Deciding Eligibility for Transplantation When a Donor Kidney Becomes Available

Abstract

The expectation of transplant success for some patient/donor-kidney matches can be so low that transplantation is not considered an option. The issue may be framed as deciding the minimum expectation of transplant success that would justify a patient's eligibility for transplantation with an available donor kidney. If the minimum is set too high, the patient will be eligible for very few donor kidneys and will wait excessively for transplantation. If the minimum is set too low, the patient has a greater risk of graft failure once transplantation has been done. A decision model calculates the minimum predicted one-year graft survival rate that would determine eligibility for an available donor kidney, with the goal of maximizing quality-adjusted life expectancy. The minimum predicted one-year graft survival rate depends on the patient's health and demographic characteristics and attitudes about quality of life with kidney-replacement therapies. Graft survival rates and quality-adjusted life expectancies may increase by as much 6.7% and 1.6 months, respectively, with only a slight increase (<0.4 months) in the quality-adjusted waiting time until transplantation. Key words: transplantation; health services research; decision analyses; rationing. (Med Decis Making 1997;17: 160-170)