An AHP framework for balancing efficiency and equity in the United States liver transplantation system

ABSRACT: Liver transplantation and allocation has been a controversial issue in the United States for decades. One of the main concerns in the allocation system is the trade-off between the two main objectives, efficiency and equity. Unfortunately, it is difficult to reach consensus on how to develop allocation policies that aim at balancing efficiency and equity, among transplantation policy makers, administrators, transplant surgeons and transplant candidates.Our research identifies and classifies the outcomes of liver allocation into two major categories, efficiency and equity, that are, often times, conflicting. Previous researchers did not consider how to balance outcomes in these two categories. Our research uses Analytic Hierarchy Process, a Multi-Criteria Decision Analysis methodology, to build a framework that quantifies the decision-making process and help decision makers to reach a valid consensus in terms of balancing these outcomes. Latest available patient registration and follow-up data are used in data analysis. Results from this analysis serve as inputs for the simulation model that is capable of evaluating alternative hypothetical policies.This research addresses the deficiencies of the current liver transplantation policy and is intended to refine the policy that will result in a more balanced allocation system with respect to efficiency and equity. Our proposed methodology can be applied to incorporate further changes in policy selection and refinement