Declining racial disparities in deceased-donor kidney allocation

Here's an article from the June issue of Health Affairs, reporting that racial disparities among deceased-donor kidney recipients seem to have declined since the introduction of a modified allocation procedure.

New Kidney Allocation System Associated With Increased Rates Of Transplants Among Black And Hispanic Patients

1. Taylor A. Melanson1, 
2. Jason M. Hockenberry2, 
3. Laura Plantinga3,
4. Mohua Basu4, 
5. Stephan Pastan5, 
6. Sumit Mohan6,
7. David H. Howard7 and 
8. Rachel E. Patzer8,*

+Author Affiliations

1. ¹Taylor A. Melanson is a doctoral student in the Laney Graduate School, Emory University, in Atlanta, Georgia.
2. ²Jason M. Hockenberry is an associate professor in the Department of Health Policy and Management, Rollins School of Public Health, at Emory University.
3. ³Laura Plantinga is an assistant professor in the Department of Medicine, Emory University School of Medicine.
4. ⁴Mohua Basu is a data analyst at the Emory University School of Medicine.
5. ⁵Stephan Pastan is an associate professor in the Department of Medicine, Emory University School of Medicine.
6. ⁶Sumit Mohan is an assistant professor in the Division of Nephrology, Department of Medicine, and in the Department of Epidemiology at Columbia University Medical Center, in New York City.
7. ⁷David H. Howard is an assistant professor in the Department of Health Policy and Management, Rollins School of Public Health, at Emory University.
8. ⁸Rachel E. Patzer (rpatzer@emory.edu) is an assistant professor in the Department of Surgery and Department of Medicine at the Emory University School of Medicine, and in the Department of Epidemiology at the Rollins School of Public Health.

1. Health Aff June 2017 vol. 36no. 6 1078-1085

Abstract

Before the 2014 implementation of a new kidney allocation system by the United Network for Organ Sharing, white patients were more likely than black or Hispanic patients to receive a kidney transplant. To determine the effect of the new allocation system on these disparities, we examined data for 179,071 transplant waiting list events in the period June 2013–September 2016, and we calculated monthly transplantation rates (34,133 patients actually received transplants). Implementation of the new system was associated with a narrowing of the disparities in the average monthly transplantation rates by 0.29 percentage point for blacks compared to whites and by 0.24 percentage point for Hispanics compared to whites, which resulted in both disparities becoming nonsignificant after implementation of the new system.

From the paper:

"The United Network for Organ Sharing implemented a new kidney allocation system in December 2014,26 in part to address long-standing racial/ethnic disparities in the allocation of deceased donor kidneys. The primary factor for determining a patient’s priority level on the waiting list for a kidney transplant is how long he or she has been waiting. Under the new system, the starting point for calculating waiting time was changed from the date the patient was put on the waiting list to the earliest of either that date or the date of the patient’s first regular dialysis. This change was expected to benefit minorities because blacks and Hispanics spend more time on dialysis before being put on the waiting list, compared to white patients.27,28 The new system made additional changes meant to improve access to transplantation, including making it easier for patients with a highly sensitized immune system to receive transplants and increasing the sharing of kidneys across donor service area boundaries. It is important to note that this policy targets the allocation of deceased-donor kidneys, not of live-donor kidneys."