Trends in kidney procurement and transplantation in New York State.

The growth in the number of Medicare patients with end stage renal disease (ESRD) in New York State receiving cadaver kidney transplants in the 1980s substantially lagged behind growth in the nation. Compared to the United States, New Yorkers on dialysis had less access to transplants. The greatest decline in transplant rates was experienced by New York's black population. During the early and mid-1980s, considerable transplant rate growth in New York City was maintained, despite very slow growth in local kidney procurement, by importing kidneys from other states, by residents seeking transplants elsewhere, and by a greater proportion of transplants going to Medicare ESRD patients. Since 1986, the number of kidneys procured in New York City increased while the number procured nationally fell. However, kidney imports to New York City dropped dramatically and thus the number of cadaver transplants declined despite the growth in local procurement. Upstate, procurement and transplants started at a higher level, but grew even more slowly.