A Kidney Transplant Support System for Patient-Clinician Shared Decision-Making.

Abstract

An optimal deceased donor allocation program requires a fair, ethical, and transparent algorithm to ensure efficient and effective allocation of deceased donor kidneys to recipients that will benefit most, by maximizing utility of the donor organs, but at the same time, ensuring all potential candidates have equitable access and equal opportunity to this scarce resource. In response to the increasing demand and the limited availability of donor organs, there has been a global concerted effort to increase the use of less optimal donor kidneys in suitable recipients. During this complex allocation process, organ acceptance decision-making is the final step. Transplant nephrologists are typically the gatekeeper of this process and make the ultimate decision regarding organ suitability for the intended patients. However, with considerable evidence suggesting the value of shared decision making, engaging patients, caregivers and their primary nephrologists prior to accepting the allocated organ, ensures the healthcare decisions align with the patients' values and their preferences. To tackle this challenge, we developed a visualisation guided simulation-based tool to assist shared decision-making. We have shown that the three-dimensional clinical information required for organ acceptance can be represented using an intuitive and user-friendly interface. By utilizing our published allocation simulation process, simKAP, this decision support system called Kidney Transplant Support System has the capacity to forecast a sequence of potential kidneys offered to a candidate on the waiting list, with the provision of estimated waiting time, donor quality and the expected post-transplant patient survivals for each consecutive offer. Implementation of this tool may inform shared decision-making and reduce organ discards.