Patient Choice in Kidney Allocation: The Role of the Queueing Discipline

Manufacturing and Service Operations Management - Tập 6 Số 4 - Trang 280-301 - 2004
Xuanming Su1, Stefanos Zenios2
1Walter A. Haas School of Business, University of California, Berkeley, California 94720
2Graduate School of Business, Stanford University, Stanford, California, 94305

Tóm tắt

This paper develops and analyzes a queueing model to examine the role of patient choice on the high rate of organ refusals in the kidney transplant waiting system. The model is an M/M/1 queue with homogeneous patients and exponential reneging. Patients join the waiting system and organ transplants are reflected by the service process. In addition, unlike the standard M/M/1 model, each service instance is associated with a variable reward that reflects the quality of the transplant organ, and patients have the option to refuse an organ (service) offer if they expect future offers to be better. Under an assumption of perfect and complete information, it is demonstrated that the queueing discipline is a potent instrument that can be used to maximize social welfare. In particular, first-come-first-serve (FCFS) amplifies patients' desire to refuse offers of marginal quality, and generates excessive organ wastage. By contrast, last-come-first-serve (LCFS) contains the inefficiencies engendered by patient choice and achieves optimal organ utilization. A numerical example calibrated using data from the U.S. transplantation system demonstrates that the welfare improvements possible from a better control of patient choice are equivalent to a 25% increase in the supply of organs.

Từ khóa


Tài liệu tham khảo

10.1287/opre.46.6.776

10.1287/mnsc.29.7.831

Bertsekas D. M., 1995, Dynamic Programming and Optimal Control, 2

Cullis J. G., 2000, Handbook of Health Economics, 1

10.1002/(SICI)1099-1050(199703)6:2<187::AID-HEC259>3.0.CO;2-W

Fudenberg D., 1990, Game Theory

10.1287/opre.49.5.720.10605

Gibbons R., 1992, Game Theory for Applied Economists

Goddard J., 1994, Setting Priorities in Health Care, 71

10.1002/hec.4730040105

10.2307/1911731

10.1177/02729890122062550

10.1016/S0167-6296(96)00518-8

10.1287/mnsc.33.3.395

10.1287/opre.35.6.895

10.1287/opre.25.2.233

10.1145/3166.3171

10.1287/opre.38.5.870

10.2307/1909200

10.1056/NEJM199805143382006

10.1002/9780470316887

10.1016/S0165-1889(00)00025-7

10.1287/mnsc.24.15.1598

Su X. Essays on patient choice. (2004) . Doctoral dissertation, Graduate School of Business, Stanford University, Stanford, CA

Su X., 2004, Oper. Res.

10.1097/01.ASN.0000127866.34592.60

10.1002/(SICI)1099-1727(199923)15:3<225::AID-SDR171>3.0.CO;2-P

10.1287/mnsc.46.9.1249.12238

10.1007/978-1-4757-2719-7

10.1136/jme.27.4.268

10.1056/NEJM199912023412303

Yates J., 1995, Private Eye, Heart and Hip

10.1287/opre.19.2.349

10.1023/A:1019162331525

10.1287/opre.48.4.549.12418

Thông tin
Thông tin xuất bản

Manufacturing and Service Operations Management

Tập 6 Số 4

280-301

Thông tin tác giả