Background: There currently exists regional variation in the supply of deceased donors as well as the demand for kidney transplantation. This has stimulated a growing interest in reevaluating the organ allocation process and potentially redefining the geographic boundaries used to structure the current organ allocation system for deceased donors. This research investigates whether or not there exists regional heterogeneity in the efficient utilization of deceased donors.

Methods: Using UNOS data on the number of deceased donors within the 11 allocation regions in the United States combined with the number of deceased donor kidney transplants during the time period 01/01/2004 through 12/31/2012 we construct a data set on regional donors and transplants conducted. The data is aggregated up to the month-year level, resulting in a data set containing 1,188 observations. Using the ratio of deceased donor kidney transplants conducted to the number of deceased donors within a region in a particular month and year we estimate a fixed effects stochastic production frontier model to determine the efficiency levels of the 11 allocation regions. The robustness of our estimates is investigated using month-year fixed effects, covariates to control for the characteristics of the deceased donor pool and covariates to control for the characteristics of those patients currently waiting for a kidney transplant.

Results: Our preliminary results provide support for the existence of substantial regional heterogeneity in the efficient utilization of the existing deceased donors. When we do not control for month-year fixed effects or characteristics of the donor pool and waiting list the efficiency scores range between 0.868 and 1.000. Controlling for temporal variation using month-year fixed effects generates efficiency scores between 0.868 and 1.000. Using the full set of control variables in the model (i.e., donor pool characteristics, waiting list characteristics, and month-year fixed effects) the efficiency scores vary between 0.665 and 1.000.

Conclusion: The efficient utilization of our existing deceased donor organs in paramount to increasing the number of kidney transplants within the United States. This research has illustrated that there exists regional heterogeneity in the efficient utilization of existing deceased donors.

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