Improving Geographic Equity in Kidney Transplantation Using Alternative Kidney Sharing and Optimization Modeling.
The national demand for kidney transplantation far outweighs the supply of kidney organs. Currently, a patient's ability to receive a kidney transplant varies depending on where he or she seeks transplantation. This reality is in direct conflict with a federal mandate from the Department of Health and Human Services. We analyze current kidney allocation and develop an alternative kidney sharing strategy using a multiperiod linear optimization model, KSHARE. KSHARE aims to improve geographic equity in kidney transplantation while also respecting transplant system constraints and priorities. KSHARE is tested against actual 2000-2009 kidney allocation using Organ Procurement and Transplant Network data. Geographic equity is represented by minimizing the range in kidney transplant rates around local areas of the country. In 2009, less than 25% of standard criteria donor kidneys were allocated beyond the local area of procurement, and Donor Service Area kidney transplantation rates varied from 3.0% to 30.0%, for an overall range of 27.0%. Given optimal sharing of kidneys within 600 miles of procurement for 2000-2009, kidney transplant rates vary from 5.0% to 12.5% around the country for an overall kidney transplant range of 7.5%. Nationally sharing kidneys optimally between local areas only further decreases the transplant rate range by 1.7%. Enhancing the practice of sharing kidneys by the KSHARE model may increase geographic equity in kidney transplantation.
Industrial Engineering and Management Sciences, Northwestern University, Evanston, Illinois (AD, SM)|Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois (AD, SM, JF, AS, MA, DL)
Ashley E
AE
Davis
Industrial Engineering and Management Sciences, Northwestern University, Evanston, Illinois (AD, SM)|Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois (AD, SM, JF, AS, MA, DL)|Center for Engineering and Health, Northwestern University, Chicago, Illinois (SM)
Sanjay
S
Mehrotra
Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois (AD, SM, JF, AS, MA, DL)
John J
JJ
Friedewald
Industrial and Operations Engineering, University of Michigan, Ann Arbor (MD)
Mark S
MS
Daskin
Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois (AD, SM, JF, AS, MA, DL)
Anton I
AI
Skaro
Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois (AD, SM, JF, AS, MA, DL)
Michael M
MM
Abecassis
Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois (AD, SM, JF, AS, MA, DL)
Daniela P
DP
Ladner
D003198:Computer Simulation; D000069576:Health Equity; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D040841:Resource Allocation / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D014481:United States
equity; geography; optimization; organ allocation