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Potential Impact of Risk and Loss Aversion on the Process of Accepting Kidneys for Transplantation

Heilman, Raymond L. MD1; Green, Ellen P. PhD2; Reddy, Kunam S. MBBS3; Moss, Adyr MD3; Kaplan, Bruce MD1

doi: 10.1097/TP.0000000000001715

Behavioral economic theory suggests that people make decisions based on maximizing perceived value; however, this may be influenced more by the risk of loss rather than of potential gain. Additionally, individuals may seek certainty over uncertainty. These are termed loss aversion and risk aversion, respectively. Loss aversion is particularly sensitive to how the decision is “framed.” Thus, labeling a kidney as high Kidney Donor Profile Index results in higher discard rates because this creates a nonlinearity in perceived risk. There is also evidence that the perceived loss due to regulatory sanction results in increased organ discard rates. This may be due to the overuse of terminology that stresses regulatory sanctions and thus perpetuates fear of loss through a form of nudging. Our goal is to point out how these concepts of behavioral economics may negatively influence the decision process to accept these suboptimal organs. We hope to make the community more aware of these powerful psychological influences and thus potentially increase the utilization of these suboptimal organs. Further, we would urge regulatory bodies to avoid utilizing strategies that frame outcomes in terms of loss due to flagging and build models that are less prone to uncertain expected versus observed outcomes.

1 Department of Medicine, Mayo Clinic, Phoenix, AZ.

2 School for the Science of Health Care Delivery, Arizona State University, Tempe, AZ.

3 Department of Surgery, Mayo Clinic, Phoenix, AZ.

Received 9 December 2016. Revision received 27 December 2016.

Accepted 5 January 2017.

The authors declare no funding or conflicts of interest.

Correspondence: Raymond L. Heilman, MD, Department of Medicine, Mayo Clinic, Phoenix, AZ. (

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