THE EFFECTS OF NEW-YORK STATES BAN ON MULTIPLE LISTING FOR CADAVERIC KIDNEY-TRANSPLANTATION

Objective. To study the effectiveness of a 1990 ban by New York state on entry to more than one waiting list for a cadaver kidney transplant , and the impact of the ban on equity in access to transplantation. Da ta Sources. (1) Waiting list files from the Organ Procurement and Tran splantation Network, (2) the Health Care Financing Administration's Me dicare Program Management and Medical Information System, and (3) U.S. Census Public Use Files. Study Design. Multivariate hazard models wer e used to estimate the impact of the ban on the overall odds of multip le listing and on the odds of multiple listing at instate and out-of-s tate transplant centers. After estimating the relationship between mul tiple listing and subsequent transplantation, we used simulation techn iques to estimate the effects of a complete multiple listing ban on gr oup waiting time differentials. Independent variables included demogra phic/socioeconomic characteristics, measures of ESRD severity, general transplantation suitability, measures that affect the likelihood of f inding a good donor organ, and measures of the productivity of the tra nsplant/dialysis center. Principal Findings. The ban was associated wi th a 66 percent reduction in the rate of multiple listing for New York patients, and multiple listing at in-state transplant centers decline d by 87 percent. Simulation results suggested that even a completely e ffective ban would produce only small, mixed equity effects. Conclusio ns. While the ban was effective in reducing the proportion of patients who registered at multiple transplant centers, taken together the res ults suggest that banning multiple listing is not likely to result in large improvements in equity in access to transplantation.