Background: Although the Centers for Medicare and Medicaid Services require that social support be used to determine transplant eligibility, guidance is vague and centers vary in their use of social support to make listing decisions. We examined how transplant clinicians weigh the importance of social support for kidney transplantation compared to other factors, and to examine variation in perceived importance by clinical role.

Methods: Discrete choice experiments examine the relative importance of different factors for transplant decisions, clarifying differences in kidney allocation preferences among transplant clinicians. Respondents compared two hypothetical candidate profiles and were asked to allocate the kidney to one patient. Candidate profiles varied levels of: life expectancy with transplant, quality of life with transplant, time on waiting list, life expectancy without transplant, adherence, age, and social support. Respondents answered 4 scenarios generated using a fractional factorial design. The survey was fielded to a national sample of surgeons and psychosocial experts in October of 2016 using the membership lists of the American Society of Transplant Surgeons and Society for Transplant Social Workers as the sampling frame. Conditional logistic regression with effects coding was used to estimate the relative value of each attribute.

Results: The survey was completed by 302 surgeons, and 292 psychosocial workers (31.55% overall response rate). Overall, respondents were most likely to choose a transplant recipient that had social support (OR 1.68, 95% CI 1.52-1.86:), always adhered to a medical regimen (OR=1.64, 95% CI: 1.48-1.83), and had a long life expectancy with transplant (OR= 1.61, 95% CI 1.42-1.83 for 15 years with transplant). The most important factors to surgeons were life expectancy with transplant and social support, and adherence while for psychosocial experts, priority for transplant was assigned based on social support, adherence, and quality of life. Surgeons valued long life expectancy (OR=1.85, 95% CI 1.54-2.21) over social support (OR=1.79, 95% CI 1.57-2.04) when prioritizing transplant recipients.

Conclusions: Variations in the perceived importance of social support within transplant teams and between centers can result in team discordance related to listing decisions and disparate treatment for patients.

CITATION INFORMATION: Ladin K, Emerson J, Butt Z, Gordon E, Hanto D, Lavelle T. The Impact of Social Support on Kidney Transplant Listing Decisions: Results from a Discrete Choice Experiment. Am J Transplant. 2017;17 (suppl 3).

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