Selection bias in reporting of median waiting times in organ transplantation

Median organ waiting times published by transplant organizations around the world may be biased when death or censoring is disregarded. This can lead to too optimistic waiting times for all organ waiting lists, but most strikingly in kidney transplantation, and as a consequence, may deceive patients on the waiting list, transplant physicians, and healthcare policy maker. In this cohort study of all trans-plant candidates in Switzerland, we use competing risk multistate models for the analysis of time-to-event data of the organ waiting list. The resulting cumulative incidences are probabilities for transplantation or death by a given time are a more accurate description of the events occurring on the waiting list. In accordance with the concept of median survival time in survival analysis in clinical trials, we suggest the median time to transplantation (MTT), the waiting time duration at which the transplant probability is 0.50, as a measure of average waiting time. Summary points ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Ethics Committee of the Canton of Bern granted an exemption from requiring ethics approval (KEK Bern; 2023-01371). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The database used are owned by the Federal Office of Public Health (FOPH), Switzerland, which establishes the requirements for their access and use.