{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T06:34:17Z","timestamp":1770186857635,"version":"3.49.0"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T00:00:00Z","timestamp":1770076800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R03 HS27671-01"],"award-info":[{"award-number":["R03 HS27671-01"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>\n                    In the US, Organ Procurement Organizations (OPOs) procure deceased-donor kidneys, whereas Transplant Programs (TxPs) make utilization decisions for candidates listed at their centers. For each donor, candidates are ranked in a strict priority sequence determined by the national allocation rules. Higher-ranked candidates have the right of first refusal over lower-ranked candidates. TxPs are expected to utilize kidneys based on the merits of performing a transplant for each candidate independently of other candidates. However, they frequently utilize kidneys for lower-ranked candidates. This phenomenon is called list diving. The prevalence of list diving has been documented in the literature but its impact on post-transplant outcomes has not been studied. Moreover, all of the reasons why TxPs exercise list diving are not observed in archival data. Therefore, we examine whether utilization decisions that occur either before or concurrently with multiple declines (referred to as batch turn downs) of higher-ranked candidates result in higher recipient and graft survival after accounting for treatment endogeneity. The out-of-sequence transplants identified via the time-based criterion are referred to as targeted placements (TPs). Such transplants signal TxPs\u2019 exercise of clinical judgment. We find that TPs reduce the waiting time for recipients (average time to transplant: 2.20 years for TP recipients vs. 2.64 years for non-targeted recipients,\n                    <jats:italic>p<\/jats:italic>\n                    \u2013value &lt; 0.01) while lengthening it for skipped candidates (average wait time until the first offer: 1.64 years for skipped candidates vs. 1.37 years for non-skipped candidates,\n                    <jats:italic>p<\/jats:italic>\n                    \u2013value &lt; 0.01). However, TPs do not significantly improve the survival chances of recipients in aggregate, despite the shortened waiting time. Concurrently, TPs prolong skipped candidates\u2019 waiting time and the extra wait does not improve survival chances of those among them who eventually receive transplants.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0333222","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T18:34:55Z","timestamp":1770143695000},"page":"e0333222","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["The impact of simultaneous batch turn downs and targeted kidney utilization decisions on patient survival"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4716-2504","authenticated-orcid":true,"given":"Diwakar","family":"Gupta","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7607-9590","authenticated-orcid":true,"given":"Jingyao","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paola","family":"Martin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,2,3]]},"reference":[{"issue":"6","key":"pone.0333222.ref001","article-title":"Characterization of transplant center decisions to allocate kidneys to candidates with lower waiting list priority","volume":"6","author":"KL King","year":"2023","journal-title":"JAMA Netw Open."},{"issue":"1","key":"pone.0333222.ref002","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/nav.21924","article-title":"A critical look at the U.S. deceased-donor organ procurement and utilization system","volume":"68","author":"OC Ersoy","year":"2020","journal-title":"Naval Research Logistics."},{"key":"pone.0333222.ref003","unstructured":"eCFR. 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Organ procurement organization (OPO) conditions for coverage final rule: revisions to outcome measures for OPOs. 2020."},{"issue":"3","key":"pone.0333222.ref028","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1053\/j.ajkd.2010.10.054","article-title":"The relationship between kidney function and long-term graft survival after kidney transplant","volume":"57","year":"2011","journal-title":"American Journal of Kidney Diseases."}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333222","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T18:35:06Z","timestamp":1770143706000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333222"}},"subtitle":[],"editor":[{"given":"Amelia J.","family":"Hessheimer","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,2,3]]},"references-count":28,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,3]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0333222","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,3]]}}}