Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, NY, USA.
The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA.
Clin Transplant. 2021 Jun;35(6):e14284. doi: 10.1111/ctr.14284. Epub 2021 Mar 25.
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.
认知偏差会影响医学决策，包括左位数偏差，即人们倾向于关注连续变量的最左边数字。我们假设左位数偏差会通过启发式处理供体年龄和肌酐来影响已故供体肾脏的利用。我们使用美国注册数据确定了 87019 个回收的肾脏（2015-2019 年），并比较了供体年龄（69 岁与 70 岁）和肌酐（1.9mg/dl 与 2.0mg/dl）阈值周围的比例，然后比较了肾脏废弃的风险。与 69 岁的供体相比，70 岁的供体的肾脏更频繁地被废弃（77%比 65%，p<0.001），即使在调整了 KDRI 后，废弃的风险仍然更高（调整后的 RR 1.11，95%CI 1.02-1.21，p=0.018）。同样，与肌酐为 1.9mg/dl 的供体相比，肌酐为 2.0mg/dl 的供体的肾脏更频繁地被废弃（37%比 29%，p<0.001），即使在调整了 KDRI 后，废弃的风险仍然更高（调整后的 RR 1.19，95%CI 1.07-1.33，p=0.001）。然而，当检查其他供体年龄（39/40、49/50、59/60 岁）或肌酐（0.9/1.0、2.9/3.0mg/dl）阈值时，并未发现明显的左位数效应。这些发现表明，在特定阈值下，可能存在影响肾脏利用的左位数效应。需要进一步研究这种启发式和其他启发式对器官利用的影响，以确定潜在的决策干预领域，旨在减少肾脏废弃。
