Comparative Evaluation of Machine Learning Models for Predicting Donor Kidney Discard

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Main Authors: Schliephacke, Peer, Schult, Hannah, Mizera, Leon, Würfel, Judith, Grieser, Gunter, Rahmel, Axel, Fischer-Fröhlich, Carl-Ludwig, Jahn-Eimermacher, Antje
Format: Preprint
Published: 2026
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author Schliephacke, Peer
Schult, Hannah
Mizera, Leon
Würfel, Judith
Grieser, Gunter
Rahmel, Axel
Fischer-Fröhlich, Carl-Ludwig
Jahn-Eimermacher, Antje
author_facet Schliephacke, Peer
Schult, Hannah
Mizera, Leon
Würfel, Judith
Grieser, Gunter
Rahmel, Axel
Fischer-Fröhlich, Carl-Ludwig
Jahn-Eimermacher, Antje
contents A kidney transplant can improve the life expectancy and quality of life of patients with end-stage renal failure. Even more patients could be helped with a transplant if the rate of kidneys that are discarded and not transplanted could be reduced. Machine learning (ML) can support decision-making in this context by early identification of donor organs at high risk of discard, for instance to enable timely interventions to improve organ utilization such as rescue allocation. Although various ML models have been applied, their results are difficult to compare due to heterogenous datasets and differences in feature engineering and evaluation strategies. This study aims to provide a systematic and reproducible comparison of ML models for donor kidney discard prediction. We trained five commonly used ML models: Logistic Regression, Decision Tree, Random Forest, Gradient Boosting, and Deep Learning along with an ensemble model on data from 4,080 deceased donors (death determined by neurologic criteria) in Germany. A unified benchmarking framework was implemented, including standardized feature engineering and selection, and Bayesian hyperparameter optimization. Model performance was assessed for discrimination (MCC, AUC, F1), calibration (Brier score), and explainability (SHAP). The ensemble achieved the highest discrimination performance (MCC=0.76, AUC=0.87, F1=0.90), while individual models such as Logistic Regression, Random Forest, and Deep Learning performed comparably and better than Decision Trees. Platt scaling improved calibration for tree-and neural network-based models. SHAP consistently identified donor age and renal markers as dominant predictors across models, reflecting clinical plausibility. This study demonstrates that consistent data preprocessing, feature selection, and evaluation can be more decisive for predictive success than the choice of the ML algorithm.
format Preprint
id arxiv_https___arxiv_org_abs_2602_21876
institution arXiv
publishDate 2026
record_format arxiv
spellingShingle Comparative Evaluation of Machine Learning Models for Predicting Donor Kidney Discard
Schliephacke, Peer
Schult, Hannah
Mizera, Leon
Würfel, Judith
Grieser, Gunter
Rahmel, Axel
Fischer-Fröhlich, Carl-Ludwig
Jahn-Eimermacher, Antje
Applications
A kidney transplant can improve the life expectancy and quality of life of patients with end-stage renal failure. Even more patients could be helped with a transplant if the rate of kidneys that are discarded and not transplanted could be reduced. Machine learning (ML) can support decision-making in this context by early identification of donor organs at high risk of discard, for instance to enable timely interventions to improve organ utilization such as rescue allocation. Although various ML models have been applied, their results are difficult to compare due to heterogenous datasets and differences in feature engineering and evaluation strategies. This study aims to provide a systematic and reproducible comparison of ML models for donor kidney discard prediction. We trained five commonly used ML models: Logistic Regression, Decision Tree, Random Forest, Gradient Boosting, and Deep Learning along with an ensemble model on data from 4,080 deceased donors (death determined by neurologic criteria) in Germany. A unified benchmarking framework was implemented, including standardized feature engineering and selection, and Bayesian hyperparameter optimization. Model performance was assessed for discrimination (MCC, AUC, F1), calibration (Brier score), and explainability (SHAP). The ensemble achieved the highest discrimination performance (MCC=0.76, AUC=0.87, F1=0.90), while individual models such as Logistic Regression, Random Forest, and Deep Learning performed comparably and better than Decision Trees. Platt scaling improved calibration for tree-and neural network-based models. SHAP consistently identified donor age and renal markers as dominant predictors across models, reflecting clinical plausibility. This study demonstrates that consistent data preprocessing, feature selection, and evaluation can be more decisive for predictive success than the choice of the ML algorithm.
title Comparative Evaluation of Machine Learning Models for Predicting Donor Kidney Discard
topic Applications
url https://arxiv.org/abs/2602.21876