Using Decision Making Science to Optimize Deceased Donor Kidney Allocation

PROJECT SUMMARY/ABSTRACT Although kidney transplantation provides better survival, quality of life, and long-term cost compared to maintenance dialysis, the majority of patients with end-stage kidney disease in the United States will never receive a transplant due to a severe shortage of donated kidneys. In response to this shortage, there has been an increasing emphasis on expanding the use of less-than-ideal deceased donor kidneys, which still provide survival and quality of life benefits over extended waiting time for a higher quality kidney. Despite efforts to increase the aggressiveness of organ recovery and utilization, thousands of likely transplantable kidneys are not recovered or discarded after recovery each year, primarily due to quality concerns. We and others have shown that clinicians’ subjective assessments of organ quality are often too conservative, and that cognitive heuristics impact perception or organ quality and likelihood of organ utilization. A key target for improving perceptions of organ quality is therefore to use decision science to improve the presentation of information during organ offers. The goal of the proposed project is to understand how surgeons prioritize and consume information during organ offer decisions, then use a mechanisms-based approach to target cognitive heuristics that favor inappropriate organ offer refusal. We will begin with improving the presentation of the results of procurement biopsies. Despite reliance on findings from these biopsies— which are the most common reason for deceased donor kidney discard— their independent prognostic capability is limited as they are currently performed. We hypothesize that our approach will enable standardization of procurement biopsy presentation in a manner that reduces deleterious impacts on organ offer acceptance. To complete the proposed project and acquire the skills needed for development into an independent investigator in the field of kidney transplantation, Dr. Husain will work closely with a multidisciplinary team of mentors and advisors, led by Dr. Sumit Mohan, to develop research expertise in the areas of interventional and prospective study design, decision making science & human-centered design, kidney transplant epidemiology, and research dissemination & professional development. Upon completion of this project, he will have the scientific and research expertise needed to be a grant-supported independent investigator in this field.