The effect of the National Kidney Registry on the kidney-exchange market

Abstract

We assess the causal effect of the National Kidney Registry (NKR), the largest national kidney-exchange network in the U.S., on kidney-exchange outcomes. Analyzing a unique database hosted by the Scientific Registry of Transplant Recipients (SRTR) that contains information on all kidney donors, wait-listed candidates, and transplant recipients in the U.S., we find that patients in an NKR hospital are 2.5 to 3 times more likely than their counterparts in a non-NKR hospital to receive a transplant from a living donor, conditional on wait-time. At the same time, NKR participation does not have a significant effect on the desirability of donors and the health status of recipients. We employ various approaches to ensure our finding is robust in addressing the non-random sorting of patients and donors. As far as the outcomes we study, the expansion of the NKR brings about an overall positive impact on the kidney exchange market.JEL Classification: I11, L14

Racial Equity in Living Donor Kidney Transplant Centers, 2008-2018

“…Adoption of health equity measures into core quality processes such as quality assurance and performance improvement may facilitate centers identifying policies and protocols that have unintended consequences when imprecisely applied, such as APOL1 testing and the living donor kidney evaluation algorithm, which embeds race into the equation . Participation in programs that facilitate LDKT for patients with incompatible donors, such as desensitization, NKR, and the United Network for Organ Sharing paired donation program, can reduce the burden of identifying potential donors for patients with reduced network size, but center participation is optional . It is likely that the degree of engagement in these programs has more of an impact than the binary option of in-or-out, and future work should examine how length and magnitude of exchange and donor benefit programs may improve equity in access to LDKT.…”

“… 92 , 93 , 94 Participation in programs that facilitate LDKT for patients with incompatible donors, such as desensitization, NKR, and the United Network for Organ Sharing paired donation program, can reduce the burden of identifying potential donors for patients with reduced network size, but center participation is optional. 5 , 95 , 96 , 97 , 98 , 99 It is likely that the degree of engagement in these programs has more of an impact than the binary option of in-or-out, and future work should examine how length and magnitude of exchange and donor benefit programs may improve equity in access to LDKT. Preliminary evidence also suggests that tailored programs should focus on expanding community-partnered approaches to increasing LDKT, including earlier engagement with dialysis facilities and nephrology practices.…”

“…5,[95][96][97][98][99] It is likely that the degree of engagement in these programs has more of an impact than the binary option of in-or-out, and future work should examine how length and magnitude of exchange and donor benefit programs may improve equity in access to LDKT. Preliminary evidence also suggests that tailored programs should focus on expanding community-partnered approaches to increasing LDKT, including earlier engagement with dialysis facilities and nephrology practices 60,[100][101][102][103][104][105].…”

Breaking Barriers and Bridging Gaps: Advancing Diversity, Equity, and Inclusion in Kidney Transplant Care for Black and Hispanic Patients in the United States

“…She eventually found a match, and the father went on to donate his kidney in exchange for a voucher, in case she would ever require a second KT [ 64 ]. The NKR aims to facilitate living kidney donor exchange, with data showing that patients who receive care at NKR hospitals are up to 3 times more likely to undergo LDKT [ 65 ].…”

The spatial scope of agglomeration economies in Brazil

“…While this approach is widely employed in health research (see, e.g.,Ghanbariamin & Chung, 2020;Lazuka, 2018;Stuart et al, 2009), its application in regional and urban economics is less common, despite the widespread use of nonlinear models with potentially endogenous explanatory variables, especially in studies of locational choice Terza et al (2008). andWooldridge (2014) provide a comprehensive presentation of the strategy.…”