*Purpose: The purpose of this study was to elicit patient preferences involving tradeoffs between a lower quality kidney offered today and a higher quality, future offer in order to inform policies to allocate kidneys at risk of discard.

*Methods: Transplant candidates and recipients were recruited through the American Association of Kidney Patients and Northwestern Comprehensive Transplant Center. They were invited via email to complete an online discrete-choice experiment (DCE). The DCE asked respondents to make choices between pairs of experimentally designed kidneys that varied in terms of graft survival, kidney function levels, and waiting time. One kidney was immediately available, while the other required 2-4 additional years of waiting time. Patient choices were analyzed using a random-parameters logit model and latent-class analysis to quantify the relative importance of kidney quality and waiting time.

*Results: A total of 605 patients completed the DCE. Respondents were willing to accept tradeoffs between expected graft survival, kidney function and waiting time. The average respondent was willing to accept a kidney today with 6.5 years of expected graft survival (95% CI: 5.9 – 7.0) in order to avoid waiting two additional years for a kidney with 11 years of expected graft survival. Three classes of patient preferences were identified. Patients had a 61%, 24% and 15% chance of being in class 1, class 2 and class 3, respectively. Patients in class 1 were more likely to have a college degree and higher functional status. Patients in class 2 were more likely to be older, identify as Black or African American, have lower education levels, have at least one previous kidney transplant, and have lower functional status. Patients in class 3 tended to be younger with no previous kidney transplant. Preference estimates for class 1 indicated a relatively even importance of kidney quality and waiting time. Estimates for class 2 indicated lower acceptance of increases in waiting time, requiring greater improvements in graft survival to accept a future kidney. Estimates for class 3 indicated a greater importance of kidney quality, with willingness to wait for future kidneys that offered relatively small improvements in graft survival.

*Conclusions: Many patients are willing to consider kidneys with lower expected graft survival in order to reduce waiting time, supporting a policy of fast tracking kidneys at risk of discard to patients lower on the waiting list.

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