A Broader View of Designing the Liver Allocation System
Bibliographic record
Abstract
We consider the problem of designing an efficient system for allocating donated livers to patients waiting for transplantation. The trade-off between medical urgency and efficiency is at the heart of the liver allocation problem. We model the transplant waiting list as a multiclass fluid model of overloaded queues, which captures the disease evolution by allowing the patients to switch between classes, i.e., health levels. We consider the bicriteria objective of minimizing total number of patient deaths while waiting for transplantation (NPDWT) and maximizing total quality-adjusted life years (QALYs) through a weighted combination. On one hand, under the objective of minimizing NPDWT, the current policy of United Network for Organ Sharing (UNOS) emerges as the optimal policy, providing a theoretical justification for the current practice. On the other hand, under the metric of maximizing QALYs, the optimal policy is an intuitive dynamic index policy that ranks patients based on their marginal benefit from transplantation, i.e., the difference in benefit with versus without transplantation. Finally, we perform a detailed simulation study to compare the performances of our proposed policies and the current UNOS policy along the following metrics: total QALYs, NPDWT, number of patient deaths after transplantation, number of total patient deaths, and number of wasted livers. Numerical experiments show that our proposed policy for maximizing QALYs outperforms the current UNOS policy along all metrics except the NPDWT.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".