Involving patients in the cadaveric kidney transplant allocation process: A decision-theoretic perspective

The United Network for Organ Sharing system of allocating cadaveric kidneys for transplantation permits only minimal involvement of patients in the selection process. The system ignores potential variations in the importance that patients may attach to outcomes associated with the transplant decision. For instance, some patients may prefer only kidneys that will give them a very favorable chance to achieve a successful transplant. We designed a decision model in which patients are surveyed about their preferences for health states that in turn affect decisions about the type of donor kidneys that would be acceptable for transplantation. Our analyses show that patients with favorable transplant characteristics (e.g., young age, good health, good immunologic match between the donor kidney and the recipient) or who expect a minimal improvement in quality of life after successful transplantation can afford to be selective when considering which kidneys to accept for transplantation. Involving patients in selecting the optimal donor-kidney should improve patients' quality and duration of life with end-stage renal disease, and thereby improve the overall efficiency of the U.S. kidney transplantation program.