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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Bibliographic Details
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
Online Access:Get full text
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Summary: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.
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ISSN:0902-0063
1399-0012
1399-0012
DOI:10.1111/ctr.14284