Patients with end-stage renal disease have two treatment options: dialysis or a kidney transplant but because donor kidneys are scarce and wait times are long, most will need to start dialysis while they remain on the transplant list.
Research from Arizona State University aims to better understand the differences in the decision-making process among clinicians about whether to accept or reject a donor kidney.
Ellen Green, associate professor of health solutions at Arizona State University, the study's principal investigator, said candidates are matched with an organ donor through the nonprofit United Network for Organ Sharing and once matches are made, they are sent out to clinics where patients with end-stage renal disease are on waiting lists.
Green and her co-investigators want to determine if an individual clinician's willingness plays a role in accepting or rejecting a kidney donation.
"In this initial study, we don't know whether or not this is a good thing or a bad thing," Green observed. "It could be that the variability is demonstrating that some clinicians are pushing the envelope while other clinicians are learning and have resources to deal with certain types of transplants that maybe are higher risk."
There are about 90,000 people in the U.S. that are waiting for a kidney transplant, and 11 people die every day in that wait, according to UNOS. Studies show while many kidney donations are deemed viable, almost 30% are declined for transplantation despite strong demand. In Arizona, 730 kidney transplants were completed in 2024, according to the Organ Procurement and Transplantation Network.
As an economist, Green noted it is a challenge to understand how a system which is not driven by price operates. She acknowledged while their study looks to learn more about clinicians' willingness, she understands other variables can affect the decision-making process.
She hopes her work will help increase the availability of donated kidneys.
"What we want to better understand is, from a clinician-to-clinician perspective, is there something that we can do or better understand about this decision-making process that we can leverage to increase those chances," Green emphasized.
Green pointed out understanding individual decision-making is something flying under the radar and argued it needs to be incorporated into current models, otherwise opportunities to have successful kidney transplants could be negatively affected.