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

Nearly 30% of kidneys from deceased donors are discarded annually in the USA. A recent study indicated that a significant number of patients would accept lower-quality kidneys to avoid long waits. We expand on previous work to assess how the distribution of patient preferences for lower-quality kidneys would change with patient time on the transplant list.

We conducted a discrete-choice experiment with US pre-transplant patients waitlisted for kidneys from deceased donors. Respondents were asked to evaluate tradeoffs between expected graft survival and waiting time. We used a logit-based regression with patient covariates to explain membership of three patient-preference phenotypes previously identified with these data. Specifically, we tested the degree to which phenotype membership changed with waiting time and how such changes were moderated by observable patient characteristics such as age, insulin use, recipient function, time on dialysis, and household income.

Waiting time had a nonlinear effect on phenotype probabilities, with more patients expected to be willing to accept lower-quality kidneys as waiting time increases. Patients with longer insulin dependence, lower income, and limited function were more likely to accept lower-quality kidneys. Higher income was significantly associated with the probability of being willing to wait for better future kidneys. Dialysis time had no significant effect.

Our analysis provides insights into time-varying effects using cross-sectional data. Results suggest that patient preferences for organ acceptability vary with waiting time and are moderated by health status and socioeconomic factors. Longer waits and worse health statuses were generally associated with greater willingness to accept lower-quality kidneys.