Addressing Geographic Inequities in Kidney Transplantation.

摘要

Geographic inequities exist in kidney transplantation in violation of federal mandate. While the transplant community is aware of this issue, there is a general lack of understanding as to why it exists and how it may be resolved. We analyzed over twenty years of transplant system data to systematically explain the geographic inequity issue. Drawing from this understanding, we designed a queueing network extension of the kidney transplantation system and created alternative kidney sharing strategies aimed to alleviate the problem. Simulation optimization techniques were then used to maximize the reduction in geographic inequity over time for each alternative kidney sharing strategy. Findings demonstrate that small, implementable changes to current practice can greatly reduce geographic inequities in kidney transplantation.