Racial Disparities in Access to Pediatric Kidney Transplantation Since Share 35

Abstract

Share 35 was enacted in 2005 to shorten transplant wait times and provide high-quality donors to children with ESRD. To investigate the possible effect of this policy on racial disparities in access to pediatric transplantation, we analyzed data from the US Renal Data System before and after Share 35. Among 4766 pediatric patients with incident ESRD, the probability of receiving a deceased-donor kidney transplant increased 46% after Share 35, with Hispanics experiencing the greatest improvements (increases of 81% for Hispanics, 45% for blacks, and 37% for whites). On average, patients received a deceased-donor kidney transplant earlier after Share 35, but this finding varied by race: 63 days earlier for whites, 90 days earlier for blacks, and 201 days earlier for Hispanics. Furthermore, a shift from living-to deceased-donor sources occurred with Share 35 for all races, with a 25% reduction in living donors for whites compared with 48% and 46% reductions for Hispanics and blacks, respectively. In summary, Share 35 seems to have attenuated racial disparities in the time to and probability of children receiving a deceased-donor kidney transplant. These changes coincided with changes in the rates of living-donor sources, which vary by race. Future studies should explore how these changes may impact racial differences in long-term graft outcomes.

Geographic Determinants of Access to Pediatric Deceased Donor Kidney Transplantation

“…Although Share 35 reduced overall DDKT waiting times for children, the policy did not necessarily improve equitable access nor did it address geographic disparities. 17 Two specific strategies could now be considered. First, the OPTN could alter how organs are geographically distributed.…”

Renal transplantation in infants

“…In the US, the current allocation policy for children (Share35) emphasizes the importance of young donors (<35 years old) and shorter waiting times over HLA-matching [19]. This algorithm has shortened the waiting times but increased mismatches, so that 84 % of transplants to children are mismatched at 4-6 alleles (A,B,DR loci) [20]. A poor match in the first graft also impairs the chances for the second graft, which is important in infant RTx, as these patients inevitably need another graft later in life [21].…”

Population Income and Longitudinal Trends in Living Kidney Donation in the United States

“…The decline in parental donations may be partly attributed to changes in organ allocation policy that made it easier for pediatric patients with renal failure to obtain a deceased-donor transplant. 17 The number of adult children donating to their parents has declined since 2006, 6 which may reflect reluctance among older patients with ESRD to accept donations from their children or a shift in clinical practice away from acceptance of younger potential donors. 6 Spousal donation was largely stable during the study period.…”