*PURPOSE: Percent glomerulosclerosis (GS) is highly associated with kidney non-use. Using UNOS’s offer simulator tool, SimUNet, we conducted a behavioral study on the impact of displaying both KDPI and a proof-of-concept, “GS-informed KDPI,” on acceptance of suboptimal kidneys. *METHODS: 57 kidney surgeons/nephrologists each received 16 mock offers by email through SimUNet, July 14-24, 2022. Anonymized offers were derived from 8 transplanted kidneys w/ graft survival 7+ years from Organ Procurement and Transplantation Network data. Donor ages ranged from 53 to 66; KDPI: 65% to 94%; and GS was either low (1-2%) or high (15-21%). Using a crossover design with a weekend ‘washout’ period, each offer was presented twice using a control and intervention interface. Offer acceptance rates for participants responding to both versions of the offer were analyzed using McNemar’s test. [

] *RESULTS: For 6 of the 8 donors, the intervention had no apparent effect on acceptance (p=1.0). However, with KDPI 94%, GS 16.7%, and GS-informed KDPI of 97% (donor #6), offer acceptance dropped from 70% to 50% with the intervention interface (p=0.02), as 12 participants accepted the offer with the control interface but refused with the intervention (vs. just 2 changing in the opposite direction). In a similar offer context (donor #5: GS of 20.8%, KDPI 94%; GS-informed KDPI 97%), acceptance also fell but insignificantly (45%->37%; p=0.48), while a higher % of declines were due to “biopsy results” (41%-> 53%). [

] *CONCLUSIONS: Displaying GS-informed KDPIs that declined due to a low GS did not increase acceptance of less-than-ideal kidneys, as hoped (although these offers already had very high baseline acceptance rates). For high GS kidneys, instead of tempering GS’s effect, displaying a GS-informed KDPI and noting that GS’s effect on graft survival was “incorporated into the KDPI,” had either no effect or exacerbated the risk of offer refusal. An evidence-driven approach to using GS in kidney utilization decisions is sorely needed; however, further development and behavioral testing are needed to avoid unintended negative consequences.CITATION INFORMATION: Stewart D., Toll A., Weiss S., Foutz J., Gupta G. A Behavioral Study on the Effect of Incorporating Glomerulosclerosis into the KDPI on Kidney Offer Acceptance Decisions AJT, Volume 23, Issue 6, Supplement 1.

Darren Stewart MS

NYU Langone Health

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