Measuring and Monitoring Equity in Access to Deceased Donor Kidney Transplantation
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The Organ Procurement and Transplantation Network monitors progress toward strategic goals such as increasing the number of transplants and improving waitlisted patient, living donor, and transplant recipient outcomes. However, a methodology for assessing system performance in providing equity in access to transplants was lacking. We present a novel approach for quantifying the degree of disparity in access to deceased donor kidney transplants among waitlisted patients and determine which factors are most associated with disparities. A Poisson rate regression model was built for each of 29 quarterly, period-prevalent cohorts (January 1, 2010-March 31, 2017; 5 years pre-kidney allocation system [KAS], 2 years post-KAS) of active kidney waiting list registrations. Inequity was quantified as the outlier-robust standard deviation (SD ) of predicted transplant rates (log scale) among registrations, after "discounting" for intentional, policy-induced disparities (eg, pediatric priority) by holding such factors constant. The overall SD declined by 40% after KAS implementation, suggesting substantially increased equity. Risk-adjusted, factor-specific disparities were measured with the SD after holding all other factors constant. Disparities associated with calculated panel-reactive antibodies decreased sharply. Donor service area was the factor most associated with access disparities post-KAS. This methodology will help the transplant community evaluate tradeoffs between equity and utility-centric goals when considering new policies and help monitor equity in access as policies change.
Matevish L, Guo J, Shubin A, MacConmara M, Hwang C, Raschzok N Transplant Direct. 2025; 11(4):e1777.
PMID: 40078822 PMC: 11896107. DOI: 10.1097/TXD.0000000000001777.
Anwar I, DeLaura I, Ladowski J, Schiliro D, Gao Q, Manook M Sci Transl Med. 2025; 17(779):eadn8130.
PMID: 39742504 PMC: 11797747. DOI: 10.1126/scitranslmed.adn8130.
Zwirner U, Kleine-Dopke D, Wagner A, Storzer S, Gronau F, Beetz O Ann Transplant. 2024; 29:e944603.
PMID: 39350474 PMC: 11453122. DOI: 10.12659/AOT.944603.
Stewart D, John P Kidney Int Rep. 2024; 9(7):1951-1953.
PMID: 39081749 PMC: 11284399. DOI: 10.1016/j.ekir.2024.05.017.
Manook M, Olaso D, Anwar I, DeLaura I, Yoon J, Bae Y Sci Transl Med. 2024; 16(751):eadk6152.
PMID: 38865482 PMC: 11328991. DOI: 10.1126/scitranslmed.adk6152.