@article{67f7e7964e654961877a68ee674304d8,
title = "A kidney offer acceptance decision tool to inform the decision to accept an offer or wait for a better kidney",
abstract = "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.",
keywords = "clinical decision-making, donors and donation, health services and outcomes research, kidney (allograft) function/dysfunction, kidney transplantation/nephrology, organ acceptance, organ procurement and allocation",
author = "Andrew Wey and Nicholas Salkowski and Kremers, {Walter K.} and Schaffhausen, {Cory R.} and Kasiske, {Bertram L.} and Israni, {Ajay K.} and Snyder, {Jon J.}",
note = "Funding Information: US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation, Grant/Award Number: HHSH250201500009C; AKI was partially supported by National Institutes of Health, Grant/Award Number: R01 HS 24527 Funding Information: Systems Bureau, Division of Transplantation). As a US Government-sponsored work, there are no restrictions on its use. The views expressed herein are those of the authors and not necessarily those of the US Government. AKI was partially supported by National Institutes of Health R01 HS 24527. The authors thank SRTR colleague Nan Booth, MSW, MPH, and ELS for manuscript editing. Funding Information: This work was conducted under the auspices of the Minneapolis Medical Research Foundation, contractor for the Scientific Registry of Transplant Recipients, as a deliverable under contract number HHSH250201500009C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). As a US Government-sponsored work, there are no restrictions on its use. The views expressed herein are those of the authors and not necessarily those of the US Government. AKI was partially supported by National Institutes of Health R01 HS 24527. The authors thank SRTR colleague Nan Booth, MSW, MPH, and ELS for manuscript editing. Funding Information: This work was conducted under the auspices of the Minneapolis Medical Research Foundation, contractor for the Scientific Registry of Transplant Recipients, as a deliverable under contract number HHSH250201500009C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Publisher Copyright: {\textcopyright} 2017 The American Society of Transplantation and the American Society of Transplant Surgeons",
year = "2018",
month = apr,
doi = "10.1111/ajt.14506",
language = "English (US)",
volume = "18",
pages = "897--906",
journal = "American Journal of Transplantation",
issn = "1600-6135",
publisher = "Wiley-Blackwell",
number = "4",
}