title: Competitive Market Analysis of Transplant Centers and Discrepancy of Wait-Listing of Recipients for Kidney Transplantation.
abstract: BACKGROUND
  There are over 250 kidney transplant programs in the USA.
  
  
  OBJECTIVE
  To determine if highly competitive regions, defined as regions with a higher number of transplant centers, will approve and wait-list more end-stage renal disease (ESRD) candidates for transplant despite consistent incidence and prevalence of ESRD nationwide.
  
  
  METHODS
  ESRD Network and OPTN data completed in 2011 were obtained from all transplant centers including listing data, market saturation, market share, organs transplanted, and ESRD prevalence. Herfindahl-Hirschman Index (HHI) was used to measure the size of firms in relation to the industry to determine the amount of competition.
  
  
  RESULTS
  States were separated into 3 groups (HHI<1000 considered competitive; HHI 1000-1800 considered moderate competition; and HHI>1800 considered highly concentrated). The percentage of ESRD patients listed in competitive, moderate, and highly concentrated regions were 19.73%, 17.02%, and 13.75%, respectively. The ESRD listing difference between competitive versus highly concentrated was significant (p<0.05).
  
  
  CONCLUSIONS
  When there is strong competition without a dominant center as defined by the HHI, the entire state tends to list more patients for transplant to drive up their own center's market share. Our analysis of the available national data suggests a discrepancy in access for ESRD patient to transplantation due to transplant center competition.
authors.affiliation: Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: P S
authors.initials: PS
authors.lastname: Cho
authors.affiliation: Division of Organ Transplantation, Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: R F
authors.initials: RF
authors.lastname: Saidi
authors.affiliation: Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: C J
authors.initials: CJ
authors.lastname: Cutie
authors.affiliation: Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA ; Department of Surgery, Division of Transplantation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: D S C
authors.initials: DS
authors.lastname: Ko
keywords: Allocation; Competition; Kidney transplantation; Market analysis; Wait-list