Eliminating transplant waiting time inequities – With an application to kidney allocation in the USA

Inequities in waiting times for deceased donor organ transplantation have received considerable attention in the last three decades and have motivated allocation policy reforms. This holds particularly true for kidney transplantation in the United States, where more than 90,000 patients are wait listed and average waiting times vary considerably among patients from different blood types and ethnic groups. This research presents a novel approach to formally model, analyze, and optimize equity of transplant waiting times and probabilities using queuing models, network flows, and Rawls’ Theory of Justice. The presented formal models address inequities resulting from blood type incompatibilities, which are interrelated to ethnic differences in patient and donor rates. Moreover, we present results of an application to the deceased donor kidney wait lists in the United States. The findings indicate that the allocation policies currently practiced red can virtually resolve blood type related inequities in average waiting time and transplant probability.