Personalized Risk Prediction Tool for Deceased Donor Kidney Offers: Stakeholder Perspectives from a Qualitative Study

Background and Hypothesis: Kidney transplant (KT) candidates in the United States face prolonged wait times, while deceased donor kidney (DDK) discard rates continue to rise. Existing tools such as the Kidney Donor Profile Index (KDPI) provide largely population level risk estimates and have limited utility for individualized decision making at the time of an offer. We sought stakeholder input on the content, design, and implementation of a prototype web based Kidney Risk Calculator intended to support patient centered decision making during DDK offer evaluation. We hypothesized that patients and providers would view risk and benefit estimates of KT outcomes, individualized to a donor recipient pair, as a useful aid for kidney offer decisions. Methods: We conducted a qualitative study using focus groups and individual interviews with transplant stakeholders at a single transplant center. Participants included transplant candidates, a patient advocate, transplant coordinators, and transplant physicians. Semi structured sessions included a live demonstration of the prototype app, after which participants provided feedback regarding usability, interpretability, contextual information needs, perceived clinical utility, and anticipated barriers and facilitators. Sessions were recorded, transcribed, and analyzed using inductive reflexive thematic analysis. Results: Stakeholders viewed individualized outcome projections as a helpful adjunct to clinical judgment, particularly for higher risk offers. Key design priorities included: (1) educational content on hepatitis C virus, Public Health Service risk criteria, calculated panel reactive antibody (cPRA), and dialysis versus transplant trade offs; (2) plain language narratives, simple visuals, minimal use of acronyms, U.S. customary units, and stepwise user input; and (3) alignment with time sensitive, phone based donor offer workflows and variable levels of digital access. Conclusions: Stakeholders highlighted the importance of combining individualized outcome predictions with accessible risk communication and integration into existing clinical workflows. These findings can inform the design, implementation, and evaluation of decision-support tools for kidney offer discussions.