"Using the Delta-Model for End-Stage Liver Disease to Improve the Decis" by Joanne Chin

Date of Conferral

2015

Degree

Ph.D.

School

Management

Advisor

Branford McAllister

Abstract

The purpose of this experimental research was to determine whether using delta-MELD as a criterion for the liver transplant patient selection process could improve the U.S. liver allocation system. This research closed a gap in current literature on the utility of delta-MELD for liver transplant patient selection. The frameworks of systems theory, the analytic hierarchy process, and the Kalman filter contributed to the development of 2 simulation models of the liver allocation system: one that used delta-MELD and one that did not use delta-MELD. The research question examined whether using delta-MELD could improve the liver allocation system by reducing the number of patients dropping off the wait list and lowering the average MELD score. Statistical t tests of 2 independent scenarios (allocation with and without delta-MELD), each with 70 runs of 180 simulated days on the liver allocation wait list, did not indicate a significant improvement to the liver allocation system by using delta-MELD for liver allocation. However, observations made from the simulation experiment, such as the median patient wait time being 11 months and delta-MELD being more variable at the end-stage of liver diseases, provided insights into how to improve the model of the liver allocation process. In addition, observations made from the status 1 patient subgroup (patients in ICU with about 7 days to live), which were excluded from this research, suggested including status 1 patients and expanding the simulation timespan from 180 to 360 days to better capture the delta-MELD variability from patients at the end-stage of liver disease. This research provides empirical evidence on the applicability of the delta-MELD criterion for non-status 1 patients, and yields recommendations to include status 1 patients in an improved simulation of the donor liver system while using delta-MELD as criterion.

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