Identifying Behavioral Factors Contributing to High Discard Rate of Deceased Donor Kidneys

10 Project Summary/Abstract Kidney diseases are a leading cause of death in the United States. Ensuring successful transplants for patients with end stage renal failure (ESRD) is a major priority of our nation, but a persistent shortage of deceased-donor kidney donations and high organ discard rates limits access to deceased-donor kidney transplants. To identify underlying causes of the non-utilization of transplant-quality kidneys, this study aims to investigate clinicians’ idiosyncratic decision-making when considering deceased-donor kidney transplant offers. Our team’s preliminary research shows that individual doctors have different ways of deciding whether a kidney is suitable for transplantation. To investigate this further, we have created a unique data set that combines information about kidney offers with on-call records of doctors who evaluated these offers, to identify the individual decision-makers evaluating each offer. This novel data linkage opens the door to an opportunity to measure offer acceptance rates and examine acceptance patterns at the individual clinician level. By analyzing these data, we discovered that even within the same medical center, where doctors have the same resources and patient populations, doctors have widely varying acceptance thresholds for donor kidney offers. The broader phase of our study has three aims. First, we aim to recruit new transplant centers to expand the individual-level, potential transplant recipient (iPTR) dataset we have begun assembling with initially enrolled cen- ters. The iPTR dataset will include clinician-level offer decisions, including refusal reasons for declined organs, as well as medical characteristics of the donors and recipients for each offer. Second, we will elicit clinicians’ be- liefs about ESRD patients’ quality-of-life while on maintenance dialysis compared to various post-transplantation health states, as well as the likelihood of kidneys of varying quality leading to better or worse post-transplant health. Third, we will identify differences in the influence of various clinical factors (e.g., donor age) and non- clinical factors (e.g, beliefs) on offer decisions across clinicians. This study investigates individual decision-making on real-world, deceased donor kidney offers for the first time. By integrating survey data capturing clinicians’ subjective beliefs about ESRD and transplant patient outcomes, we will better understand how behavioral factors impact the transplantation system alongside clinical factors. This study has the potential to make a significant impact on the health of our population by providing novel insights to guide the future development of targeted interventions that can lead to more successful kidney transplants and improved length and quality of life for kidney disease patients.