*Adjusted mean donation rates estimated using linear spine function assessing differences in rates of donation before and after legislation enactment. Year ‘0’ represents the year legislation was enacted for each state. Negative years represent years before legislation was enacted for each state; positive numbers represent years after legislation was enacted for each state. Solid lines represent adjusted (for annual incidence and prevalence of end-stage renal disease in each state and type of legislation enacted) mean donation rate among states. Dotted lines represent projected mean rate of donation in legislation had not been enacted in states. (A) ^§Slopes of regression lines represent mean increase in overall living kidney donation rate per year during years before legislation was enacted in states (a) and mean increase in overall living kidney donation rate per year during years after legislation was enacted in states (b) presented as mean slope (95% CI). †Mean increase in rate per year after legislation was enacted not statistically significantly greater than before legislation was enacted (change (95% CI): −0.71 (−1.43 to 0.02), p = 0.06. (B) ^§Slopes of regression lines represent mean increase in donation rate per year during years before legislation was enacted in states (a) and mean increase in living-related kidney donation rate per year during years after legislation was enacted in states (b) or mean increased in living-unrelated kidney donation rate per year during years before legislation was enacted (c) and mean increase in living-unrelated kidney donation rate per year during years after legislation was enacted (d) presented as mean slope (95% CI). ‡Mean increase in rate per year after legislation was enacted statistically significantly less than rate of increase before legislation was enacted (change in mean increase (95% CI): −1.00 (−1.59 to −0.42), p < 0.01). §Mean increase in rate per year after legislation was enacted statistically significantly greater than rate of increase before legislation was enacted (change in mean increase (95% CI): 0.26 (0.04 to 0.47), p = 0.02).

Number of (continental U.S.) states* enacting legislation providing support for living organ donors and other federal initiatives from 1988–2005.

*Adjusted mean donation rates estimated using linear spine function assessing differences in rates of donation from before 1997, when federal legislation/initiatives commenced, from 1997 to 2002, and from 2002 to 2006. Dotted lines represent adjusted (for annual incidence and prevalence of end-stage renal disease in each state) mean donation rate among states with legislation. Solid lines represent adjusted (for annual incidence and prevalence of end-stage renal disease in each state) mean donation rate among states without legislation. (A) ^§Slopes of regression lines represent mean increase in overall living kidney donation rate per year before 1997 (a), from 1997 to 2002 (b), and after 2002 (c) for states with legislation; and mean increase in overall living kidney donation rate per year before 1997 (d), from 1997 to 2002 (e), and after 2002 (f) for states without legislation; presented as mean slope (95% CI). **CI = Confidence Interval. †Mean increase in rate per year after 2002 (c) statistically significantly less than mean increase in rate per year during 1997–2002 (b) for states with legislation (change (95% CI): −2.28 (−3.29 to −1.27), p < 0.01). ‡ Mean increase in rate per year from 1997–2002 (e) statistically significantly greater than mean increase in rate per year before 1997 (d) for states without legislation (change (95% CI): 1.18 (0.57 to 1.81), p < 0.01). §Mean decrease in rate per year after 2002 (f) statistically significantly less than mean increased in rate per year during 1997–2002 (e) for states without legislation (change (95% CI): −2.44 (−3.43 to −1.46), p < 0.01). (B) ^§Slopes of regression lines represent mean increase in living-related and living-unrelated donation rates (respectively) per year before 1997 (a and g), from 1997 to 2002 (b and h), and after 2002 (c and i) for states with legislation; and mean increase in living-related and unrelated donation rates (respectively) per year before 1997 (d and j), from 1997 to 2002 (e and k), and after 2002 (f and l) for states without legislation; presented as mean slope (95% confidence interval). †Mean increase in rate per year after 2002 statistically significantly less than rate of increase during 1997–2002 (change in mean increase (95% CI): −2.05 (−2.92 to −1.19), p < 0.01). ‡Mean decrease in rate per year after 2002 statistically significantly less than rate of increase during 1997–2002 (change from previous mean increase (95% CI): −1.71 (−2.61 to −0.82), p < 0.01). §Mean increase in rate per year from 1997 to 2002 statistically significantly greater than rate of increase before 1997 (change in mean increase (95% CI):0.75 (0.56 to 0.94), p < 0.01). ¶Mean increase in rate per year after 2002 statistically significantly less than rate of increase during 1997–2002 (change in mean increase (95% CI): −0.47 (−0.77 to −0.17), p < 0.01). ‡‡Mean increase in rate per year from 1997 to 2002 statistically significantly greater than rate of increase before 1997 (change in mean increase (95% CI):1.07 (0.86 to 1.28), p < 0.01). §§Mean increase in rate per year after 2002 statistically significantly less than rate of increase during 1997–2002 (change in mean increase (95% CI): −0.84 (−1.17 to −0.51), p < 0.01).