The Impact of Kidney Allocation System 250 (KAS250) on Access to a Deceased Donor Kidney Transplant Among Waitlisted U.S. Adults Restricted; Files Only

Abstract

Access to a deceased donor kidney transplant is increasingly critical as the incidence of ESRD steadily rises in the US. Amendments to kidney transplant allocation policy over the last decade have sought to address disparities and increase the utility of procured organs. Geographic disparities in access to a kidney transplant have been a long-standing issue, which the Kidney Allocation System 250 (KAS250), implemented on March 15, 2021, aimed to address. This policy change significantly affected all transplant centers, patients, and donor hospitals in the United States, introducing notable changes to transplant operations. This study investigates how KAS250 impacted access to kidney transplant by using a measure called local access to kidney supply. Greater local access to kidney supply was associated with greater access to transplant overall, however, when examining the pre-KAS250 period individually, it was an insignificant predictor. This study found that wait times overall decreased after KAS250. Additionally, KAS250 was associated with increased median wait times in some regions, and decreased median wait times in others. While this study should be interpreted in light of its limitations, it provides valuable insights for transplant patients, transplant centers, and the broader transplant community. With potential changes to kidney transplant policy on the horizon, it is recommended that future amendments consider balancing geographic equity and broader organ distribution with reducing cold ischemia time and organizational burdens. 

Table of Contents

I. Introduction ......................................................................................................................................... 1 

a. Background: End Stage Renal Disease and the Kidney Transplant System ............................ 1 

b. Review of the Literature: Geographic Disparities ..................................................................... 3 

c. Policy Context: Kidney Allocation System 250 (KAS250) .......................................................... 6 

d. KAS250: Current Studies and Gap in the Literature ............................................................... 9 

II. Methods.............................................................................................................................................. 10 

a. Theoretical Framework ............................................................................................................... 10 

b. Measurement of Variables ......................................................................................................... 14 

c. Hypothesis .................................................................................................................................... 15 

d. Analytic Sample ........................................................................................................................... 15 

e. Data Description ............................................................................................................................ 17 

f. Data Analysis .................................................................................................................................. 18 

III. Results. ............................................................................................................................................ 18 

a. Descriptive Results .................................................................................................................... 18 

b. Cox Proportional Hazards Regression Models ......................................................................... 21 

c. Kaplan-Meier Graphs. ............................................................................................................... 26 

e. Distribution of Local vs Nonlocal Transplants ......................................................................... 28 

f. Regional Analysis .......................................................................................................................... 29 

IV. Discussion........................................................................................................................................... 30 

V. References ........................................................................................................................................... 36 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Health Policy and Management
Degree	M.S.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Parola chiave	Kidney Transplantation Health Policy
Committee Chair / Thesis Advisor	David Howard , Emory University
Committee Members	Arpita Basu, Emory University William Kitchens , Emory University

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