INTRO: Inequities (ineqs) in access to KTx date from the inception of the nationalized allocation system and remain a serious problem. The present study examines current access to KTx in a state housing 3 DSAs and reviews underlying causes.

METHODS: Retrospective review of data drawn from SRTR. DSAs are designated by abbreviations for cities housing their respective Organ procurement Organization headquarters (San Antonio [SA], Dallas [D], Houston [H]). Non-major metro Tx communities are designated by DSA affiliation & Alternative Local Unit (ALU) status (DSA-H ⇒ Fort Worth [+ALU], Lubbock [+ALU]; DSA-D ⇒ Galveston [+ALU], Tyler [+ALU], Temple [+ALU]; & DSA-SA ⇒ Austin [NoALU]). The following, DSA-specific supply and demand parameters were analyzed: population base (PB), # eligible deaths (ED)/yr, # of acute care hospitals (ACH), # of ACH with ≥ 10 ED/yr, wait list size, # ESRD pts indexed to PB, & # of pts listed in DSA-SA who reside but do not list in DSA-D ('SA-Listed/D-reside-but-not-listed'). Summary data are expressed as means ± SD.

RESULTS: Ineqs are confined to DSA-SA and disproportionately impact Hispanics (table 1). Supply/demand imbalances inherent in DSA boundary structures, influx of substantial #'s of 'SA-listed/D-reside-but-not-listed-D' pts, & +ALU vs NoALU status all contribute to disparate waiting times in DSA-SA (table 1).

CONCLUSION: These observations indicate that states with multiple DSAs and diverse ethnic populations may be at high risk for disparities in access to KTx and argue for careful study and policy alterations.

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