Split Liver Transplantation : An Analytical Decision Support Model

Split liver transplantation (SLT) is a procedure that potentially saves two lives using one liver, increasing the total benefit derived from the limited number of donated livers available. SLT may also improve equity, by giving transplant candidates who are physically smaller (including children) increased access to liver transplants. However, SLT is rarely used in the US. To help quantify the benefits of increased SLT utilization and provide decision support tools, we introduce a deceased-donor liver allocation model with both efficiency and fairness objectives. We formulate our model as a multi-queue fluid system, incorporating the specifics of donor-recipient size matching and patients’ dynamically changing health conditions. Leveraging a novel decomposition result, we find the exact optimal matching procedure, enabling us to benchmark the performance of different allocation policies against the theoretical optimal. Numerical results, utilizing data from UNOS, show that increased utilization of SLT can significantly increase total quality-adjusted life years, reduce patient deaths, and improve fairness among different patient groups