Equitable allocation of livers for orthotopic transplantation: an application of the analytic hierarchy process

The Analytic Hierarchy Process (AHP) was used to develop a rating system allocation of cadaver livers for orthotopic transplantation. Five major criteria for comparison were established, defined, and rated relative to one another: logistic considerations, tissue compatibility, waiting time, financial considerations, and medical status. Subcriteria were also established and rated to one another in relative terms. Patients that met appropriate inclusion screening criteria were then ranked for selection by assigning the appropriate rating to subcriteria in the major selection criteria. Final weighing can be used to develop an alternative to the rigid computerized multifactorial point system that now exists. The AHP process is thus shown to be useful in complex medical decision making. The point system was never formally evaluated; it depends on the intuition of the people using it. The use of AHP may provide the necessary equitable evaluation to rationally justify the allocation of livers for transplantation.