Purpose: The Statewide Sharing (SS) local allocation variance offers non-locally allocated kidneys to patients listed in other Donor Service Areas (DSA) within the state of procurement before offering regionally and nationally. Two states adopted the variance in the early 1990s, but its effect on statewide allocation equity and efficiency has not been assessed.

Methods: A retrospective analysis of OPTN data files was performed for 1987-2009 to analyze the SS variance’s impact on equity by proxy of four performance indicators: deceased donor kidney transplant rates, waiting time to transplantation, cumulative dialysis time, and five year graft survival. Allocation efficiency was assessed by comparing cold-ischemic time for statewide versus local kidney allocation. Performance indicators and allocation efficiency were compared with states with the same amount of DSAs.

Results: Prior to SS variance implementation (1987-1992), inequity and inefficiency existed for all states. After implementation (2005-2009), states adopting the SS variance demonstrated higher statewide equity for each equity indicator and efficiency significantly improved, while they persisted and worsened in the other states.

Conclusions: We demonstrate that the SS variance, a small change to current policy, significantly improved allocation equity and efficiency. Such findings should be considered as allocation and remapping of the allocation system are considered by UNOS.

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