178967 Public health implications of renal transplant candidates on the Expanded Criteria Donor waiting list

Monday, October 27, 2008

Tammy T. Hshieh, BA , Warren Alpert Medical School, Brown University, Providence, RI
Paul E. Morrissey, MD , Division of Organ Transplantation, Rhode Island Hospital, Providence, RI
Jennifer Christian, Pharm D, MPH , Community Health Department, Brown University, Providence, RI
Edward Feller, MD, FACP , Warren Alpert Medical School, Brown University, Providence, RI
BACKGROUND: A public health organ crisis exists in the United States. To increase the inadequate Deceased Donor kidney pool, Expanded Criteria Donation (ECD) of marginal kidneys for older, sicker patients was instituted. Studies demonstrate improved morbidity and mortality in ECD recipients. Implementation, however, remains highly variable. Our goal was to assess demographics of renal transplant candidates listed for ECD waitlists and the impact on ECD utilization at center, regional, national levels.

METHODS: We conducted a cross-sectional study comparing Rhode Island Hospital (RIH), the regional organ procurement organization (OPO), Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR) databases. Approximate statistical analysis was performed to calculate crude Odds Ratios and 95% Confidence Intervals. Exposures examined were age, ethnicity, gender, diagnosis, bloodtype. Outcomes were ECD waitlisting, ECD transplantation.

RESULTS: Patients at RIH are less likely to be ECD waitlisted than patients at other centers in the New England OPO (53.1% versus 34.1%) and nationally (14.7%). 15% of both ECD and Standard Criteria Donation (SCD) waitlisted candidates in the nation are transplanted compared to 28% at RIH and 17.8% in New England. Increased likelihood of being waitlisted for ECD was associated with increasing age (OR 14.01), male gender (OR 1.28), diabetes mellitus (OR 1.40), and non-white/non-black ethnicity (OR 1.69) at all sites.

CONCLUSIONS: The utilization of ECD kidneys varies. Efforts to optimize utilization of marginal kidneys should reduce discards, shorten wait times and improve allocation policy based on differences in health outcomes.

Learning Objectives:
1. Understand the public health implications of a national shortage in transplantable kidneys 2. Discuss the current national renal transplant allocation policy 3. Understand the role of Expanded Criteria Donation (ECD) in increasing the Deceased Donor kidney pool

Keywords: Medicine, Models for Provision

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Brown University Medical Student who conducted public health research on renal transplantation for my Community Health Clerkship, under the guidance of two physicians
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.