Socioeconomic factors and multiple listing for cadaveric kidney transplantation among medicare end-stage renal disease program beneficiaries

E vety year, thousands of end-stage renal disease patients join waiting lists to receive a cadaver kidney transplant. According to the United Network for Organ Sharing (UNOS) Scientific Registry, there were 7,682 cadaveric kidney transplants performed in the United States in 1995, yet 3 1,045 patients were waiting for such transplants at the end of that year. As these ligures suggest, the major obstacle to transplantation is, and will continue to be, the shortage of cadaveric donor organs. Because of this shortage, waiting lists for kidney transplants can be quite long. For patients who received a transplant in 1994, UNOS Scientific Registry data showed that the median waiting time for a cadaver kidney transplant was 838 days. (Median waiting time data for 1995 are not yet available.) Because kidneys are allocated first to suitable candidates on local transplant waiting lists, many people believe that the odds of getting a transplant can be increased by acceptance onto waiting lists in more than one area (ie, by being multiply-listed). Sanlilippo et al’ found that patients who were multiply-listed waited significantly less time to receive their first kidney transplant, but they did not address the characteristics of multiple listers vis a vis patients on only one list. In other work we showed that multiple listing had a strong impact on access to a kidney transplant. Those who multiply-listed within 6 months of their initial listing were about 3.4 timzs as likely to obtain a transplant as others, and those who multiply-listed from 7 to 12 months of their first listing were about 2.6 times as likely to obtain a