Author ORCID Identifier

https://orcid.org/0009-0002-7122-3482

Date of Award

Spring 4-30-2026

Document Type

Thesis (Master's)

Degree Name

Master of Public Health (MPH)

First Advisor

Tina Foster, MD

Second Advisor

Meghan Longacre, MS, PhD

Abstract

For children with end-stage liver disease, liver transplantation is the only cure. While organ scarcity is a national challenge, internal pre-listing processes remain within an institution's control. This quality improvement initiative applied Lean Six Sigma and mixed-methods process mapping to the pediatric deceased donor liver transplant pathway at Boston Children's Hospital. By integrating five years of electronic health record data with multidisciplinary interviews, the project developed a comprehensive process map and performance dashboard.

The study revealed a median of 65 days elapsed between referral and waitlist activation—a timeline entirely within internal operational control. This delay was concentrated in two specific phases: referral to evaluation start (21 days) and evaluation to committee review (43 days). Conversely, the committee-to-listing transition required a median of just one day. The subsequent 119-day listing-to-transplant interval reflected national allocation dynamics rather than internal inefficiencies.

Qualitative data identified committee meeting cadence, scheduling burdens, and limited workflow visibility as primary drivers of delay. To address these bottlenecks, three interventions are proposed: flexible committee access for clear cases, dedicated evaluation scheduling infrastructure, and shared transparency mechanisms.

The resulting twelve-lane process map and reproducible dashboard provide a data-informed, replicable framework to monitor and accelerate the pre-listing pathway at pediatric and adult transplant centers.

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