The Extent and Predictors of Waiting Time Geographic Disparity in Kidney Transplantation in the United States

Davis, Ashley E.; Mehrotra, Sanjay; McElroy, Lisa M.; Friedewald, John; Skaro, Anton I.; Lapin, Brittany; Kang, Raymond; Holl, Jane L.; Abécassis, Michaël; Ladner, Daniela P.

doi:10.1097/01.tp.0000438623.89310.dc

Cited by 52 publications

(45 citation statements)

References 28 publications

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“…In more refined and sophisticated analyses, others have shown considerable geographic variability in LDKT rate by state and region, as well as population density, even after controlling for such factors as age, race/ethnicity, sex, and medical factors (6,58). In addition, adults residing greater distances from a transplant center and who are wait-listed in regions with shorter deceased donor waiting times are less likely to receive a LDKT (6,59). Moreover, patients have a higher likelihood of receiving a LDKT if they are referred to a transplant center that uses more unrelated living donors and that have active strategies for overcoming donor-recipient incompatibility (e.g., paired kidney donation, desensitization protocols) (60).…”

Section: Geographymentioning

confidence: 99%

Living Donor Kidney Transplantation

Rodrigue

Kazley

Mandelbrot

et al. 2015

Clinical Journal of the American Society of Nephrology

106

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Despite its superior outcomes relative to chronic dialysis and deceased donor kidney transplantation, live donor kidney transplantation (LDKT) is less likely to occur in minorities, older adults, and poor patients than in those who are white, younger, and have higher household income. In addition, there is considerable geographic variability in LDKT rates. Concomitantly, in recent years, the rate of living kidney donation (LKD) has stopped increasing and is declining, after decades of consistent growth. Particularly noteworthy is the decline in LKD among black, younger, male, and lower-income adults. The Live Donor Community of Practice within the American Society of Transplantation, with financial support from 10 other organizations, held a Consensus Conference on Best Practices in Live Kidney Donation in June 2014. The purpose of this meeting was to identify LKD best practices and knowledge gaps that might influence LDKT, with a focus on patient and donor education, evaluation efficiencies, disparities, and systemic barriers to LKD. In this article, we discuss trends in LDKT/LKD and emerging novel strategies for attenuating disparities, and we offer specific recommendations for future clinical practice, education, research, and policy from the Consensus Conference Workgroup focused on disparities.

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Section: Geographymentioning

confidence: 99%

Living Donor Kidney Transplantation

Rodrigue

Kazley

Mandelbrot

et al. 2015

Clinical Journal of the American Society of Nephrology

106

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“…In 2011, nearly 17,000 kidney transplants were performed in the United States, but 94,000 patients remained on the waiting list (1,2). This discrepancy has led to an increase in waiting time to kidney transplantation from 3.3 years in 2000 to 4.72 years by 2009, increasing the cumulative time on dialysis and the mortality rate while awaiting a transplant (3)(4)(5). Furthermore, there is disparity in waiting time for a kidney transplant depending on where a patient is located geographically.…”

Section: Introductionmentioning

confidence: 99%

The Effect of the Statewide Sharing Variance on Geographic Disparity in Kidney Transplantation in the United States

Davis¹,

Mehrotra²,

Kilambi

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives The Statewide Sharing variance to the national kidney allocation policy allocates kidneys not used within the procuring donor service area (DSA), first within the state, before the kidneys are offered regionally and nationally. Tennessee and Florida implemented this variance. Known geographic differences exist between the 58 DSAs, in direct violation of the Final Rule stipulated by the US Department of Health and Human Services. This study examined the effect of Statewide Sharing on geographic allocation disparity over time between DSAs within Tennessee and Florida and compared them with geographic disparity between the DSAs within a state for all states with more than one DSA (California, New York, North Carolina, Ohio, Pennsylvania, Texas, and Wisconsin).Design, setting, participants, & measurements A retrospective analysis from 1987 to 2009 was conducted using Organ Procurement and Transplant Network data. Five previously used indicators for geographic allocation disparity were applied: deceased-donor kidney transplant rates, waiting time to transplantation, cumulative dialysis time at transplantation, 5-year graft survival, and cold ischemic time.Results Transplant rates, waiting time, dialysis time, and graft survival varied greatly between deceased-donor kidney recipients in DSAs in all states in 1987. After implementation of Statewide Sharing in 1992, disparity indicators decreased by 41%, 36%, 31%, and 9%, respectively, in Tennessee and by 28%, 62%, 34%, and 19%, respectively in Florida, such that the geographic allocation disparity in Tennessee and Florida almost completely disappeared. Statewide kidney allocations incurred 7.5 and 5 fewer hours of cold ischemic time in Tennessee and Florida, respectively. Geographic disparity between DSAs in all the other states worsened or improved to a lesser degree.Conclusions As sweeping changes to the kidney allocation system are being discussed to alleviate geographic disparity-changes that are untested run the risk of unintended consequences-more limited changes, such as Statewide Sharing, should be further studied and considered.

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“…However, another study carried out in the same area showed that journalism students have a less favorable attitude [9]. The number of living donations in Spain increases very slightly, despite the higher success rate of living vs deceased organ transplantations [11], a fact surveyed students were well aware of. As we have seen in our study, living donations are successful because they are a related-type of donation, where emotional factors are fundamental.…”

Section: Discussionmentioning

confidence: 97%