Extent and Drivers of Geographic Inequity in Kidney Transplantation in the US

[Clark]

http://www.atcmeetingabstracts.com/abstract/extent-and-drivers-of-geographic-inequity-in-kidney-transplantation-in-the-united-states-the/

Extent and Drivers of Geographic Inequity in Kidney Transplantation in the United States, The
A. Davis, S. Mehrotra, J. Friedewald, A. Skaro, L. McElroy, R. Kang, J. Holl, M. Abecassis, D. Ladner

Purpose: The waiting time for a deceased donor kidney transplant (DDKT) varies greatly across the United States (US), having a significant impact on outcomes pre- and post-transplantation. The extent of the current problem and the drivers leading to areas with long waiting times has not been explored. We analyzed the waiting time differences across the 58 US Donor Service Areas (DSA) and the DSA characteristics that affect long DSA waiting times.

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Conclusions: The current geographic inequity in kidney transplantation waiting time is significant, and has worsened over time. High demand for kidney transplantation, low local kidney availability, low patient socioeconomic status, and local listing behavior drive long DSA waiting times. Center behaviors, such as the use of marginal quality organs and higher rates of living donor kidney transplant, have not eliminated the geographic inequity. Changes to the allocation system are needed to mitigate this geographic inequity.