Underutilization of marginal-quality kidney-organs for transplantation has occupied the community and led to introducing the idea of expediting the placement of kidneys for populations at increased risk of not receiving a transplant. Although well-intended, such policies can be less efficacious for specific individuals and should be scrutinized until the decision-making for accepting marginal-quality organs, which heretofore has relied on experiential judgment, is better understood at the individual-level. We develop an individualized, clinically-relevant computational methodology, based on decision trees, that analyzes the patient's dilemma: to accept an offer for a marginal-quality organ now or reject that offer. Two quantities of interest are calculated: the survival-benefit of accepting an organ of given KDPI now and the survival-benefit of rejecting that offer. Valuations of the latter are contingent on future opportunities and subject to uncertainty in the timing of successive offers and the quality and characteristics of donors. The methodology accounts for this uncertainty and calculates these values while adjusting for patient demographics; clinical factors including comorbidities and sensitization; donor characteristics; and also characteristics of transplant centers and organ procurement organizations. Analyses are demonstrated for a realistic patient profile. Deployment of the methodology would aid decision-making and identification of candidates for expedited placements.

CITATION INFORMATION: Mehrotra S., Gordon H., Bui K., Friedewald J., Ladner D., Kaplan B., Kilambi V. Evaluation of Accepting Kidneys of Varying Quality for Transplantation or Expedited Placement with Decision Trees Am J Transplant. 2017;17 (suppl 3).

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