*Purpose: On March 15, 2021, Donation Service Area (DSA) and OPTN Region were removed from kidney allocation and replaced with a 250 nautical mile (NM) fixed circle around the donor hospital with proximity points in an effort to remove geography as a barrier to transplantation. Although monitoring reports show increased transplants, decreased discards, and broader sharing, we wanted to determine if there were associated costs or outcomes at the transplant center level.

*Methods: This retrospective, single center study includes all adult, deceased donor kidney transplants that occurred 6 months prior to and 6 months after March 15, 2021 at our center. Clinical and cost variables were collected and cohorts were compared as pre-policy change (9/15/2020-3/14/2021) and post-policy change (3/15/2021-09/14/2021) using Wilcoxon Rank Sum or chi-squared tests for categorical variables.

*Results: A total of 222 patients were included in our analyses (105 pre- and 117 post-). There was no difference in age, gender, race, blood type, dialysis vintage, cPRA, KDPI, HLA-mismatch, or length of hospital stay. There was a significant increase in broader sharing on both a regional and national level with reduction in local organs transplanted (p<0.001). There were increased cold ischemia times (15.5 vs. 17.4 hours, p<0.03). A 5.2% increase in costs post-policy change for direct patient care also occurred (p<0.05).

*Conclusions: The intended goals of broader sharing with the elimination of DSA and OPTN Region are being realized. With more regional and national sharing concerns have been raised about increases in cold ischemia times which may affect outcomes and increasing costs for the overall system as organs travel further distances. We present center-level data that costs have been higher post-policy change. It will be important to continue to monitor and present granular data with continuous distribution for kidney allocation.

« Back to 2022 American Transplant Congress