Accepting a donor kidney: an evaluation of patients' and transplant surgeons' priorities

Despite a trend toward patient autonomy in clinical practice, the decision whether or not to accept a kidney for transplantation is made predominantly by the transplant surgeon. The purpose of this study is to examine how patients and surgeons prioritize relevant factors when deciding to accept or decline an available kidney.

We elicited patient and surgeon rankings for a list of factors involved in the decision using a validated computer survey. We computed the relative importance of each factor and examined associations between patient characteristics and priorities using Spearman's correlation coefficient and the Mann-Whitney U-test for continuous and categorical variables, respectively.

Patients placed the greatest value on kidney quality and predictors of transplant outcome. Patients who were on the waiting list longer gave less importance to kidney quality and function. Surgeons placed the greatest value on kidney quality, difficulty for the patient to be matched to a kidney, and the age of the donor.

The results of this study suggest that decision support tools can be used to improve the understanding of patient priorities in the decision to accept a donor kidney.