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Evaluation of Accepting Kidneys of Varying Quality for Transplantation or Expedited Placement With Decision Trees.
- Source :
-
Transplantation [Transplantation] 2019 May; Vol. 103 (5), pp. 980-989. - Publication Year :
- 2019
-
Abstract
- Background: Underutilization of marginal-quality kidneys for transplantation produced ideas of expediting kidney placement for populations with decreased opportunities of receiving transplants. Such policies can be less efficacious for specific individuals and should be scrutinized until the decision-making for accepting marginal-quality organs, which has relied on experiential judgment, is better understood at the individual level. There exist rigorous tools promoting personalized decisions with useful and objective information.<br />Methods: This article introduces a decision-tree methodology that analyzes a patient's dilemma: to accept a kidney offer now or reject it. The methodology calculates the survival benefit of accepting a kidney given a certain quality now and the survival benefit of rejecting it. Survival benefit calculation accounts for patients' and donors' characteristics and transplant centers' and organ procurement organizations' performances and incorporates patients' perceived transplant and dialysis utilities. Valuations of rejecting an offer are contingent on future opportunities and subject to uncertainty in the timing of successive kidney offers and their quality and donor characteristics.<br />Results: The decision tree was applied to a realistic patient profile as a demonstration. The tool was tested on 1000 deceased-donor kidney offers in 2016. Evaluating up to 1 year of future offers, the tool attains 61% accuracy, with transplant utility of 1.0 and dialysis utility of 0.5. The accuracy reveals potential bias in kidney offer acceptance/rejection at transplant centers.<br />Conclusions: The decision-tree tool presented could aid personalized transplant decision-making in the future by providing patients with calculated, individualized survival benefits between accepting and rejecting a kidney offer.
- Subjects :
- Adolescent
Adult
Aged
Decision Making
Female
Humans
Kidney Failure, Chronic mortality
Kidney Transplantation statistics & numerical data
Male
Middle Aged
Patient Participation methods
Renal Dialysis statistics & numerical data
Resource Allocation methods
Resource Allocation statistics & numerical data
Risk Assessment methods
Risk Factors
Survival Analysis
Time Factors
Transplants statistics & numerical data
Waiting Lists
Young Adult
Decision Trees
Donor Selection methods
Kidney Failure, Chronic therapy
Kidney Transplantation methods
Models, Biological
Subjects
Details
- Language :
- English
- ISSN :
- 1534-6080
- Volume :
- 103
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 30720682
- Full Text :
- https://doi.org/10.1097/TP.0000000000002585