228852 What Are My Chances? Age-based Disparities In Living Donor Kidney Transplantation

Monday, November 8, 2010

Keren Ladin, MSc , Department of Health Policy, Harvard University, Cambridge, MA
Yves Chretien, BA , Department of Statistics, Harvard University, Cambridge, MA
Erica Langnas, BA , Transplant Surgery, Beth Israel Deaconess Medical Center, Boston, MA
James Rodrigue, PhD , Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
Didier Mandelbrot, MD , Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
Martha Pavlakis, MD , Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
Douglas Hanto, MD, PhD , Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
Introduction: Despite being the optimal treatment for End-Stage Renal Disease and the favorable cost-benefit ratio, disparities in living-donor kidney transplantation persist. While age-based disparities are pervasive, the relationship between age of recipient and donor willingness and eligibility remain unexplored. Though clinicians often observe that older patients wait longer and have fewer living donors, this has not been documented thus far.

Methods: Sample included 752 recipients (1450 person-years-on-study) and 654 donors evaluated between 2004 and 2008. Using two endpoints: (1) presentation of potential donor for evaluation, and (2) LDKT, we compared the time between recipient evaluation and either the endpoint or censoring by race. Parametric survival models estimated time until first potential donor presentation, adjusting for socio-demographic, medical, and network variables.

Results: We stratified recipients by age at evaluation into five categories: younger than 40, 40-49, 50-59, 60-69, and 70 or older. Among these categories, the respective proportions who had at least a single potential donor within 1 year were 0.47, 0.43, 0.42, 0.30, and 0.21 (p <0.001). Following age 60, patients the rate of donor presentation drops precipitously, indicating a shift in willingness of donor, recipients, or both.

Conclusion: Disparities in rates of donor presentation track with age and cannot be explained by differences in measured covariates. Qualitative analysis is needed to examine whether low donation rates for elders is driven by lower willingness of potential donors to donate based on recipient age (fair innings) or lower willingness of patients to request or accept donations from younger people.

Learning Areas:
Chronic disease management and prevention
Ethics, professional and legal requirements
Public health or related public policy

Learning Objectives:
* Review and evaluate the latest research related to age-based disparities in kidney transplantation and living-donor kidney transplantation * Examine the likelihood that a patient will have potential donors present within a year by age group * Evaluate ethical arguments for and against mitigating age-based disparities in transplantation

Keywords: Health Disparities, Aging

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present this research because I serve as the Director for Ethics and Health Policy Research and have overseen this study.
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.