{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T05:39:34Z","timestamp":1784957974838,"version":"3.55.0"},"reference-count":19,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2022,9,9]],"date-time":"2022-09-09T00:00:00Z","timestamp":1662681600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Donor service area was removed from kidney and pancreas allocation system in the United States on March 15, 2021 in favor of a distance based policy to provide geographic equity to access to transplantation. The policy change was introduced at a time when ongoing Coronavirus Disease 2019 (COVID\u201019) pandemic cases were declining following the first delta wave.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this Scientific Registry of Transplant Recipients based study, deceased donor kidney transplant recipients between March 15 and December 2 of 2019, 2020 and 2021 were compared representing pre\u2010policy change, pre\u2010COVID cohort; pre\u2010policy change, early COVID cohort; and post\u2010policy change, late COVID cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 11336, 11808, and 12914 kidney transplants in the 2019, 2020, and 2021 cohorts, respectively. Proportion of kidney transplants increased from 8798 (78%) to 9496 (80%) to 11152 (86%), and decreased from 2538 (22%) to 2312 (20%) to 1762 (14%) within and beyond 250 nautical miles in subsequent years. Median distance between donor and transplant hospital increased (73\u00a0vs. 63\u00a0vs. 119 nautical miles, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001) and mean cold ischemia time increased (18.1\u00a0vs. 17.8\u00a0vs. 19.9\u00a0h, <jats:italic>P<\/jats:italic>\u00a0&lt; .001). Access to transplantation did not change for various racial groups (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.07), pediatric patients (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.29), dialysis vintage of &gt;5 years (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.21), veterans (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.07) and decreased for those with calculated PRA of 99% and 100% (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001). Rate of kidney discard (19.6%\u00a0vs. 20.4%\u00a0vs. 24%) remained high. Although there were numerical increases in transplants from donors with donation after circulatory death, donor acute kidney injury, kidney donor profile index &gt;85% and donor age &gt;60 years in successive years, rates of kidney discard also increased proportionally.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Improvement in the access to transplantation following the policy change was attenuated by the concurrent prevalence of the COVID\u201019 pandemic.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.14797","type":"journal-article","created":{"date-parts":[[2022,8,21]],"date-time":"2022-08-21T11:08:40Z","timestamp":1661080120000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Dual impact of donor service area removal from kidney allocation system and Coronavirus Disease 2019 pandemic on access to transplantation"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3745-7533","authenticated-orcid":false,"given":"Srijan","family":"Tandukar","sequence":"first","affiliation":[{"name":"John C. McDonald Regional Transplant Center, Willis\u2010Knighton Medical Center  Shreveport Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5248-8066","authenticated-orcid":false,"given":"Zenith","family":"Tandukar","sequence":"additional","affiliation":[{"name":"University of Minnesota  Saint Paul Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,9,9]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14922"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16441"},{"key":"e_1_2_8_4_1","unstructured":"Removal of DSA and region from kidney allocation policy \u2010 OPTN. Accessed: March 4 2022.https:\/\/optn.transplant.hrsa.gov\/professionals\/by\u2010organ\/kidney\u2010pancreas\/kidney\u2010allocation\u2010system\/removal\u2010of\u2010dsa\u2010and\u2010region\u2010from\u2010kidney\u2010allocation\u2010policy\/"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000003523"},{"key":"e_1_2_8_6_1","unstructured":"Simulated Allocation Models. Accessed: March 4 2022.https:\/\/www.srtr.org\/requesting\u2010srtr\u2010data\/simulated\u2010allocation\u2010models\/"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14622"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2019.08.018"},{"key":"e_1_2_8_9_1","unstructured":"Distribution of Kidneys and Pancreata from Alaska \u2010 OPTN. Accessed: March 4 2022.https:\/\/optn.transplant.hrsa.gov\/policies\u2010bylaws\/public\u2010comment\/distribution\u2010of\u2010kidneys\u2010and\u2010pancreata\u2010from\u2010alaska\/"},{"key":"e_1_2_8_10_1","unstructured":"Final rule \u2010 OPTN. Accessed: March 4 2022.https:\/\/optn.transplant.hrsa.gov\/about\/final\u2010rule\/"},{"key":"e_1_2_8_11_1","unstructured":"Policies \u2010 OPTN. Accessed: March 4 2022.https:\/\/optn.transplant.hrsa.gov\/policies\u2010bylaws\/policies\/"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e3181ac620b"},{"key":"e_1_2_8_13_1","unstructured":"EPTS calculator \u2010 OPTN. Accessed March 3 2022.https:\/\/optn.transplant.hrsa.gov\/data\/allocation\u2010calculators\/epts\u2010calculator\/"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/tri.13840"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.NAJ.0000751076.87046.19"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.02690221"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16982"},{"key":"e_1_2_8_18_1","unstructured":"Regulations.gov. Accessed: June 10 2022.https:\/\/www.regulations.gov\/document\/CMS\u20102019\u20100187\u20100001"},{"key":"e_1_2_8_19_1","unstructured":"BookerS GaunttK Eliminate use of DSA and region from kidney allocation 6 month post\u2010implementation monitoring report. Published online 2021."},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2019.2322"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.14797","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ctr.14797","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.14797","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T15:53:31Z","timestamp":1692460411000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.14797"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,9]]},"references-count":19,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2022,11]]}},"alternative-id":["10.1111\/ctr.14797"],"URL":"https:\/\/doi.org\/10.1111\/ctr.14797","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,9]]},"assertion":[{"value":"2022-05-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-08-16","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-09-09","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e14797"}}