# Examining Transparency in Kidney Transplant Recipient Selection Criteria: Nationwide Cross-Sectional Study

## TL;DR

This study finds that most US kidney transplant centers do not clearly share patient selection criteria online, limiting patient choice and transparency.

## Contribution

The study uses natural language processing and a large language model to quantify the transparency of kidney transplant selection criteria across US centers.

## Key findings

- Only 2.6% of guideline-recommended kidney transplant recipient selection criteria were found on center websites.
- Socioeconomic and behavioral criteria were more frequently mentioned than medical or comorbidity-related criteria.
- 45.2% of the 31 selection criteria were not mentioned on any website, with geographic disparities observed.

## Abstract

Choosing a transplant program impacts a patient’s likelihood of receiving a kidney transplant. Most patients are unaware of the factors influencing their candidacy. As patients increasingly rely on online resources for health care decisions, this study quantifies the available online patient-level information on kidney transplant recipient (KTR) selection criteria across US kidney transplant centers.

We aimed to use natural language processing and a large language model to quantify the available online patient-level information regarding the guideline-recommended KTR selection criteria reported by US transplant centers.

A cross-sectional study using natural language processing and a large language model was conducted to review the websites of US kidney transplant centers from June to August 2024. Links were explored up to 3 levels deep, and information on 31 guideline-recommended KTR selection criteria was collected from each transplant center.

A total of 255 US kidney transplant centers were analyzed, comprising 10,508 web pages and 9,113,753 words. Among the kidney transplant guideline–recommended KTR selection criteria, only 2.6% (206/7905) of the information was present on the transplant center web pages. Socioeconomic and behavioral criteria were mentioned more than those related to the patient’s medical conditions and comorbidities. Of the 31 criteria, finances and health insurance was the most frequently mentioned, appearing in 25.5% (65/255) of the transplant centers. Other socioeconomic and behavioral criteria, such as family and social support systems, adherence, and psychosocial assessment, were addressed in less than 4% (9/255) of the transplant centers. No information was found on any web page for 45.2% (14/31) of the KTR selection criteria. Geographically, disparities in reporting were observed, with the South Atlantic division showing the highest number of distinct criteria, while New England had the fewest.

Most transplant center websites do not disclose patient-level KTR selection criteria online. The lack of transparency in the evaluation and listing process for kidney transplantation may limit patients in choosing their most suitable transplant center and successfully receiving a kidney transplant.