title: A clinically based discrete-event simulation of end-stage liver disease and the organ allocation process.
abstract: BACKGROUND
  The optimal allocation of scarce donor livers is a contentious health care issue requiring careful analysis. The objective of this article was to design a biologically based discrete-event simulation to test proposed changes in allocation policies.
  
  
  METHODS
  The authors used data from multiple sources to simulate end-stage liver disease and the complex allocation system. To validate the model, they compared simulation output with historical data.
  
  
  RESULTS
  Simulation outcomes were within 1% to 2% of actual results for measures such as new candidates, donated livers, and transplants by year. The model overestimated the yearly size of the waiting list by 5% in the last year of the simulation and the total number of pretransplant deaths by 10%.
  
  
  CONCLUSIONS
  The authors created a discrete-event simulation model that represents the biology of end-stage liver disease and the health care organization of transplantation in the United States.
authors.affiliation: Department of Industrial Engineering, University of Pittsburgh, Pennsylvania, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Shechter
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Bryce
authors.forename: Oguzhan
authors.initials: O
authors.lastname: Alagoz
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Kreke
authors.forename: James E
authors.initials: JE
authors.lastname: Stahl
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Schaefer
authors.forename: Derek C
authors.initials: DC
authors.lastname: Angus
authors.forename: Mark S
authors.initials: MS
authors.lastname: Roberts
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D003198:Computer Simulation; D003661:Decision Support Techniques; D006085:Graft Survival; D006801:Humans; D017114:Liver Failure, Acute / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D018579:Patient Selection; D019057:Quality-Adjusted Life Years; D012042:Registries; D040841:Resource Allocation / Q000379:methods; D009927:Tissue and Organ Procurement / Q000379:methods*; D014850:Waiting Lists