Centrality and Equity in Access to Kidney Transplant: A Spatial Flow Analysis in Paraná State, Brazil

To analyze the displacement of kidney patients from their municipalities of residence to transplant centers in the state of Paraná, using spatial analysis that considers the interaction between geographic space and flows. This cross-sectional ecological study employed spatial analysis techniques using short- and long-distance interaction indices (SDII and LDII) and global and local geographic centrality indices (GGCI and LGCI) to categorize spatial units as isolated, externally oriented, locally oriented and global. Spatial patterns of patient displacement were compared with the current configuration of transplant centers, and an optimized model was generated through spatial realignment. In the current model, mean SDII and LDII were 7.259 and 2.615 (GGCI = 0.769) at 60 min, and 5.561 and 2.104 (GGCI = 0.590) at 120 min (p > 0.05). The southwest, northwest, and north regions of the state were classified as isolated and externally oriented, while in the southern region, we found global and locally oriented units, where the increase in travel time was significant. In the optimized model, SDII and LDII increased to 11.072 and 4.429 (GGCI = 0.978) at 60 min (p = 0.003) and to 9.045 and 5.033 (GGCI = 0.965) at 120 min (p = 0.028), indicating a more balanced spatial structure. The results of this study can guide strategic planning and development public policies to enhance a more equitable transplant system in Brazil.