Is the allocation of kidney-transplants among MEDICARE patients in the US maximizing the total gain in health expectancy among all potential recipients ?

Monique Zimmermann-Stenzel, University of Marburg
Ulrich Mueller, University of Marburg

The potential recipients of kidney transplants are all ESRD (End Stage Renal Disease) patients covered by MEDICARE on the waiting list. Transplant allocation is optimal, if it maximizes the sum of individual gains in life expectancy among all patients. Data base is a longitudinal subsample of the USRDS (United States Renal Data System), N=1506 observed end 1993 - end 2001. Controling for socio-economic, behavioural, biomedical parameters, we simulated the survival functions of all recipients, as if they had not received a transplant, and of all nonrecipients, as if they had received one, and calculated real and simulated DALYs for all patients. By comparing the real and simulated DALYs for the recipients and the non recipients we found that the allocation of kidney-transplants is optimal. This is a non-trivial result given the multistage allocation decision process in which many criteria are applied beyond the ones in our post hoc evaluation.