A kidney offer acceptance decision tool to inform the decision to accept an offer or wait for a better kidney

Andrew Wey, Nicholas Salkowski, Walter K. Kremers, Cory R. Schaffhausen, Bertram L. Kasiske, Ajay K. Israni, Jon J. Snyder

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


We developed a kidney offer acceptance decision tool to predict the probability of graft survival and patient survival for first-time kidney-alone candidates after an offer is accepted or declined, and we characterized the effect of restricting the donor pool with a maximum acceptable kidney donor profile index (KDPI). For accepted offers, Cox proportional hazards models estimated these probabilities using transplanted kidneys. For declined offers, these probabilities were estimated by considering the experience of similar candidates who declined offers and the probability that declining would lead to these outcomes. We randomly selected 5000 declined offers and estimated these probabilities 3 years post-offer had the offers been accepted or declined. Predicted outcomes for declined offers were well calibrated (<3% error) with good predictive accuracy (area under the curve: graft survival, 0.69; patient survival, 0.69). Had the offers been accepted, the probabilities of graft survival and patient survival were typically higher. However, these advantages attenuated or disappeared with higher KDPI, candidate priority, and local donor supply. Donor pool restrictions were associated with worse 3-year outcomes, especially for candidates with high allocation priority. The kidney offer acceptance decision tool could inform offer acceptance by characterizing the potential risk–benefit trade-off associated with accepting or declining an offer.

Original languageEnglish (US)
Pages (from-to)897-906
Number of pages10
JournalAmerican Journal of Transplantation
Issue number4
StatePublished - Apr 2018


  • clinical decision-making
  • donors and donation
  • health services and outcomes research
  • kidney (allograft) function/dysfunction
  • kidney transplantation/nephrology
  • organ acceptance
  • organ procurement and allocation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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