Rachel Patzer-helmed study finds national kidney policy change increased some patients’ transplant referrals and evaluations
MARCH 2022
After analyzing data from three southeastern states, a study led by Rachel Patzer, PhD, MPH, Professor and Director of the Emory Health Services Research Center, found that following the implementation of the national kidney allocation system (KAS) in 2014, access to early steps in the kidney transplant process increased for some patients.
The new policy changed the start of allocation time from the date of waitlisting to the date of diagnosis of end-stage kidney disease, and was enacted in part to improve equity of transplantation access. The researchers observed that dialysis facilities referred more newly diagnosed patients and transplant centers evaluated more new patients following initiation of the policy, but fewer of these patients were placed onto the transplant waitlist. Meanwhile, prevalent patients (those who had been on dialysis for multiple years) experienced significantly higher waitlisting rates than pre-KAS levels, but showed no notable increase in referral or evaluation starts.
"One unintended consequence of the national policy change was a decline in waitlisting nationally, which was probably due to a decreased urgency to waitlist new patients who would still have to wait several years to receive a transplant," says Dr. Patzer. "Our research suggests that waitlisting has increased among patients who are most likely to go to the top of the waiting list and get transplanted faster, which is a good thing. However, our finding that referrals and evaluations have not increased among this group suggests that greater awareness of the policy change among referring providers may be needed."
This study, published in the American Journal of Kidney Diseases by Dr. Patzer and collaborators from nine other transplant centers representing the Southeastern Kidney Transplant Coalition, implies that that the KAS may have influenced changes in dialysis facility and transplant center behaviors. The potential to have such an impact underscores the importance of collecting surveillance data on pre-waitlisting process measures nationally, particularly as changes in kidney allocation and new quality measures in dialysis facilities and transplant programs are under development.
