Do Patients Think it's Worth Waiting for a Kidney? Evidence from a Discrete-Choice Experiment

Area of Science:

• Nephrology
• Transplant Surgery
• Health Economics

Background:

• Approximately 30% of deceased donor kidneys are discarded annually in the USA.
• A significant number of patients awaiting kidney transplants express willingness to accept lower-quality organs to shorten wait times.

Purpose of the Study:

• To assess how patient preferences for lower-quality kidneys change with increasing time on the kidney transplant waiting list.
• To identify patient characteristics that moderate these time-varying preferences.

Main Methods:

• Conducted a discrete-choice experiment with US pre-transplant patients on deceased donor kidney waiting lists.
• Utilized logit-based regression analysis to model patient preferences based on tradeoffs between graft survival and waiting time.
• Examined the influence of patient covariates including age, insulin use, recipient function, dialysis duration, and household income.

Main Results:

• Waiting time demonstrated a nonlinear effect on patient phenotype probabilities, with increased willingness to accept lower-quality kidneys over time.
• Patients with longer insulin dependence, lower income, and poorer health function were more inclined to accept suboptimal kidneys.
• Higher income was significantly associated with a greater likelihood of waiting for a better-quality kidney.

Conclusions:

• Patient preferences for organ acceptability are dynamic and vary significantly with time spent on the transplant waiting list.
• Health status and socioeconomic factors, such as income and insulin dependence, critically moderate these evolving preferences.
• Extended waiting periods and compromised health status generally correlate with an increased acceptance of lower-quality deceased donor kidneys.