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Diagnosing disparities in existing and proposed allocation systems for kidney transplantation

Award Number: F32DK136310
ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: FELLOWSHIP/SCHOLARSHIP/STUDENT LOANS
PERIOD OF PERFORMANCE START DATE: 07/09/2024
PERIOD OF PERFORMANCE END DATE: 06/30/2026
AWARD TERMINATION DATE: 08/18/2026

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Diagnosing disparities in existing and proposed allocation systems for kidney transplantation - PROJECT SUMMARY/ABSTRACT All patients in the US with kidney failure should have fair and timely access to the benefits of kidney transplantation, but long-standing disparities and ineffective organ allocation policy have frustrated that promise. There have been multiple changes to the kidney allocation system to address transplant disparities, most recently in March 2021 when kidneys were prioritized to candidates listed within a 250 nautical mile radius of the hospital of the deceased donor (KAS250), rather than within fixed donor service areas. Because kidney organ allocation uses complex rules that incorporate several patient characteristics to determine which candidates receive deceased donor organs, changes aimed at mitigating one problem often have unintended consequences. For instance, a 2014 change to the allocation system increased kidney transplants for sensitized candidates but unintentionally reduced transplants for pediatric candidates 0-6 years of age. We therefore propose to comprehensively study the impact of the new allocation system, both in ensuring equitable distribution of organs to transplant centers across the US based on patient priority on the waitlist, which was the aim of the policy change, and the new policy’s impact on kidney transplant rate disparities for vulnerable populations who have historically been disenfranchised by allocation policy. The new KAS250 system will ultimately evolve to continuous allocation where transplant candidate distance from donor hospital will be one weighted component among other patient factors. Our group has an ongoing R01-funded study (R01DK132395) to design a continuous allocation system for kidneys using a computationally intensive simulation and optimization algorithm that simulates thousands of possible continuous allocation systems. We will apply our equity metrics to simulation outputs to determine the impacts of any proposed allocation system on vulnerable populations. We will also incorporate our metrics into the R01 algorithm to design a continuous allocation system that prevents inequity by design. In this project, we will accomplish the following aims: (1) To evaluate whether the supply of organs is equitably distributed among US transplant centers in the new KAS250 system (2) To develop novel metrics that describe the landscape of disparities for vulnerable populations in the new allocation system and (3) To evaluate projected disparities from simulations of proposed continuous allocation systems. The equity metrics of Aims 1 and 2 will be calculated from adjusted regression models using national databases. By performing this research while pursuing a PhD in Epidemiology at the richly resourced NYU Langone Vilcek Institute, Dr. Liyanage will receive rigorous training in epidemiology, research methodology, conceptual frameworks of social determinants of health, and simulations and machine learning as it applies to health policy, furthering her goal of becoming an independent surgeon-scientist by following the example of her mentor, Dr. Dorry Segev.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = -$1,759 )
2026	2025	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	2	8/18/2026	TERMINATION	-$1,759
														Subtotal = -$1,759

Issue Date FY: 2025 ( Subtotal = $98,744 )
2025	2025	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	2	7/8/2025	NON-COMPETING CONTINUATION	$98,744
														Subtotal = $98,744

Issue Date FY: 2024 ( Subtotal = $92,756 )
2024	2024	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	1	1/30/2024	NEW	$11,500
2024	2024	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	1	1/9/2024	NEW	$76,292
2024	2024	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	002	1	1/30/2024	NEW	$0
2024	2024	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	003	1	5/3/2024	NEW	$4,964
														Subtotal = $92,756

Grand Total All Awards = $189,741

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Diagnosing disparities in existing and proposed allocation systems for kidney transplantation

Award Number: F32DK136310

ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: FELLOWSHIP/SCHOLARSHIP/STUDENT LOANS

PERIOD OF PERFORMANCE START DATE: 07/09/2024

PERIOD OF PERFORMANCE END DATE: 06/30/2026

AWARD TERMINATION DATE: 08/18/2026

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