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. 2021 Jun;35(6):e14284.
doi: 10.1111/ctr.14284. Epub 2021 Mar 25.

Left-digit bias and deceased donor kidney utilization

S Ali Husain  1   2 , Kristen L King  1   2 , Sumit Mohan  1   2   3
Affiliations

Left-digit bias and deceased donor kidney utilization

S Ali Husain et al. Clin Transplant. 2021 Jun.

Abstract

Cognitive biases shown to impact medical decision-making include left-digit bias, the tendency to focus on a continuous variable's leftmost digit. We hypothesized that left-digit bias impacts deceased donor kidney utilization through heuristic processing of donor age and creatinine. We used US registry data to identify 87 019 kidneys recovered (2015-2019) and compared the proportion around thresholds for donor age (69 vs. 70 years) and creatinine (1.9 vs. 2.0 mg/dl), then compared the risk of kidney discard. Kidneys from donors aged 70 vs. 69 years were more frequently discarded (77% vs. 65%, p < .001), with higher risk of discard even after adjusting for KDRI (adjusted RR 1.11, 95% CI 1.02-1.21, p = .018). Similarly, kidneys from donors with final creatinine 2.0 vs. 1.9 mg/dl were more frequently discarded (37% vs. 29%, p < .001), with higher risk of discard after adjusting for KDRI (adjusted RR 1.19, 95% CI 1.07-1.33, p = .001). However, no significant left-digit effect was found when examining other donor age (39/40, 49/50, 59/60 years) or creatinine (0.9/1.0, 2.9/3.0 mg/dl) thresholds. The findings suggest a possible left-digit effect affecting kidney utilization at specific thresholds. Additional investigations of the impact of this and other heuristics on organ utilization are needed to identify potential areas for decision-making interventions aimed at reducing kidney discard.

Keywords: cognitive heuristics; decision-making; kidney donor; kidney transplantation; organ utilization.

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Conflict of interest statement

Disclosures

The authors declare that they have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Proportion of deceased donor kidneys recovered for transplant in the United States (2015–2019) and subsequently discarded, by donor age and final creatinine. Consistent with the presence of a left-digit bias impacting organ utilization, kidneys from donors age 70 years were significantly more likely to be discarded than those from donors age 69 years, as were kidneys from donors with creatinine 2.0 mg/dL compared to those from donors with creatinine 1.9 mg/dL.
See this image and copyright information in PMC

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