Disparities in Access to Kidney Transplantation Between Donor Service Areas in Texas

Abstract

We examined the current status of pronounced disparities in waiting times to kidney transplantation (KTx) within the state of Texas first documented more than a decade ago. The state's three, geographically contiguous donor service areas (DSAs) were compared for rates of deceased donor KTx within 3 years of listing as well as population base; waiting list size; number of dialysis patients; annual eligible deaths; number and size of acute care hospitals; organ procurement organization performance; correspondence between DSA of residence versus DSA of listing; and distribution of alternative local units (ALUs). The data show that significant inequities of access to KTx are persistent, localized to one of the state's three DSAs and disproportionately affect Hispanics as well as counties with lower median family incomes. Imbalances in determinants of supply and demand, discordance between DSAs of residence versus listing and ALU dispositions dating to the 1990s were identified as underlying causes. Parity will not be established by upcoming revisions in national allocation policies that call for regionalizing initial offers of kidneys with the worst 15% of donor profile index scores and elimination of ALUs. Potential remedies include adopting more equitable maximums in waiting time differentials between DSAs within single states.