A New Methodology for Measuring and Monitoring Equity in Access to Deceased Donor Kidney Transplants.
United Network for Organ Sharing, Richmond, VA
Meeting: 2017 American Transplant Congress
Abstract number: 284
Keywords: Allocation, Kidney transplantation, Multivariate analysis, Public policy
Session Information
Session Name: Concurrent Session: Transplant Regulation and Management: Allocation, Access and Other Transplant Management Topics
Session Type: Concurrent Session
Date: Monday, May 1, 2017
Session Time: 2:30pm-4:00pm
Presentation Time: 2:54pm-3:06pm
Location: E451b
Background: The OPTN monitors progress on increasing the number of transplants, improving patient outcomes, and other goals. However, a well-established methodology for assessing system performance in providing equitable access to transplants did not previously exist. We present a novel approach to quantify the degree of disparity in access to DD Ki Tx among waitlisted patients and determine which factors are most associated with disparities.
Methods: Cox regression with 15 candidate covariates (including CPRA as time-dependent) was applied to 25 quarterly, period-prevalent cohorts (1/1/10-3/31/16) of active kidney waiting list registrations. Disparity was quantified as the standard deviation (SD) of model xbetas among registrations, after “discounting” for desired, policy-induced disparities (pediatric, prior living donor, medical urgency priorities) by holding these factors constant. Risk-adjusted, factor-specific disparities were calculated as the SD of xbetas, holding all other factors constant.
Results: Discounted disparity in access to transplant, though substantial, improved markedly after KAS (Fig 1), as SD dropped by 40%.
Disparities associated with CPRA decreased sharply but were not eliminated by KAS. Though disparities associated with donor service area (DSA) of listing, all else equal, dropped 27%, DSA (SD=0.60) was the candidate factor most associated with disparity post-KAS, followed by CPRA (0.46) and ABO (0.34). (Fig 2)
Discussion: The OPTN has a new methodology to quantify and continually monitor equity in access to kidney transplantation as new policies are implemented. This framework will also help the transplant community evaluate tradeoffs between equity and other goals (increase transplants; improve outcomes) when considering the merits of new policy proposals.
CITATION INFORMATION: Stewart D, Wilk A, Cherikh W, Harper A, Urban R, Klassen D, Edwards E. A New Methodology for Measuring and Monitoring Equity in Access to Deceased Donor Kidney Transplants. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Stewart D, Wilk A, Cherikh W, Harper A, Urban R, Klassen D, Edwards E. A New Methodology for Measuring and Monitoring Equity in Access to Deceased Donor Kidney Transplants. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/a-new-methodology-for-measuring-and-monitoring-equity-in-access-to-deceased-donor-kidney-transplants/. Accessed November 22, 2024.« Back to 2017 American Transplant Congress