Kidney Transplant Patients May Reap Big Benefits From Small Policy Changes

Small policy changes may help reduce geographic disparities in donor kidney distribution.  (Image: JAMA, ©AMA)

Small policy changes may help reduce geographic disparities in donor kidney distribution, a new study reports. (Image: JAMA, ©AMA)

An experimental policy that helped 2 states ease their geographic disparities in allocating donor kidneys may play a role in alleviating similar discrepancies nationwide, according to a new study.

National policy now specifies that if a donor kidney isn’t used in the donor service area that requested it, the organ then is offered regionally or nationally. The United States has 58 donor service areas, which are designated by the Centers for Medicare & Medicaid Services. Despite a 1998 rule from the US Department of Health and Human Services requiring geographic parity for kidney transplants, wait times for a donor kidney can vary among donor services areas, even those located next to each other.

In the early 1990s, however, Tennessee and Florida were allowed to implement a variance to keep kidneys available in-state before allocating them regionally or nationally. To learn whether the change alleviated geographic disparities, researchers at Northwestern University’s campuses in Chicago and Evanston, Illinois, analyzed data from the Organ Procurement and Transplant Network.

Their analysis compared geographic disparities in Tennessee and Florida for 5 years before the variances were implemented, from 1987 to 1991, and afterward, from 1992 to 2009. Comparisons with other states that didn’t implement variances were included in the study, published online today in the Clinical Journal of the American Society of Nephrology.

The investigators measured disparities with 5 indicators: kidney transplant rates, wait times for transplants, cumulative dialysis time, 5-year graft survival, and how long the kidney was chilled with a small or no blood supply. Results showed that disparities measured with those indicators decreased by 41%, 36%, 31%, 9%, and 7.5 hours, respectively, in Tennessee and by 28%, 62%, 34%, 19%, and 5 hours, respectively, in Florida.

In the comparison states—North Carolina, Pennsylvania, Wisconsin, California, New York, and Ohio—geographic disparities worsened or improvement was inconsistent from 1987 to 2009.

The study authors wrote that Tennessee and Florida have “the only [United Network for Organ Sharing ] policy variances for which actual evidence exists in support of its ability to reduce geographic disparity.”

They added that their findings are timely, as discussions are under way to restructure the kidney allocation system to reduce geographic disparities. Small changes to the existing system can lead to substantial improvements without risking unforeseen problems that may arise from more sweeping changes, such as redefining regions, the authors wrote.

Categories: Health Policy, Kidney Transplantation, Surgery, Transplantation