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Does greater scrutiny of transplant centers create disparities for the sickest patients?


A new study indicates that transplant centers that receive low scores on performance evaluations tend to remove more patients from the transplant waiting list. According to US data from the Scientific Registry of Transplant Recipients on 315,796 candidates on the kidney transplant waiting list from 2007 to 2014, the rate of removal was approximately 60% higher for centers that received low performance evaluations compared with all other centers, even after adjusting for candidates' demographic and clinical characteristics.

Transplant rates significantly declined following low performance evaluations, and deaths following waitlist removal were significantly lower among candidates removed at centers with low performance evaluations. This suggests that these centers removed a relatively healthier group of patients.

The results reveal that a consequence of greater scrutiny of transplant center performance may be reduced access to transplantation for the most sick and complicated patients, because centers with poor outcomes become more conservative with their waiting list.

"These findings must be placed in perspective that numerous studies verify that the survival benefit of kidney transplantation extends to patients with multiple risk factors and with use of relatively higher risk donor organs. Thus, any policies that may stifle the growth of transplantation should be carefully examined," said Dr. Jesse Schold, lead author of the American Journal of Transplantation study. "At the same time, transplant centers must be vigilant that their processes of care are based on best clinical judgment and available empirical evidence and not irrationally influenced by regulatory oversight. Ultimately, as a field, we must critically assess whether we can align policies and care practices to best treat patients and provide transplant opportunities for recipients and donor families."


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