Diagnostic Thresholds, Written Consent Requirements, and the Utilization of Scarce Organs
中文摘要
本文探讨诊断阈值和书面同意要求如何影响患者与移植外科医生之间就使用逝世捐献者肾脏所作的决策。结合覆盖美国全部器官捐献者和移植受者的行政数据，我们发现，在2002年末至2014年末实施的扩大标准捐献者（ECD）制度下，基于年龄的断点导致其他方面无法区分的肾脏在弃用率上分别出现4.0个和5.4个百分点的差异。随后引入的肾脏捐献者概况指数（KDPI）呈现方式中的一个断点导致弃用率产生2.6个百分点的差异。我们提供的证据表明，诊断阈值对决策制定和信息获取具有微妙而复杂的影响；例如，在ECD制度基于年龄的断点处，获取器官时的活检率大幅上升。我们进一步表明，ECD和KDPI标签体系所触发的书面同意要求，大幅减少了肾脏在被弃用前提供给潜在受者的数量。这一渠道可以解释现行制度下“高KDPI”肾脏弃用率上升的大部分原因。
Abstract
This paper explores how diagnostic thresholds and a written consent requirement affect decision making between patients and transplant surgeons regarding the use of deceased donor kidneys. Combining administrative data on the universe of organ donors and transplant recipients in the United States, we show that age-based discontinuities within the Expanded Criteria Donor system (ECD), which was in place from late 2002 to late 2014, led to 4.0 and 5.4 percentage point differences in the rates at which otherwise indistinguishable kidneys were discarded. A discontinuity within the subsequent presentation of the Kidney Donor Profile Index (KDPI) led to a 2.6 percentage point difference. We present evidence that diagnostic thresholds have nuanced effects on decision making and information acquisition; procurement biopsy rates, for example, rose substantially at the ECD system’s age-based discontinuities. We further show that written consent requirements triggered within the ECD and KDPI labeling systems substantially reduced the number of potential recipients to whom kidneys were offered prior to being discarded. This channel can explain the majority of the increased rate at which “High-KDPI” kidneys are discarded under the current system.