Changes in Geographic Disparity in Kidney Transplantation Since the Final Rule
Changes in Geographic Disparity in Kidney Transplantation Since the Final Rule
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DOI：
10.1097/tp.0000000000000446
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发表时间：
2014-11-15
期刊：
影响因子：
6.2
通讯作者：
Friedewald, John J.
中科院分区：
文献类型：
--
作者：
Davis, Ashley E.;Mehrotra, Sanjay;Friedewald, John J.
随着等待名单的扩大和器官短缺的持续，国家器官分配系统将承受死亡供体肾移植的负担。1998年，美国卫生与公众服务部发布了《最终规则》，规定器官和组织的分配应基于客观的优先标准，而不是地理上的偶然因素。然而，这一规则在鼓励各地区公平分担额外负担方面是否有效尚未得到解决。目的评估自规则通过以来四个指标的地理差异变化的重要性：等待时间，移植率，移植前死亡率和器官质量。方法使用1988年至2009年的器官采购和移植网络数据，计算了所有捐献者服务区和器官共享联合网络地区的年度指标范围。时间序列分析被用来比较的指标之前和之后颁布的最终Rule.Results共412,127肾移植候选人和178,163死亡供体受体进行了分析。各地区的人口统计情况差异很大。这四个指标的范围已经恶化了约30%或更多的最终规则后，在区域和捐助者的服务areas levels.Conclusion分配程序中的地域差异的增加可能会产生不同的结果和经验，在不同的地点，否则类似的候选人。需要在衡量分配差异和政策干预方面达成共识，以减轻不公平现象。
Background The national organ allocation system for deceased-donor kidney transplant will endure increased burden as the waitlist expands and organ shortage persists. The Department of Health and Human Services issued the Final Rule in 1998 that states Organs and tissues ought to be distributed on the basis of objective priority criteria and not on the basis of accidents of geography. However, it has not been addressed whether the rule was effective in encouraging regions to share the additional burden equitably.Objective To assess the significance of changes of geographic disparities for four metrics since the rule's adoption: waiting times, transplant rates, pretransplant mortality, and organ quality.Methods Using Organ Procurement and Transplant Network data from 1988 through 2009, annual ranges of the metrics were calculated for all donor service areas and United Network for Organ Sharing regions. Time series analyses were used to compare the metrics before and after the enactment of the Final Rule.Results A total of 412,127 kidney transplant candidates and 178,163 deceased-donor recipients were analyzed. Demographics varied significantly by region. The ranges of the four metrics have worsened by approximately 30% or more after the Final Rule at both the regional and donor service area levels.Conclusion Increasing geographic disparity in allocation procedures may yield diverging outcomes and experiences in different locations for otherwise similar candidates. Consensus for measuring allocation discrepancies and policy interventions are required to mitigate the inequities.