title: The effect of the Statewide Sharing variance on geographic disparity in kidney transplantation in the United States.
abstract: OBJECTIVE
  The Statewide Sharing variance to the national kidney allocation policy allocates kidneys not used within the procuring donor service area (DSA), first within the state, before the kidneys are offered regionally and nationally. Tennessee and Florida implemented this variance. Known geographic differences exist between the 58 DSAs, in direct violation of the Final Rule stipulated by the US Department of Health and Human Services. This study examined the effect of Statewide Sharing on geographic allocation disparity over time between DSAs within Tennessee and Florida and compared them with geographic disparity between the DSAs within a state for all states with more than one DSA (California, New York, North Carolina, Ohio, Pennsylvania, Texas, and Wisconsin).
  
  
  METHODS
  A retrospective analysis from 1987 to 2009 was conducted using Organ Procurement and Transplant Network data. Five previously used indicators for geographic allocation disparity were applied: deceased-donor kidney transplant rates, waiting time to transplantation, cumulative dialysis time at transplantation, 5-year graft survival, and cold ischemic time.
  
  
  RESULTS
  Transplant rates, waiting time, dialysis time, and graft survival varied greatly between deceased-donor kidney recipients in DSAs in all states in 1987. After implementation of Statewide Sharing in 1992, disparity indicators decreased by 41%, 36%, 31%, and 9%, respectively, in Tennessee and by 28%, 62%, 34%, and 19%, respectively in Florida, such that the geographic allocation disparity in Tennessee and Florida almost completely disappeared. Statewide kidney allocations incurred 7.5 and 5 fewer hours of cold ischemic time in Tennessee and Florida, respectively. Geographic disparity between DSAs in all the other states worsened or improved to a lesser degree.
  
  
  CONCLUSIONS
  As sweeping changes to the kidney allocation system are being discussed to alleviate geographic disparity--changes that are untested run the risk of unintended consequences--more limited changes, such as Statewide Sharing, should be further studied and considered.
authors: Industrial Engineering and Management Sciences, Northwestern University, Evanston, Illinois; Northwestern University Transplant Outcomes Research Collaborative (NUTORC) Comprehensive Transplant Center.
authors: Ashley E
authors: AE
authors: Davis
authors: Industrial Engineering and Management Sciences, Northwestern University, Evanston, Illinois; Northwestern University Transplant Outcomes Research Collaborative (NUTORC) Comprehensive Transplant Center, Center for Engineering and Health, Institute for Public Health and Medicine.
authors: Sanjay
authors: S
authors: Mehrotra
authors: Industrial Engineering and Management Sciences, Northwestern University, Evanston, Illinois; Center for Engineering and Health, Institute for Public Health and Medicine.
authors: Vikram
authors: V
authors: Kilambi
authors: Northwestern University Transplant Outcomes Research Collaborative (NUTORC) Comprehensive Transplant Center, Department of Preventative Medicine.
authors: Joseph
authors: J
authors: Kang
authors: Northwestern University Transplant Outcomes Research Collaborative (NUTORC) Comprehensive Transplant Center, Center for Healthcare Studies, Institute for Public Health and Medicine, and.
authors: Lisa
authors: L
authors: McElroy
authors: Northwestern University Transplant Outcomes Research Collaborative (NUTORC) Comprehensive Transplant Center.
authors: Brittany
authors: B
authors: Lapin
authors: Northwestern University Transplant Outcomes Research Collaborative (NUTORC) Comprehensive Transplant Center, Center for Healthcare Studies, Institute for Public Health and Medicine, and.
authors: Jane
authors: J
authors: Holl
authors: Northwestern University Transplant Outcomes Research Collaborative (NUTORC) Comprehensive Transplant Center.
authors: Michael
authors: M
authors: Abecassis
authors: Northwestern University Transplant Outcomes Research Collaborative (NUTORC) Comprehensive Transplant Center, Division of Nephrology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors: John J
authors: JJ
authors: Friedewald
authors: Northwestern University Transplant Outcomes Research Collaborative (NUTORC) Comprehensive Transplant Center, Center for Healthcare Studies, Institute for Public Health and Medicine, and dladner@nmh.org.
authors: Daniela P
authors: DP
authors: Ladner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D050377:Cold Ischemia / Q000639:trends; D005260:Female; D006085:Graft Survival; D006291:Health Policy / Q000639:trends*; D006297:Health Services Accessibility / Q000639:trends*; D054625:Healthcare Disparities / Q000639:trends*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000639:trends*; D008297:Male; D008875:Middle Aged; D011050:Policy Making; D012040:Regional Health Planning / Q000639:trends; D006435:Renal Dialysis / Q000639:trends; D012111:Residence Characteristics; D012189:Retrospective Studies; D013219:State Government; D013221:State Health Plans / Q000639:trends*; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution; D009927:Tissue and Organ Procurement / Q000458:organization & administration / Q000639:trends*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists; D055815:Young Adult
keywords: kidney donation; renal transplantation; transplant outcomes