Improving Geographic Equity in Kidney Transplantation Using Alternative Kidney Sharing and Optimization Modeling

Area of Science:

• Organ transplantation research
• Health services research
• Operations research

Background:

• The national demand for kidney organs significantly exceeds the available supply.
• Patient access to kidney transplantation currently varies geographically, conflicting with federal mandates.
• Existing kidney allocation systems present disparities in transplant rates across different regions.

Purpose of the Study:

• To analyze current kidney allocation practices and develop an improved kidney sharing strategy.
• To enhance geographic equity in kidney transplantation while adhering to system constraints and priorities.
• To introduce the KSHARE (Kidney Sharing) model, a multiperiod linear optimization tool.

Main Methods:

• Utilized Organ Procurement and Transplant Network data from 2000-2009 for analysis.
• Developed and applied a multiperiod linear optimization model named KSHARE.
• Assessed geographic equity by minimizing the range of kidney transplant rates across local areas.

Main Results:

• In 2009, less than 25% of standard criteria donor kidneys were allocated outside their local procurement area.
• Donor Service Area kidney transplantation rates showed a wide range (3.0% to 30.0%, a 27.0% difference).
• Optimal sharing within 600 miles reduced the transplant rate range to 7.5% (5.0% to 12.5%); national sharing further reduced it by 1.7%.

Conclusions:

• The KSHARE model demonstrates potential to substantially increase geographic equity in kidney transplantation.
• Optimizing kidney sharing, even within a 600-mile radius, significantly reduces regional disparities.
• Enhanced kidney sharing practices are crucial for addressing inequities in the national transplant system.