Small Changes Improve Geographic Disparity in Kidney Transplantation

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Daniela P Ladner, MD, MPH, FACS Assistant Professor Transplant Surgery Department of Surgery, Division of Organ Transplantation Director Northwestern University Transplant Outcomes Research Collaborative (NUTORC) Comprehensive Transplant Center Feinberg School of Medicine, Northwestern UniversityMedicalResearch.com Interview with
Daniela P Ladner, MD, MPH, FACS
Assistant Professor Transplant Surgery
Department of Surgery, Division of Organ Transplantation
Director Northwestern University Transplant Outcomes Research Collaborative (NUTORC)
Comprehensive Transplant Center
Feinberg School of Medicine, Northwestern University

MedicalResearch: What are the main findings of the study?

Dr. Ladner: With the current kidney organ allocation system, there exists significant geographic disparity between the 58 Donor Services Areas (DSAs) in the US, which are distributed among 11 regions. This means that depending on where a patient lives it might take shorter or longer to receive a kidney organ for transplantation. Despite efforts, this has not improved over the course of 20 years and in most regions this has worsened. In 1991 and 1992 respectively, two states changed their kidney allocation system, such that kidneys would first be allocated with the DSA of procurement, then statewide, then regionally (which may include several states) and then nationally. Usually kidneys don’t get allocated statewide before regionally.

The main finding of this study is that in those two states (FL, TN), where a minor change to the kidney allocation was put into place, there was significant reduction in the geographic disparity between their Donor Services Areas. In other comparable states (equal numbers of DSAs within the state) the geographic disparity did not improve and in many the geographic disparity worsened.

MedicalResearch: Were any of these findings unexpected?

Dr. Ladner: This is an observational study. Basically a natural experiment occurred within those two states and it tremendously impacted the geographic disparity. This was a surprising finding.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Ladner: The findings are important, because they demonstrate a real-life scenario of improved geographic disparity in kidney organ allocation. Presently, increased scrutiny has led to discussions about improvement of geographic disparity in kidney allocation within UNOS (United Network for Organ Sharing). As multiple models are being considered including sweeping changes to the existing allocation system, this natural history study can provide important information for this discussion, such as the potent effect of small changes to the existent allocation system. Especially, unintended consequences are already accounted for in such an experiment.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Ladner: Many models to improve geographic disparity in kidney allocation have to be examined. This study should add to the discussion and the consideration of small changes to the existing model.

Citation:

The Effect of the Statewide Sharing Variance on Geographic Disparity in Kidney Transplantation in the United States
CJASN CJN.05350513; published ahead of print June 26, 2014, doi:10.2215/CJN.05350513
Ashley E. Davis, Sanjay Mehrotra, Vikram Kilambi, Joseph Kang, Lisa McElroy, Brittany Lapin, Jane Holl, Michael Abecassis, John J. Friedewald, and Daniela P. Ladner

 

 

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