RESEARCH PROPOSAL: The effect of distance from kidney transplant center and the effect of size of kidney transplant center on the speed of kidney transplantation in the U.S., Part I

Eliyahu Lazovsky
Northern Illinois University
Department of Public Health
PHHE 611
All rights reserved to the author.
Monday, December 7, 2009

Project Summary
The objective of this study is to study the correlation between the distance transplants recipients live from their transplant centers and the speed with which they obtain a transplant. The study also studies the correlation between the quantity of transplants done at a given transplant center and the speed with which they obtain a transplant.
One hypothesis that is being tested is the closer a person lives to a transplant center, the less time they will spend on the kidney transplant waiting. Another hypothesis that is being tested is the greater the quantity of kidney transplants performed at the person’s transplant center, the less time that will be spent on the kidney transplant waiting list.
The study will be a cross-sectional systematic sample of 1,000 people out of the approximately 10,000 people who received kidney transplants from the U.S. kidney transplant waiting list from the from January, 1, 2000 through December 31, 2009. A questionnaire with questions relating to the participants’ kidney transplantation experiences will be the source of the data.
There is an extreme shortage of kidneys available for transplantation in the United States. Thousands of people die annually while awaiting a transplant that they never receive. This study attempts to determine whether geographical distance to a transplant center measured in miles and the size of the transplant center measured by the number of kidney transplants performed annually at the center play a role in the speed with which a person obtains a kidney transplant.
Lessons learned from this study can be used to assess the equity of the current transplant process and to help determine which variables currently are associated with quicker access to kidney transplantation. Hopefully, lessons learned from people who receive their kidney transplants in a quicker time frame can be applied to currently underserved and more slowly served populations to decrease their time on the waiting list which will also lead to a decrease in this population’s mortality rate.
Background
In 2006, 3,916 people in the U.S. died while awaiting a kidney transplant. (“25 Facts,” 2008). These people, the grieving families they left behind, and all of the people on the transplant waiting list are the reasons this study is important. There were “87,654 deaths in all patients undergoing ESRD [end stage renal disease] treatment” in 2006. (“Kidney and,” 2008). There is a great need cut down the number of deaths from ESRD.
This descriptive study will attempt to investigate the effect geographical proximity to a major transplant center and the size of the transplant center have on the speed with which a person is able to obtain a kidney transplant after they have been placed on the kidney transplant waiting list.
The research questions are: what type of association is there between the distance to a transplant center and the time a person spends on the waiting list awaiting their kidney transplant; and what type of association is there between the size of the transplant center and the time a person spends on the waiting list awaiting their kidney transplant.
“Transplant center size and proximity, as well as regional variations in matching algorithms, may also play a role” in patients abilities to obtain a kidney transplant. (Alexander, 1998, p.1151).
Intuitively, it would seem that the closer one lives to a major transplant center, the higher the chance of the patient getting a kidney transplant because then there is the expertise and infrastructure in place (the kidney needs to be transplanted quickly so it doesn’t die before it is implanted into the patient.)
A study of people on the Scotland renal registry analyzed data to determine various characteristics of people and how it effected their chances of being put on the transplant waiting list and the chance of getting kidney transplants (Oniscu, 2003, p.1). This study found that the further a person lived from a transplant center, the quicker they were put on a kidney transplant waiting list, but once they were on the list, they obtained the kidneys at similar speeds to people who lived closer to the transplant center (p.2). It also found inequities which included inequities based on distance the patient was from the transplant center, sex, dialysis status, and at which transplant center was the patient put on the waiting list (p.4). The study does not focus on the affect the size of the transplant center has on the speed of the transplant. This study also only studies people on the Scotland Renal Registry.
This study will use the same type of approach to study the U.S. transplant center because laws and algorithms that calculate and govern who gets organs and when they get them change from country to country so this study will add to the literature by seeing how various characteristics affect the speed with which a person can obtain a kidney transplant in the U.S.
This study will also add internationally to the literature by examining the effect of the size of the transplant center has on the amount of time a person spends on the U.S. kidney transplant waiting list. A similar study has not been found in the literature review. Studies have been done that compare transplants centers to each other, but they have never focuses on the effect that the quantity of transplant s performed at each center has on the speed with which a transplant is obtained by people at that center compared to people at other centers.
Speed with which a person obtains a transplant is crucial because the longer a person remains on dialysis, the worse the outcomes of the kidney transplants tend to be. “Waiting time had the strongest effect on survival once a patient got on a transplant list. At centers with the longest wait times, patients' risk of death was a third higher than at those with the shortest waits”(“Shorter Wait,” 2009). This is why this study will focus on speed of the transplant. The quicker the patient obtains a transplant, the lower their risk of death.
Some studies acknowledge that proximity to transplant center may play a role but this study will try to determine what role demographic characteristics play. Many studies compare the chances of obtaining a transplant based on demographic characteristics but this study will attempt to study the speed with which various demographic groups are able to obtain a transplant, not just whether they get a transplant or don’t get a transplant.