Date of Award

January 2025

Document Type

Thesis

Degree Name

Doctor of Nursing Practice (DNP)

Department

Yale University School of Nursing

First Advisor

Joanne Iennaco

Abstract

Evidence shows that implicit bias adversely impacts health outcomes for disenfranchised marginalized patients, and pediatric liver transplant candidates are susceptible to the effects of bias. Existing liver transplant selection processes for pediatric candidates do not include a standardized psychosocial assessment tool which might limit the chances of implicit bias impacting the pre-evaluation. The DNP project piloted the use of a standardized psychosocial assessment protocol, the Pediatric Transplant Rating Instrument (P-TRI), in pediatric patient pre-transplant evaluation and evaluated its effectiveness by comparing to results to the existing psychosocial assessment process in retrospective vs. prospective cohorts. Results using the existing assessment process showed a total of 24 of 40 participants were approved for transplant candidacy, 10 of 20 (50%) from the retrospective cohort compared to 14 of 20 (70%) prospectively evaluated. With implementation of standardized P-TRI assessment and referrals, all 20 participants (100%) in the prospective cohort were approved for transplant candidacy. Referrals were made in 8 of 20 children in the retrospective cohort compared to 19 of 20 in the prospective cohort, with 37 of 48 referrals placed in the prospective cohort. The project findings offer novel information regarding the impact of a standardized assessment protocol on decision-making in pediatric transplantation. Using an objective screening process with intervention and referral for patient and family needs related to clinical, psychosocial, economic, and demographic factors improved the likelihood of children being listed as candidates for liver transplant, and offered the opportunity for life saving treatment once structural barriers to care were addressed.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 07/11/2026

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