Abstract MP09: Geographic Disparities in Rates of End-Stage Renal Disease and Organ Supply in Gulf States Compared to Non-Gulf States

Abstract

Background: Organ Procurement Organizations are responsible for procuring and allocating organs for transplantation from deceased donors in Donation Service Areas (DSAs). The Final Rule prohibits geographic disparities in access to organs, but the current kidney allocation system does not account for potential supply variations based on disease burden and other population characteristics within DSAs. As such, regions with traditionally high rates of comorbid disease, such as the Gulf States region, may be disadvantaged if local supply is limited. Methods: Using data from the 2016 Robert Wood Johnson Foundation County Health Rankings, the Scientific Registry of Transplant Recipients public reports, and the United States Renal Data System, we compared comorbid disease prevalence, rates of end-stage renal disease (ESRD), and expected organ donation rates by Gulf States location. Results: Prevalence of African American ethnicity, diabetes, fair/poor self-rated health, physical inactivity, food insecurity, and uninsurance were higher among DSAs in the Gulf States region vs. non-Gulf States (Table). Conversely, the prevalence of non-Hispanic White ethnicity, college education, and median household income were higher among non-Gulf States. The rate of ESRD varied by DSA, ranging from < 162 cases per 100,000 to > 225 cases per 100,000 (Figure). Median rate of ESRD was 214.4 per 100,000 among DSAs in the Gulf States, vs. 187.1 per 100,000 in the non-Gulf States (p=0.003). Expected rate of organ donation per 100 eligible deaths was 71.1 in Gulf States and 75.4 in non-Gulf States (p=0.01). Conclusion: Higher rates of ESRD were observed in the Gulf States region, suggesting a greater need for organs than non-Gulf States. However, fewer donors were estimated in Gulf States, likely due to high comorbid disease burden, compared to non-Gulf States. These data suggest the need to examine allocation policy to prevent geographic disparities in access to deceased donor transplantation.