Patient Optimism and the Trade-Off Between Kidney Quality and Waiting Time
Author(s)
Tina Cheng, MPH1, Jui-Chen Yang, MEM1, Sanjay Mehrotra, PhD2, Juan M. Gonzalez, PhD1;
1Duke University, Durham, NC, USA, 2Northwestern University, Evanston, IL, USA
1Duke University, Durham, NC, USA, 2Northwestern University, Evanston, IL, USA
OBJECTIVES: Over 12 people in the US die daily waiting for a kidney transplant, while more than 1 in 4 recovered kidneys go unused. Nonuse of deceased-donor kidneys has risen to nearly 30% in 2023, especially for lower-quality kidneys. Matching these kidneys with willing patients is crucial to reduce organ discard. Previous studies showed less educated patients and patients of color are more willing to accept lower-quality kidneys. This study examines how patients’ optimism about the availability of better kidneys in the future influence their acceptance of lower-quality kidneys and the potential exacerbation of health disparities.
METHODS: Data from a discrete-choice experiment involving 605 patients living with end-stage-kidney-disease in the US were used to quantify the degree to which less educated patients and patients of color systematically opt for lower-quality kidneys available today. We constructed an instrumental variable to capture patients’ optimism about their ability in getting a future kidney and used this information to test whether optimism is correlated with avoidance of waiting.
RESULTS: Our analysis showed significant variation in patients’ optimism for future organ offers by observed characteristics, including patients’ income, race, and education level. Non-White patients were less optimistic (OR: 0.55, p = 0.009) compared to White patients, but this effect was mitigated by increases in yearly income (OR: 1.2, p < 0.001). Respondents were less likely to choose future kidneys (OR: 0.6, p = 0.002) even when kidneys today were of lower quality, but the significance of this effect weakened among patients with greater optimism about future kidneys.
CONCLUSIONS: While preference heterogeneity analysis identified patient characteristics associated with accepting lower-quality kidneys, caution is needed. It remains unclear if this preference reflects genuine comfort with risk or low optimism of a future kidney. Future research should consider whether preferences reflect individual differences or underlying perceived constraints that can exacerbate health disparities.
METHODS: Data from a discrete-choice experiment involving 605 patients living with end-stage-kidney-disease in the US were used to quantify the degree to which less educated patients and patients of color systematically opt for lower-quality kidneys available today. We constructed an instrumental variable to capture patients’ optimism about their ability in getting a future kidney and used this information to test whether optimism is correlated with avoidance of waiting.
RESULTS: Our analysis showed significant variation in patients’ optimism for future organ offers by observed characteristics, including patients’ income, race, and education level. Non-White patients were less optimistic (OR: 0.55, p = 0.009) compared to White patients, but this effect was mitigated by increases in yearly income (OR: 1.2, p < 0.001). Respondents were less likely to choose future kidneys (OR: 0.6, p = 0.002) even when kidneys today were of lower quality, but the significance of this effect weakened among patients with greater optimism about future kidneys.
CONCLUSIONS: While preference heterogeneity analysis identified patient characteristics associated with accepting lower-quality kidneys, caution is needed. It remains unclear if this preference reflects genuine comfort with risk or low optimism of a future kidney. Future research should consider whether preferences reflect individual differences or underlying perceived constraints that can exacerbate health disparities.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
PCR149
Topic
Patient-Centered Research
Topic Subcategory
Instrument Development, Validation, & Translation, Patient Behavior and Incentives
Disease
SDC: Urinary/Kidney Disorders, STA: Surgery