Physician Preferences when Selecting Candidates for Lower-Quality Kidney Offers

Area of Science:

• Transplantation immunology
• Nephrology
• Surgical decision-making

Background:

• Over 50% of lower-quality kidneys (Kidney Donor Profile Index >85) are discarded in the US.
• Utilizing more of these marginal kidneys could benefit patients on the transplant waiting list.
• Physician decision-making in accepting lower-quality kidneys requires assessment.

Purpose of the Study:

• To assess the trade-offs physicians make when selecting recipients for lower-quality donor kidneys.
• To understand the key factors influencing the acceptance of marginal kidney allografts.

Main Methods:

• A discrete choice experiment (DCE) was conducted with US surgeons and nephrologists.
• Kidney quality metrics (e.g., Kidney Donor Profile Index, cold ischemia time, donor age) and recipient characteristics (e.g., age, diabetes history, dialysis duration, Karnofsky score) were varied.
• Regression analysis quantified acceptability weights for kidney and recipient factors.

Main Results:

• Kidney acceptance likelihood decreased with lower kidney quality, longer cold ischemia time, and missing donor information.
• Physicians prioritized recipients who were higher on the waiting list, younger, had less dialysis history, and no diabetes.
• Recipient performance status and calculated panel reactive antibody showed significant associations, while HLA match did not.

Conclusions:

• Physicians weigh recipient characteristics predicting post-transplant survival when accepting marginal kidneys.
• Recipient factors, particularly those related to long-term graft survival, are critical in marginal kidney allocation.