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Reducing Geographic Disparity in Access to Kidney Transplantation Using Artificial Intelligence and Operations Research

Award Number: R01DK149346
ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 08/20/2026
PERIOD OF PERFORMANCE END DATE: 05/31/2031

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Reducing Geographic Disparity in Access to Kidney Transplantation Using Artificial Intelligence and Operations Research - PROJECT SUMMARY/ABSTRACT Geographic disparity in access to deceased donor kidney transplants in the U.S. is substantial, with wait times varying up to tenfold geographically, contributing to nearly half of waitlist candidates becoming too ill for a transplant. Although a 2021 organ allocation policy aimed to reduce this disparity through wider organ sharing, it has led to unintended consequences like increased wait time uncertainty and a higher possibility of organ non-use. There are substantial knowledge gaps in the causal understanding of the complex dynamics, such as whether Allocation Out-of-Sequence (AOOS) causes geographic disparity and whether there is an interplay between geographic disparity and center organ acceptance behavior over time. Further, what should be the optimal kidney allocation boundary to jointly minimize geographic disparity and organ transplantation system inefficiencies? Research in this area is urgently needed to provide quantitative and qualitative knowledge to inform new policies that reduce geographic disparity, mitigate unintended systemic inefficiencies, and create fairer access to kidney transplantation, aligning with the intentions of the National Organ Transplant Act (NOTA) of 1984 and the Organ Procurement and Transplantation Network (OPTN) Final Rule. Our overarching research goal is to achieve geographical fairness in organ transplantation by understanding the complex dynamics of the allocation system using advanced statistical methods, artificial intelligence, and operations research. This study addresses three key areas to inform better policy: Specific Aim 1 will determine the causal effect of Allocation Out-of-Sequence (AOOS) on geographic disparity, hypothesizing that AOOS exacerbates the disparity despite reducing organ non-use. Specific Aim 2 will characterize the interplay between geographic disparity and center organ acceptance practices over time, hypothesizing a nonlinear relationship. Specific Aim 3 will determine the optimal boundary for organ allocation to improve placement efficiency and reduce geographic disparity while considering logistical and organ viability constraints, hypothesizing that a dynamic boundary adapting to patient population spread and organ arrival rates will be most effective. These hypotheses will be evaluated using an innovative and advanced statistical modeling, artificial intelligence, and operations research approaches on the retrospective cohort study of the de-identified Scientific Registry of Transplant Recipients (SRTR) and Potential Transplant Recipient (PTR) datasets from January 2019 through March 2023. SRTR is a U.S. national registry that maintains information on all the patients who are at various stages of their transplant journey. Specifically, SRTR contains data on the transplant waiting lists, the donor and recipient matching process, deceased donors, living donors, and transplant recipients.


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 = $327,450 )
2026	2026	THE RESEARCH FOUNDATION FOR THE STATE UNIVERSITY OF NEW YORK	520 LEE ENTRANCE STE 211	AMHERST	NY	14228	ERIE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	1	8/20/2026	NEW	$327,450
														Subtotal = $327,450

Grand Total All Awards = $327,450

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Reducing Geographic Disparity in Access to Kidney Transplantation Using Artificial Intelligence and Operations Research

Award Number: R01DK149346

ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 08/20/2026

PERIOD OF PERFORMANCE END DATE: 05/31/2031

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