Left‐digit bias and deceased donor kidney utilization

Cognitive biases shown to impact medical decision‐making include left‐digit bias, the tendency to focus on a continuous variable's leftmost digit. We hypothesized that left‐digit bias impacts deceased donor kidney utilization through heuristic processing of donor age and creatinine. We used US...

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Published in:	Clinical transplantation Vol. 35; no. 6; pp. e14284 - n/a
Main Authors:	Husain, S. Ali, King, Kristen L., Mohan, Sumit
Format:	Journal Article
Language:	English
Published:	Denmark 01.06.2021
Subjects:	Adult Bias cognitive heuristics decision‐making Donor Selection Graft Survival Humans Kidney kidney donor Kidney Transplantation organ utilization Risk Factors Tissue and Organ Procurement Tissue Donors cognitive heuristics kidney donor decision-making organ utilization kidney transplantation
ISSN:	0902-0063, 1399-0012, 1399-0012
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Abstract	Cognitive biases shown to impact medical decision‐making include left‐digit bias, the tendency to focus on a continuous variable's leftmost digit. We hypothesized that left‐digit bias impacts deceased donor kidney utilization through heuristic processing of donor age and creatinine. We used US registry data to identify 87 019 kidneys recovered (2015–2019) and compared the proportion around thresholds for donor age (69 vs. 70 years) and creatinine (1.9 vs. 2.0 mg/dl), then compared the risk of kidney discard. Kidneys from donors aged 70 vs. 69 years were more frequently discarded (77% vs. 65%, p < .001), with higher risk of discard even after adjusting for KDRI (adjusted RR 1.11, 95% CI 1.02–1.21, p = .018). Similarly, kidneys from donors with final creatinine 2.0 vs. 1.9 mg/dl were more frequently discarded (37% vs. 29%, p < .001), with higher risk of discard after adjusting for KDRI (adjusted RR 1.19, 95% CI 1.07–1.33, p = .001). However, no significant left‐digit effect was found when examining other donor age (39/40, 49/50, 59/60 years) or creatinine (0.9/1.0, 2.9/3.0 mg/dl) thresholds. The findings suggest a possible left‐digit effect affecting kidney utilization at specific thresholds. Additional investigations of the impact of this and other heuristics on organ utilization are needed to identify potential areas for decision‐making interventions aimed at reducing kidney discard.
AbstractList	Cognitive biases shown to impact medical decision-making include left-digit bias, the tendency to focus on a continuous variable's leftmost digit. We hypothesized that left-digit bias impacts deceased donor kidney utilization through heuristic processing of donor age and creatinine. We used US registry data to identify 87 019 kidneys recovered (2015-2019) and compared the proportion around thresholds for donor age (69 vs. 70 years) and creatinine (1.9 vs. 2.0 mg/dl), then compared the risk of kidney discard. Kidneys from donors aged 70 vs. 69 years were more frequently discarded (77% vs. 65%, p < .001), with higher risk of discard even after adjusting for KDRI (adjusted RR 1.11, 95% CI 1.02-1.21, p = .018). Similarly, kidneys from donors with final creatinine 2.0 vs. 1.9 mg/dl were more frequently discarded (37% vs. 29%, p < .001), with higher risk of discard after adjusting for KDRI (adjusted RR 1.19, 95% CI 1.07-1.33, p = .001). However, no significant left-digit effect was found when examining other donor age (39/40, 49/50, 59/60 years) or creatinine (0.9/1.0, 2.9/3.0 mg/dl) thresholds. The findings suggest a possible left-digit effect affecting kidney utilization at specific thresholds. Additional investigations of the impact of this and other heuristics on organ utilization are needed to identify potential areas for decision-making interventions aimed at reducing kidney discard.Cognitive biases shown to impact medical decision-making include left-digit bias, the tendency to focus on a continuous variable's leftmost digit. We hypothesized that left-digit bias impacts deceased donor kidney utilization through heuristic processing of donor age and creatinine. We used US registry data to identify 87 019 kidneys recovered (2015-2019) and compared the proportion around thresholds for donor age (69 vs. 70 years) and creatinine (1.9 vs. 2.0 mg/dl), then compared the risk of kidney discard. Kidneys from donors aged 70 vs. 69 years were more frequently discarded (77% vs. 65%, p < .001), with higher risk of discard even after adjusting for KDRI (adjusted RR 1.11, 95% CI 1.02-1.21, p = .018). Similarly, kidneys from donors with final creatinine 2.0 vs. 1.9 mg/dl were more frequently discarded (37% vs. 29%, p < .001), with higher risk of discard after adjusting for KDRI (adjusted RR 1.19, 95% CI 1.07-1.33, p = .001). However, no significant left-digit effect was found when examining other donor age (39/40, 49/50, 59/60 years) or creatinine (0.9/1.0, 2.9/3.0 mg/dl) thresholds. The findings suggest a possible left-digit effect affecting kidney utilization at specific thresholds. Additional investigations of the impact of this and other heuristics on organ utilization are needed to identify potential areas for decision-making interventions aimed at reducing kidney discard. Cognitive biases shown to impact medical decision-making include left-digit bias, the tendency to focus on a continuous variable's leftmost digit. We hypothesized that left-digit bias impacts deceased donor kidney utilization through heuristic processing of donor age and creatinine. We used US registry data to identify 87 019 kidneys recovered (2015-2019) and compared the proportion around thresholds for donor age (69 vs. 70 years) and creatinine (1.9 vs. 2.0 mg/dl), then compared the risk of kidney discard. Kidneys from donors aged 70 vs. 69 years were more frequently discarded (77% vs. 65%, p < .001), with higher risk of discard even after adjusting for KDRI (adjusted RR 1.11, 95% CI 1.02-1.21, p = .018). Similarly, kidneys from donors with final creatinine 2.0 vs. 1.9 mg/dl were more frequently discarded (37% vs. 29%, p < .001), with higher risk of discard after adjusting for KDRI (adjusted RR 1.19, 95% CI 1.07-1.33, p = .001). However, no significant left-digit effect was found when examining other donor age (39/40, 49/50, 59/60 years) or creatinine (0.9/1.0, 2.9/3.0 mg/dl) thresholds. The findings suggest a possible left-digit effect affecting kidney utilization at specific thresholds. Additional investigations of the impact of this and other heuristics on organ utilization are needed to identify potential areas for decision-making interventions aimed at reducing kidney discard. Cognitive biases shown to impact medical decision-making include left-digit bias, the tendency to focus on a continuous variable’s leftmost digit. We hypothesized that left-digit bias impacts deceased donor kidney utilization through heuristic processing of donor age and creatinine. We used United States registry data to identify 87,019 kidneys recovered (2015–2019) and compared the proportion around thresholds for donor age (69 vs 70 years) and creatinine (1.9 vs 2.0mg/dL), then compared the risk of kidney discard. Kidneys from donors aged 70 vs 69 years were more frequently discarded (77% vs 65%, p<0.001), with higher risk of discard even after adjusting for KDRI (adjusted RR 1.11, 95%CI 1.02–1.21, p=0.018). Similarly, kidneys from donors with final creatinine 2.0 versus 1.9mg/dL were more frequently discarded (37% vs 29%, p<0.001), with higher risk of discard after adjusting for KDRI (adjusted RR 1.19, 95%CI 1.07–1.33, p=0.001). However, no significant left-digit effect was found when examining other donor age (39/40, 49/50, 59/60 years) or creatinine (0.9/1.0, 2.9/3.0mg/dL) thresholds. The findings suggest a possible left-digit effect affecting kidney utilization at specific thresholds. Additional investigations of impact of this and other heuristics on organ utilization are needed to identify potential areas for decision-making interventions aimed at reducing kidney discard. Cognitive biases shown to impact medical decision‐making include left‐digit bias, the tendency to focus on a continuous variable's leftmost digit. We hypothesized that left‐digit bias impacts deceased donor kidney utilization through heuristic processing of donor age and creatinine. We used US registry data to identify 87 019 kidneys recovered (2015–2019) and compared the proportion around thresholds for donor age (69 vs. 70 years) and creatinine (1.9 vs. 2.0 mg/dl), then compared the risk of kidney discard. Kidneys from donors aged 70 vs. 69 years were more frequently discarded (77% vs. 65%, p < .001), with higher risk of discard even after adjusting for KDRI (adjusted RR 1.11, 95% CI 1.02–1.21, p = .018). Similarly, kidneys from donors with final creatinine 2.0 vs. 1.9 mg/dl were more frequently discarded (37% vs. 29%, p < .001), with higher risk of discard after adjusting for KDRI (adjusted RR 1.19, 95% CI 1.07–1.33, p = .001). However, no significant left‐digit effect was found when examining other donor age (39/40, 49/50, 59/60 years) or creatinine (0.9/1.0, 2.9/3.0 mg/dl) thresholds. The findings suggest a possible left‐digit effect affecting kidney utilization at specific thresholds. Additional investigations of the impact of this and other heuristics on organ utilization are needed to identify potential areas for decision‐making interventions aimed at reducing kidney discard.
Author	Mohan, Sumit King, Kristen L. Husain, S. Ali
AuthorAffiliation	3. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 2. The Columbia University Renal Epidemiology (CURE) Group, New York, NY 1. Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, NY
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Snippet	Cognitive biases shown to impact medical decision‐making include left‐digit bias, the tendency to focus on a continuous variable's leftmost digit. We... Cognitive biases shown to impact medical decision-making include left-digit bias, the tendency to focus on a continuous variable's leftmost digit. We... Cognitive biases shown to impact medical decision-making include left-digit bias, the tendency to focus on a continuous variable’s leftmost digit. We...
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SubjectTerms	Adult Bias cognitive heuristics decision‐making Donor Selection Graft Survival Humans Kidney kidney donor Kidney Transplantation organ utilization Risk Factors Tissue and Organ Procurement Tissue Donors
Title	Left‐digit bias and deceased donor kidney utilization
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