Assessing the impact of cognitive biases on patient and provider willingness to accept imperfect kidneys for transplantation - PROJECT SUMMARY Although more than 88,000 patients in the US are waiting to receive a kidney transplant, each year we discard more than 4,900 deceased donor kidneys. Many of the discarded kidneys are imperfect but still offer a survival advantage compared to continued dialysis. Transplantable organs are often discarded due to patient and physician decisions to decline offers. However, systematic human errors in decision-making, known as cognitive biases, can negatively impact these decisions. Understanding the role that cognitive biases play in decisions to accept or decline organs can help identify strategies to improve patient and physician decision- making, decrease the organ discard rate, and optimize outcomes for patients awaiting transplantation. The proposed project is a 5-year Mentored Patient-Oriented Research Career Development Award (K23) that responds to PA-20-206 and will support the career development of Carrie Thiessen, MD, PhD. The project has three specific aims. The first two aims will characterize the status quo bias that may cause patients to underestimate the risks of continued dialysis relative to transplant. The third aim examines the extent to which physicians experience a bandwagon effect that leads them to overvalue other clinicians’ assessments of organ quality. For Aim 1, we will interview patients who are being re-evaluated to stay on the kidney transplant waiting list to determine how worsening health status affects their decision to decline consent to imperfect kidney offers. For Aim 2, we will use national registry data to characterize waitlist patients who continue to decline consent to imperfect organ offers as their health worsens. We will explore the impact of transitioning from non- consent to consent to imperfect organ offers on the likelihood of transplantation, death on the waiting list, and delisting. For Aim 3, we will determine the effect of knowledge of prior declines on transplant surgeons’ organ acceptance rates by conducting a single-center pilot study that randomizes actual organ offers to presentation with the number of prior declines (standard-of-care) versus temporary masking of the number of prior declines (intervention). Under the guidance of a multi-disciplinary team of skilled mentors, Dr. Thiessen will supplement this mentored research with formal training in behavioral economics, advanced qualitative methods and biostatistics, and interventional study design. As a transplant surgeon and bioethicist at an academic institution with an outstanding research environment and a track record of successfully supporting early-stage surgeon-scientists, Dr. Thiessen is well-positioned to conduct this project. This K23 will provide Dr. Thiessen with the protected time, mentorship, and training to achieve her long-term goal of becoming an independent health services researcher who optimizes outcomes for patients with end-stage organ disease by improving patient and physician decision-making frameworks.
