Using Decision Making Science to Optimize Deceased Donor Kidney Allocation

利用决策科学来优化已故捐赠者肾脏的分配

• 批准号: 10669248
• 负责人: Syed Ali Husain
• 金额: $ 16.55万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10669248
• 关键词: Accident and Emergency department; Area; Biopsy; Characteristics; Chest Pain; Clinical; Clinical Data; Cognitive; Communities; Consumption; Coupled; Data; Decision Making; Development; Dialysis procedure; Digit structure; End stage renal failure; Epidemiology; Evaluation; Federal Government; Frequencies; Goals; Grant; Histologic; Intervention Studies; Kidney; Kidney Failure; Kidney Transplantation; Label; Left; Maintenance; Mentors; Nephrosclerosis; Organ; Organ Procurements; Outcome; Patients; Pattern; Perception; Prospective Studies; Quality of life; Recording of previous events; Recovery; Reporting; Research; Research Design; Research Personnel; Risk; Scheme; Science; Standardization; Structure; Surgeon; Testing; Time; Transplant Surgeon; Transplantation; Triage; United States; Wait Time; Work; cognitive load; cohort; cost comparison; cost effective treatment; data standards; data visualization; design; discounting; heuristics; human centered design; improved; kidney biopsy; multidisciplinary; organ allocation; organ procurement transplantation network; post-transplant; pressure; prognostic; randomized trial; research data dissemination; response; satisfaction; skill acquisition; trait; transplant centers; usability

PROJECT SUMMARY/ABSTRACT Although kidney transplantation provides better survival, quality of life, and long-term cost compared to maintenance dialysis, the majority of patients with end-stage kidney disease in the United States will never receive a transplant due to a severe shortage of donated kidneys. In response to this shortage, there has been an increasing emphasis on expanding the use of less-than-ideal deceased donor kidneys, which still provide survival and quality of life benefits over extended waiting time for a higher quality kidney. Despite efforts to increase the aggressiveness of organ recovery and utilization, thousands of likely transplantable kidneys are not recovered or discarded after recovery each year, primarily due to quality concerns. We and others have shown that clinicians’ subjective assessments of organ quality are often too conservative, and that cognitive heuristics impact perception or organ quality and likelihood of organ utilization. A key target for improving perceptions of organ quality is therefore to use decision science to improve the presentation of information during organ offers. The goal of the proposed project is to understand how surgeons prioritize and consume information during organ offer decisions, then use a mechanisms-based approach to target cognitive heuristics that favor inappropriate organ offer refusal. We will begin with improving the presentation of the results of procurement biopsies. Despite reliance on findings from these biopsies— which are the most common reason for deceased donor kidney discard— their independent prognostic capability is limited as they are currently performed. We hypothesize that our approach will enable standardization of procurement biopsy presentation in a manner that reduces deleterious impacts on organ offer acceptance. To complete the proposed project and acquire the skills needed for development into an independent investigator in the field of kidney transplantation, Dr. Husain will work closely with a multidisciplinary team of mentors and advisors, led by Dr. Sumit Mohan, to develop research expertise in the areas of interventional and prospective study design, decision making science & human-centered design, kidney transplant epidemiology, and research dissemination & professional development. Upon completion of this project, he will have the scientific and research expertise needed to be a grant-supported independent investigator in this field.

项目摘要/摘要 尽管与肾移植相比，肾移植提供了更好的存活率、生活质量和长期成本 维持性透析，美国大多数终末期肾病患者永远不会 由于捐献的肾脏严重短缺而接受移植。为了应对这种短缺，已经有了 越来越重视扩大不太理想的已故供体肾脏的使用，这仍然提供 生存和生活质量的好处超过了等待更高质量肾脏的时间延长。尽管做出了努力 增加器官恢复和利用的侵略性，数千个可能的可移植肾脏不是 每年在回收后回收或丢弃，主要是由于质量问题。我们和其他人已经展示了 临床医生对器官质量的主观评估往往过于保守，认知启发式 影响知觉或器官质量和器官利用的可能性。一个关键目标是改善人们对 因此，器官质量是利用决策科学来改进器官提供过程中的信息呈现。 这个被提议的项目的目标是了解外科医生如何在器官移植过程中优先处理和使用信息。 提供决策，然后使用基于机制的方法来针对支持不适当的认知启发式 机关要约拒绝。我们将首先改进采购活组织检查结果的列报方式。尽管 对这些活检结果的依赖--这是已故捐赠者肾脏最常见的原因 放弃-他们的独立预后能力是有限的，因为他们目前的执行。我们假设 我们的方法将使采购活组织检查报告标准化，从而减少 对器官接受的有害影响。 完成拟议的项目并获得发展为独立调查员所需的技能 在肾移植领域，侯赛因博士将与一个由多学科导师和 由Sumit Mohan博士领导的顾问，开发干预和前瞻性领域的研究专门知识 研究设计、决策科学和以人为本的设计、肾移植流行病学和研究 传播与专业发展。这个项目完成后，他将拥有科学和 研究专业知识需要成为这一领域中由赠款资助的独立调查者。

项目成果

Timed Creatinine Clearance and Measured Glomerular Filtration Rate in Living Kidney Donors.

• DOI: 10.1016/j.xkme.2022.100572
• 发表时间: 2023-01
• 期刊: KIDNEY MEDICINE
• 影响因子: 3.9
• 作者: Husain, S. Ali;Stevens, Jacob S.;King, Kristen L.;Robbins-Juarez, Shelief Y.;Cohen, Matthew;Lyashchenko, Alexander K.;Cremers, Serge;Mohan, Sumit
• 通讯作者: Mohan, Sumit

Age-related changes in nephrosclerosis in a multiethnic living kidney donor cohort.

多民族活体肾捐献者队列中肾硬化的年龄相关变化。

• DOI: 10.1016/j.kint.2023.04.028
• 发表时间: 2023
• 期刊: Kidney international
• 影响因子: 19.6
• 作者: Emmons,BrendanR;Batal,Ibrahim;Radhakrishnan,Jai;Husain,SAli
• 通讯作者: Husain,SAli

Characterization of Transplant Center Decisions to Allocate Kidneys to Candidates With Lower Waiting List Priority.

• DOI: 10.1001/jamanetworkopen.2023.16936
• 发表时间: 2023-06-01
• 期刊: JAMA NETWORK OPEN
• 影响因子: 13.8
• 作者: King, Kristen L.;Husain, S. Ali;Yu, Miko;Adler, Joel T.;Schold, Jesse;Mohan, Sumit
• 通讯作者: Mohan, Sumit