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Measuring and monitoring equity in access to deceased donor kidney transplantation
Author(s) -
Stewart D. E.,
Wilk A. R.,
Toll A. E.,
Harper A. M.,
Lehman R. R.,
Robinson A. M.,
Noreen S. A.,
Edwards E. B.,
Klassen D. K.
Publication year - 2018
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.14922
Subject(s) - medicine , equity (law) , poisson regression , transplantation , kidney transplantation , psychological intervention , organ procurement , environmental health , demography , intensive care medicine , population , nursing , sociology , political science , law
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 w ) 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 w declined by 40% after KAS implementation, suggesting substantially increased equity. Risk‐adjusted, factor‐specific disparities were measured with the SD w 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.