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The Effects of DonorNet 2007 on Kidney Distribution Equity and Efficiency
Author(s) -
Massie A. B.,
Zeger S. L.,
Montgomery R. A.,
Segev D. L.
Publication year - 2009
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/j.1600-6143.2009.02670.x
Subject(s) - medicine , equity (law) , logistic regression , demography , statistics , econometrics , mathematics , political science , law , sociology
In 2007, UNOS released DonorNet 2007 ® (DN07) in hope of improving allocation equity and efficiency. We hypothesized that hard‐to‐place organs might be less efficiently handled through this regimented process. We analyzed associations between DN07 and center‐level equity, number of refusals per organ and cold ischemia time (CIT). A total of 8244 kidney transplants between 1/2006 and 12/2006 (pre‐DN07) were compared with 6029 transplants between 5/2007 and 2/2008 (post‐DN07). Distribution equity was assessed by the Gini coefficient, changes in the number of refusals and CIT by negative binomial regression and discard rates by logistic regression. We estimated quantile‐specific differences in CIT by bootstrapping. We found no significant change in center‐level distribution equity after DN07. Number of refusals per organ increased by 20% (adjusted rate ratio 1.12 1.20 1.28 , p < 0.001) at the patient level and 11% (ARR 1.07 1.11 1.16 , p < 0.001) at the center level. Regression models of CIT showed no global change in CIT associated with DN07, but those kidneys with the longest CIT pre‐DN07 had statistically significantly longer CIT post‐DN07. The discard rate also increased significantly (ARR 1.06 1.11 1.17 , p < 0.001). DN07 has not improved equity or efficiency in allocation of deceased donor kidneys, and may be harming the allocation of hard‐to‐place kidneys.