Geographic Inequities in Kidney Transplantation: Investigating Possible Solutions

描述（由申请人提供）：终末期肾病（ESRD）是一个巨大的公共卫生问题，在过去三十年中患病率增加了三倍。目前对ESRD患者的唯一医学恢复疗法是肾移植。然而，肾移植因肾器官的稀缺而受到损害。由于这种器官短缺和其他复杂的系统相关因素，在全国范围内，ESRD等待名单上的患者必须等待接受肾移植的中位等待时间存在显著的地理差异。17，18目前，中位等待时间在0.93和4.14年之间变化，具体取决于患者的等待名单地理区域。19这种等待移植的时间差异性地影响了该国不同地区等待的终末期肾病患者的生活质量。12-14移植界普遍意识到这种地理不平等，24迄今为止，几乎没有人提出缩小这种差距的建议。在这项拟议的研究中，我们打算在两个地区调查这种地理差异。 的方式首先，我们打算完成多个移植数据库的二级数据分析，以全面说明目前不公平的原因和范围。其次，我们的目标是从工程的角度来研究目前的肾脏器官分配政策，以开发替代的，优化的肾脏器官共享策略，以提高肾脏器官分配政策的地理公平性，通过最小的建议修改目前的政策。通过这种多学科的努力，在西北 大学移植结果研究协作（NUTORC），我们的研究团队希望对目前的肾脏分配政策辩论产生重大影响。大约八年来，器官共享联合网络（UNOS）肾脏委员会分析了目前的肾脏器官分配政策，最近提出了对目前肾脏分配政策的修改，目前公开征求公众意见。肾脏器官分配的巨大地理差异被认为是不久的将来需要调查的一个重要组成部分。随着UNOS肾脏委员会当选主席John弗里德瓦尔德博士作为我们研究团队的研究员，我们打算与该委员会的主要成员密切合作，以影响和促进未来关于这一重要问题的政策讨论。总的来说，全面了解目前肾器官分配的地理差异和减少其影响的潜在干预措施，将通过减少整个肾移植过程中不成比例的地理患者经历，提高移植过程中的公平性。此外，我们预计，建立的战略性肾脏器官共享机制可能会提高肾脏器官分配政策在实践中发挥作用的效率，从而相应地增加用于移植的采购肾脏器官的利用率。 公共卫生相关性：由于肾移植等待时间的变化，目前肾器官分配的地理差异已经严重影响了生活在全国各地的ESRD患者的生活质量。通过这种合作，我们将通过了解当前系统的不公平性和创建肾脏器官共享策略来减少美国各地不同的ESRD患者经历，从而减少差异。此外，通过建立战略性的简化肾脏器官共享机制，我们旨在提高肾脏器官分配过程的效率，从而提高采购肾脏器官的利用率，以增加潜在的肾脏移植数量。

DESCRIPTION (provided by applicant): End Stage Renal Disease (ESRD) is a large public health problem with a three-fold rise in prevalence over the past three decades. The only current medical restorative therapy for ESRD patients is kidney transplantation. Kidney transplantation however is marred by a scarcity of kidney organs. As a result of this organ shortage and other compounding system-related factors, a significant geographic disparity exists across the country with respect to the median waiting time ESRD waitlisted patients must wait to receive a kidney transplant.17,18 Currently, the median waiting time varies between 0.93 and 4.14 years depending on a patient's geographic area of waitlisting. 19 This waiting time to transplantation differential disproportionally affects the quality of life of ESRD patients waitingin different areas of the country. 12-14 There is general awareness within the transplant community of this geographic inequity, 24 yet to date, little has been proposed to curtail this disparity. Within this proposed research, we intend to investigate this geographic disparity in two ways. First, we intend to complete secondary data analysis with respect to multiple transplantation databases to comprehensively account for the cause and scope of the present inequities. Secondly, we aim to investigate current kidney organ allocation policy from an engineering perspective to develop alternative, optimized kidney organ sharing strategies to improve geographic equity in kidney organ allocation policy through minimal proposed modifications to the present policy. Through this multi-disciplinary effort within the Northwestern University Transplant Outcomes Research Collaborative (NUTORC), our research team hopes to have a significant impact on the present kidney allocation policy debate. For approximately eight years, the United Network of Organ Sharing (UNOS) Kidney Committee has analyzed the present kidney organ allocation policy, and recently proposed modifications to the current kidney allocation policy which are open for current public comment.30, 35 During this process, the significant geographic disparity in kidney organ allocation has been recognized as an important component to be investigated in the near future.34 With the UNOS Kidney Committee Chair-elect, Dr. John Friedewald, as an investigator within our research team, we intend to work closely with key members within this committee to impact and contribute to the future policy discussion with regards to this important issue. In total, a comprehensive understanding of the current geographic disparity in kidney organ allocation and potential interventions to lessen its effects will improve fairness within the transplantation process through lessening the disproportionate geographic patient experiences throughout the kidney transplantation process. In addition, we anticipate that the strategic kidney organ sharing mechanisms created may increase the efficiency with which the kidney organ allocation policy functions in practice and thus correspondingly increase the utilization of procured kidney organs for transplantation. PUBLIC HEALTH RELEVANCE: Current geographic disparities in kidney organ allocation have disproportionally affected the quality of life of ESRD patients living around the country due to th variability in waiting time to kidney transplantation. Through this collaboration, we will lessen disparate ESRD patient experiences throughout the United States by understanding current system inequities and creating kidney organ sharing strategies by which to curtail the disparity. In addition, through the creation of strategic, streamlined kidney organ sharing mechanisms, we aim to increase the efficiency of the kidney organ allocation process, and as a result, increase the utilization of procured kidney organs to increase the quantity of potential kidney transplantations.