U.Va. Systems Engineers Working With Doctors To Improve Liver Transplant Decision Process

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April 26, 2011 — Each year, 5,000 people across the country receive liver transplants, while an additional 17,000 wait their turn for a chance to drastically improve the length and quality of their lives. For the thousands of patients faced with liver ailments, determining the best route of action is a life-or-death decision. But how does anyone know what is really the best choice?

That's where Yacov Haimes comes in.

Since August, Haimes, professor of systems and information engineering at the University of Virginia School of Engineering and Applied Science – along with Drs. Carl Berg and Patrick Northup from the U.Va. Health System's Liver Transplant Services and systems engineering graduate student Justin Bleistein – has been working on what is called a multi-objective decision tree, or MODT, to help decide how to allocate donor livers. The MODT methodology and software program analyze the decision process and the costs and benefits (in remaining life-years) of various treatments for those suffering specifically with heptocellular carcinoma, commonly known as liver cancer.

This is the first time that Haimes has used his risk-management analysis in conjunction with medical sciences. Since founding the Center for Risk Management of Engineering Systems in 1987, Haimes has collaborated with a number of different departments at U.Va., as well as with government defense and intelligence agencies, national labs and corporations.

The idea of collaborating with the School of Medicine had been floated for a while, and ultimately the two entities agreed on a project that would analyze the options available to individuals with liver cancer.

Haimes explained that liver cancer physicians, along with their patients, have more than 100 combinations of different sequential treatment options from which to choose.

"At the beginning, patients are diagnosed and screened for treatment and, if required, presented with the possible option of surgery, knowing that there is a waiting list for the latter," said Haimes, who is the Lawrence Quarles Professor of Engineering and Applied Science and the director of the Center for Risk Management of Engineering Systems.

"As you progress, however, the options begin to branch out. It is mind-boggling how many different sequential treatment options are available."

MODT – which was created by Haimes and his students several years ago – is able to track multiple objectives that analyze the tradeoffs of various decisions for treatment options. For something like determining courses of action for liver cancer, MODT can track outcomes such as societal and individual costs, he said. The methodology and related research could help physicians to both make better-informed decisions about the 15,000 patients each year who need liver transplants and inform public policy.

Applying MODT to liver cancer treatments can be defined in two discrete ways, according to Haimes.

"First, it can improve the quality of decision-making by physicians who can know the consequences of each possible choice. They can be approached with options A, B, C and D and then assess what the results of each choice would be. That, in turn, would improve the quality of life for their patients.

"Secondly, this can also help individuals in their decision-making process. They can make the decision to rush to surgery or to evaluate the available different alternatives. This allows them to talk things over with their physicians and to know and understand what the consequence of each option is."

Haimes said the research project will continue to evolve in parallel with developments in liver cancer research. The collaborators are writing a paper on their findings, as Haimes sees the project making major contributions to the medical field.
   
Bleistein, the graduate student, has worked roughly 20 hours per week on the project. Much of his work includes combing through the Standard Transplant Analysis and Research database of patient records. So far, he estimates that he has gone through the records of nearly 5,000 transplant patients.

Originally focused on mechanical engineering, Bleistein decided to shift his efforts to a new field. While he was working with Haimes as a teaching assistant, Bleistein learned of the liver project Haimes was planning to pursue, and it immediately piqued his interest.

"It feels good to work on something that can impact so many people," said Bleistein, who graduates in May. "This will really impact the people who seek help and treatment; they can see that option A may be better than option B. They can consider and evaluate different options that might yield more-positive results for them."

— By Andrew Clark

Media Contact

Zak Richards

Senior Writer/SEAS