Med Decis Making - Improving Geographic Equity in Kidney Transplantation Using Alternative Kidney Sharing and Optimization Modeling.

Tópicos

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Resumo

The national demand for kidney transplantation far outweighs the supply of kidney organs. Currently, a patient's ability to receive a kidney transplant varies depending on where he or she seeks transplantation. This reality is in direct conflict with a federal mandate from the Department of Health and Human Services. We analyze current kidney allocation and develop an alternative kidney sharing strategy using a multiperiod linear optimization model, KSHARE. KSHARE aims to improve geographic equity in kidney transplantation while also respecting transplant system constraints and priorities. KSHARE is tested against actual 2000-2009 kidney allocation using Organ Procurement and Transplant Network data. Geographic equity is represented by minimizing the range in kidney transplant rates around local areas of the country. In 2009, less than 25% of standard criteria donor kidneys were allocated beyond the local area of procurement, and Donor Service Area kidney transplantation rates varied from 3.0% to 30.0%, for an overall range of 27.0%. Given optimal sharing of kidneys within 600 miles of procurement for 2000-2009, kidney transplant rates vary from 5.0% to 12.5% around the country for an overall kidney transplant range of 7.5%. Nationally sharing kidneys optimally between local areas only further decreases the transplant rate range by 1.7%. Enhancing the practice of sharing kidneys by the KSHARE model may increase geographic equity in kidney transplantation.

Resumo Limpo

nation demand kidney transplant far outweigh suppli kidney organ current patient abil receiv kidney transplant vari depend seek transplant realiti direct conflict feder mandat depart health human servic analyz current kidney alloc develop altern kidney share strategi use multiperiod linear optim model kshare kshare aim improv geograph equiti kidney transplant also respect transplant system constraint prioriti kshare test actual kidney alloc use organ procur transplant network data geograph equiti repres minim rang kidney transplant rate around local area countri less standard criteria donor kidney alloc beyond local area procur donor servic area kidney transplant rate vari overal rang given optim share kidney within mile procur kidney transplant rate vari around countri overal kidney transplant rang nation share kidney optim local area decreas transplant rate rang enhanc practic share kidney kshare model may increas geograph equiti kidney transplant

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