Reducing Unnecessary Organ Discards: Utilizing Best Case/Worst Case to Improve Conversations Regarding ‘Increased Risk’ Kidney Donors with Patients

Abstract

In 1994, to guide patients and surgeons in making informed decisions about organ transplantation and reduce transplant-mediated infectious disease transmission, the Centers for Disease Control and Prevention announced the Public Health Service guidelines for increased risk donor (IRD) organs. This classification identifies donors associated with greater risk for contracting human immunodeficiency virus, hepatitis B virus, and hepatitis C virus as increased risk donors. These donor organs are discarded at higher rates than non-IRD organs, despite equivalent patient and graft survival rates following transplantation. Biases and stigmas, as well as misunderstandings about the term “increased risk,” may contribute to the discard of these high-quality organs. Novel communication strategies regarding the risk of disease transmission from IRD organs are needed to reduce misunderstandings between patients and providers and shift the conversation from probabilities and statistics to patient-centered values and expectations. Using a standardized tool such as Best Case/Worst Case to elicit patients’ preferences and share expected outcomes of accepting versus rejecting an IRD organ has the potential to improve IRD risk communication. The purpose of this article is to elucidate the underutilization of IRD organs, through the example of a potential kidney transplantation, to demystify this complex and high-stakes decision utilizing a novel communication strategy and to propose policy changes to IRD organ management that could result in hundreds of additional lives saved each year.