients’ life expectancies. We find a significant loss in a patient’s life expectancy, on average, when the patient ignores the waiting list information, and that the currently published partial information is nearly sufficient to eliminate this loss.