Racial Disparity in Deceased Donor Kidney Transplantation: Causes and Solutions

End Stage Renal Disease (ESRD) is the last stage of Chronic Kidney Disease and if not treated, will result in a certain death of the patient. Currently, transplantation of a new kidney is the treatment option with the highest life expectancy. Despite the goal to provide equity among patients, some ethnic minority groups have a lower probability to get a deceased donor kidney. This thesis analytically shows that two fundamental matching rules, which are used in matching procedures around the world, cause racial disparity. We examine the role of identical blood type matching and HLA type matching. We have used the average waiting time of an ethnic group as indicator of racial disparity and have used queuing models to calculate the average waiting times. We have shown, with the stochastic ordering theory, that different blood type distributions and different ESRD and donor rates among ethnic groups cause racial disparity if identical blood type matching is used. We have also shown, with a probabilistic service discipline in a queuing model, that HLA type matching leads to racial disparity. Every ethnicity has a different probability of finding a donor with a suitable HLA profile, which negatively affects the average waiting time of ethnic minorities. We have formulated an approach to solve the racial disparity that occurs when the identical blood type matching and HLA type matching is used. Reducing this disparity contains three parts: First, a number of (compatible) cross transplants between blood types must be allowed. Second, kidneys that are used for these cross transplants must have the right composition of ethnicities. Third, the selection probabilities of ethnic groups within blood types must be adjusted. It is, due to the high complexity of this model, not possible to find an analytical expression that calculates the values of these three parts within the scope of this research. We however give an extensive description of the modeling approach.