Kidney allocation system may improve access to kidney transplants
The implementation of a kidney allocation system improved equity in access to kidney transplants; however, there were geographic disparities, according to results published in the American Journal of Transplantation.
“In some parts of the country, candidates can expect to wait upwards of 10 years for a kidney; while in other areas, the wait is only 2 or 3 years,” Darren E. Stewart, MS, told Healio/Nephrology. “This finding highlights the importance of present efforts to revise organ allocation policies to ensure that organs are distributed as broadly as feasible and in an equitable way.”
Stewart, along with the other authors of the paper, are part of the United Network for Organ Sharing team that manages the Kidney Allocation System.
Researchers used data from the Organ Procurement and Transplantation Network to develop the kidney allocation system which quantified the degree of disparity in access to deceased donor kidney transplants in waitlisted patients and determined factors that correlated with disparities. Researchers created Poisson rate regression models for 29 quarterly, period-prevalent groups of active kidney wait list registrations. After discounting for intentional, policy-induced disparities, researchers quantified inequity as the outlier-robust standard deviation of predicted transplant rates among registrations.
Results showed that after implementation of the system, the overall standard deviations decreased by 40% — a substantial increase in equity. Standard deviations were used to measure risk-adjusted factor-specific disparities after other factors were held constant. Across the calculated panel-reactive antibody spectrum, investigators noted a 50% reduction in disparities. The factor that correlated most with access disparities after kidney allocation system was donor service area of the candidate’s transplant hospital.
“In applying our methodology to kidney transplantation, we found that the kidney allocation system of 2014 was associated with substantially improved equity, as measured by reduced disparities among candidates on the waiting list in timely access to a deceased donor kidney transplant,” he said. “This improvement was driven largely by improved chances of receiving a kidney for very highly ‘sensitized’ candidates, who are compatible with very few donors due to pre-formed [human leukocyte antigen] HLA antibodies. – by Monica Jaramillo
Disclosure s : The authors report no relevant financial disclosures.