Patient Preferences for Waiting Time and Kidney Quality

Area of Science:

• Nephrology
• Transplantation Medicine
• Health Services Research

Background:

• Approximately 20% of deceased donor kidneys are discarded annually in the US.
• Some discarded kidneys could be suitable for waitlisted patients.
• Understanding patient preferences for marginal-quality kidneys is crucial for increasing transplantation rates.

Purpose of the Study:

• To quantify patient preferences for kidney quality versus waiting time.
• To identify patient subgroups with distinct preferences regarding kidney acceptance criteria.

Main Methods:

• A discrete choice experiment was conducted with 605 kidney transplant candidates.
• Participants evaluated trade-offs between kidney quality (expected graft survival, function) and waiting time.
• Data were analyzed using random-parameters logit and latent-class analysis.

Main Results:

• Patients are willing to accept a kidney with 6.5 years of expected graft survival to avoid waiting 2 additional years for a kidney with 11 years of expected graft survival.
• Three distinct patient preference classes were identified based on their willingness to trade quality for time.
• Demographic and clinical factors, including age, race, education, and dialysis status, were associated with specific preference classes.

Conclusions:

• Kidney transplant candidates generally prefer shorter waiting times, even if it means accepting a lower-quality kidney.
• Patient preferences vary significantly, with older patients and those with lower functional status showing a stronger preference for reduced waiting time.