Does the Present Allocation of Kidney Transplants in the US Maximize the Gain in Total Life Expectancy in the Potential Recipient Population?

Monique Zimmermann-Stenzel, University of Marburg

The population of potential recipients of kidney transplants are End Stage Renal Disease patients on the waiting list. A distribution of transplants is optimal, if it maximizes the sum of all individual gains in life expectancy. Our data base is a longitudinal subsample of ESRD-patients in the US Renal Data System N=11.142 observed 1993-2001. Considering socio-economic, behavioral, biomedical parameters, we estimated the survival functions of all recipients, if they had not received a transplant, and of all non recipients, if they had received one. There were inequalities by sex, incidence age, ethnicity, education. We found hints for suboptimal distribution of transplants under present selection criteria. On average, a recipient would have lost 214 days of life expectancy without a transplant; a non recipient would have gained 322 days with one. We present models of identifiying candidates for hypothetical re-allocation, with large net gains per new recipient in every model.