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Purpose: AI models for kidney transplant acceptance must be rigorously evaluated for bias to ensure equitable healthcare access. This study investigates demographic and clinical biases in the Final Acceptance Model (FAM), a donor-recipient matching deep learning model that complements surgeons’ decision-making process in predicting whether to accept available kidneys for their patients with end of stage renal disorder. Methods: AI models for kidney transplant acceptance must be rigorously evaluated for bias to ensure equitable healthcare access. This study investigates demographic and clinical biases in the Final Acceptance Model (FAM), a donor-recipient matching deep learning model that complements surgeons’ decision-making process in predicting whether to accept available kidneys for their patients with end of stage renal disorder. Results: There is no significant racial bias in the model’s predictions (p=1.0), indicating consistent outcome across all racial combinations between donors and recipients. Gender-related effects as shown in Figure 1, while statistically significant (p=0.008), showed minimal practical impact with mean differences below 1% in prediction probabilities. Significant difference Clinical factors involving diabetes and hypertension showed significant difference (p=4.21e-19). The combined presence of diabetes and hypertension in donors showed the largest effect on predictions (mean difference up to -0.0173, p<0.05), followed by diabetes-only conditions in donors (mean difference up to -0.0166, p<0.05). These variations in clinical factor predictions showed bias against groups with comorbidities. Conclusions: The biases observed in the model highlight the need to improve the algorithm to ensure absolute fairness in prediction.more » « lessFree, publicly-accessible full text available August 1, 2026
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