Using behavioral economics to reduce the discard rate of viable kidneys: Validating new methods to identify factors that influence the acceptance of deceased-donor kidneys

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Project Summary Viable kidneys from deceased donors are being discarded while the waitlist of candidates who could use them continues to grow. Though the quality of the offered kidney contributes to the acceptance rate, there exists a large variance in clinicians' decisions. An underlying barrier to improving the allocation and acceptance of deceased-donor kidneys is a lack of a fundamental understanding as to why the refusal rate for similar kidneys is high for some transplant centers, but not others. The premise for our work is that the unexplained heterogeneity in acceptance rates is caused by idiosyncratic preferences and behavioral biases in clinician's decision- making. Although many preferences and biases have been hypothesized to affect clinician's decisions, researchers lack a validated instrument to measure them. We will pilot and validate a platform that will allow us to estimate the influence of a wide range preferences and behavioral biases on acceptance rates. To validate our platform, we will test for correlations between clinicians' risk preferences elicited in a simulated environment to risk preferences from retrospective acceptance behavior in practice.