Impact of the new kidney allocation system A2/A2B --> B policy on access to transplantation among minority candidates

UMMS Affiliation

Department of Surgery, Transplant and Hepatobiliary Surgery Division, UMass Memorial Medical Center

Publication Date


Document Type



Analytical, Diagnostic and Therapeutic Techniques and Equipment | Bioethics and Medical Ethics | Health Policy | Health Services Administration | Health Services Research | Nephrology | Race and Ethnicity | Surgery


Blood group B candidates, many of whom represent ethnic minorities, have historically had diminished access to deceased donor kidney transplantation (DDKT). The new national kidney allocation system (KAS) preferentially allocates blood group A2/A2B deceased donor kidneys to B recipients to address this ethnic and blood group disparity. No study has yet examined the impact of KAS on A2 incompatible (A2i) DDKT for blood group B recipients overall or among minorities. A case-control study of adult blood group B DDKT recipients from 2013 to 2017 was performed, as reported to the Scientific Registry of Transplant Recipients. Cases were defined as recipients of A2/A2B kidneys, whereas controls were all remaining recipients of non-A2/A2B kidneys. A2i DDKT trends were compared from the pre-KAS (1/1/2013-12/3/2014) to the post-KAS period (12/4/2014-2/28/2017) using multivariable logistic regression. Post-KAS, there was a 4.9-fold increase in the likelihood of A2i DDKT, compared to the pre-KAS period (odds ratio [OR] 4.92, 95% confidence interval [CI] 3.67-6.60). However, compared to whites, there was no difference in the likelihood of A2i DDKT among minorities post-KAS. Although KAS resulted in increasing A2/A2B-->B DDKT, the likelihood of A2i DDKT among minorities, relative to whites, was not improved. Further discussion regarding A2/A2B-->B policy revisions aiming to improve DDKT access for minorities is warranted.


disparities, ethics and public policy, ethnicity/race, health services and outcomes research, kidney transplantation/nephrology, organ procurement and allocation

DOI of Published Version



Am J Transplant. 2018 Aug;18(8):1947-1953. doi: 10.1111/ajt.14719. Epub 2018 Mar 31. Link to article on publisher's site

Journal/Book/Conference Title

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

Related Resources

Link to Article in PubMed

PubMed ID