Designing
Behavior.
Increasing transplant referrals and broadening perceived kidney options through behavioral design.
- Challenge
- Increase referrals from dialysis centers to transplant centers, and change the pattern of surgeons declining viable kidneys. Every discarded kidney was a patient on dialysis waiting another year. The work was designing around the biases driving the decisions, not just the decisions themselves.
- My Role
- Business Designer. Owned the Change Package of 68 best-practice initiatives, led patient and clinician user interviews, built the metrics and data visualizations behind the digital tools, and guided implementation in dialysis centers.
- Team Structure
- Service Design Lead, Business Designer (me), Visual Designer, Project Manager. A healthcare client as the sponsor.
- Impact
- Two shipped products — a patient booklet now in dialysis center waiting rooms and a Change Package of 68 best-practice initiatives for dialysis centers nationwide. The behavioral framework reshaped how both patient-facing education and clinician decision-support tools were designed across the client’s ecosystem.
Overview
End-stage renal disease is a design problem disguised as a medical one. Transplants give
patients longer lives and better outcomes than years of dialysis, but the system that moves
patients from waitlist to transplant is held together by human judgment calls — surgeons
weighing risk, patients weighing hope, both working under cognitive load that quietly shapes
which kidneys get accepted and which get discarded.
A healthcare client came to Fjord with two asks. A motivational booklet to help more dialysis
patients see transplant as a path they could take. A Change Package to help dialysis centers
increase patient motivation around High-KDPI kidneys, the ones most often passed over.
The frame I brought in: this project wasn’t about education or communication. It was about
bias. If we could name the specific biases shaping decisions at each point in the journey, we
could design around them — upstream for patients, downstream for clinicians, structurally
for the system.
The problem
Transplants give patients longer lives
and better outcomes than years of
dialysis, and the system has the kidneys
to do it — nearly 20,000 recovered from
deceased donors every year. But almost
20% of those kidneys are discarded
instead of transplanted, and 11 people a
day die waiting for the ones that are.
And with a hundred thousand patients
already waiting for a kidney, the demand
continuously outpaces the supply.
Because of this, eleven people die
every day waiting for a kidney transplant
in the United States. To make matters
worse, of all donated kidneys, about 19%
are discarded instead of transplanted
into patients.
Mapping the full journey
The first drop-off is medically binary — a kidney either matches basic criteria or it doesn’t. The design opportunity is upstream of the drop-off: accelerating how the clinical information gets captured and how fast it reaches the decision-makers downstream.
The waitlist ping-pong
A kidney moves down the waitlist, offered to one transplant center after another. Communication and logistics consume critical time, increasing the chance that a viable kidney is ultimately discarded.
Drop-off at the patient offer
Patients wanted more say in which kidneys worked for them, but were often unprepared for the cognitive load and complexity of the offer. Many defaulted to rejection, optimistic that a better kidney would arrive soon.
Changing the bias behavior
upstream increased the number
of viable kidneys available for
patients to accept.
OPTIMISM BIAS
The tendency to be overly optimistic and underestimate the probability of undesired outcomes. “There will be a better kidney offer tomorrow.”
Upstream design
Ethnographic interviews with patients
and families became five user stories
built to meet patients where their
biases actually lived. Journeys in their
own words, quotes they’d recognize,
take-away advice, and a “life after
transplant” section built to make the
possibility feel real rather than abstract.
Transplant terminology got rewritten in
the way patients actually talk. High-KDPI
kidneys got reframed as the ones that
could get someone off dialysis sooner.
The booklet lives where patients spend
four hours every other day — the waiting
room distributed itself.
Risk aversion plays a major role in
shaping how organ offer decision-
makers (typically transplant surgeons)
view kidney offers. Surgeons don't want
to transplant a kidney they believe
could put their patient or transplant
program at risk: these risks seem more
temporally powerful than the patient's
long-term gains. Cognitive burden
among surgeons is also evident; while
the organ allocation technology
provides clinical information on the
organ donor, the surgeon must use their
best clinical judgment to compare that
data to the clinical characteristics of
their patient. We designed a tool to
alleviate these biases and cognitive
load through data visualization and
transparency.
Decision point design
We built solutions across the ecosystem so that more kidneys were accepted across the process
Outcomes
The work also increased understanding of KDPI, established transplant as a natural next step, and increased education efforts for advocacy.
65%
Increased speed of decisions
48%
Increased kidney acceptance rate
25%
Increased acceptance of high risk kidneys
