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OPTN Registration Fees

Registration Fee Collection

HRSA has developed a Pay.gov user guide for transplant centers as they transition to submitting payments through Pay.gov. You can view the guide with the link below:
Pay.gov user guide

What is the OPTN patient registration fee?

Most of the operating costs of the OPTN are paid for by patient registration fees. These fees are paid by transplant programs for each candidate they add to the national transplant waiting list. The fee amount is set each year by the OPTN Board and approved by HRSA.

New OPTN patient registration fee rate for FY26

On August 25, 2025, HRSA approved the OPTN Board of Directors’ recommended Fiscal Year (FY) 2026 OPTN Patient Registration Fee of $1,036 per transplant candidate. This fee will go into effect on October 1, 2025.

HRSA’s decision is based on the following considerations:

  1. For the past three years HRSA has not approved a fee increase based on the availability of funds in the OPTN operating accounts.
  2. The OPTN has expended the available funds, now requiring additional resources to cover the costs of OPTN operations.
  3. The recommended fee includes funding to address critical priorities including:
    1. HRSA directives (i.e., allocation out of sequence, donation after circulatory death policy, normothermic regional perfusion);
    2. Secretarial Data Directives; and
    3. Enhancing the security and stability of the OPTN IT system.

HRSA will begin to bill transplant centers in October 2025 for transplant candidates added to the OPTN waiting list after August 31, 2025.

  • October 2025 invoices (for candidates added between September 1–30, 2025) will reflect the Fiscal Year 2025 (current) fee amount of $868 per candidate.
  • November 2025 invoices (for candidates added between October 1–31, 2025) will reflect the Fiscal Year 2026 (new) fee of $1,036 per candidate.

OPTN patient registration fee collection: transition and timeline

In November 2025, the new federal funding bill (HR 5371) was signed into law and extends HRSA’s authority to collect OPTN patient registration fees that was originally granted in the 2025 Full-Year Continuing Appropriations and Extensions Act (Sec. 1904 in P.L. 1968). For decades, UNOS, as the sole OPTN contractor, has managed this fee collection process.

Under the new law, HHS will now assume responsibility for collecting these fees, a shift designed to:

  • Enhance transparency in how fees are collected and used
  • Expand opportunities for multiple best-in-class contractors to support the operations of the OPTN
  • Strengthen oversight, performance, and accountability across the network

HRSA has reached out to transplant hospitals to confirm their billing points of contact and provide information on the transition to the new fee collection process.

HRSA is preparing to send invoices to transplant centers for OPTN patient registrations that occurred as of September 1, 2025. HRSA’s anticipated timeline for sending these invoices includes:

  • September Invoices (patients added between September 1-30): Invoices sent by November 21st
  • October Invoices (patients added between October 1-31): Invoices sent by December 5th
  • November Invoices (patients added between November 1-30): Invoices sent by December 12th

All subsequent invoices will be billed around the 15th of each month. As a reminder, invoices will be sent to both the Transplant Program and Billing/Invoice Contact(s) provided to HRSA. Any overdue invoices, including invoices for patients added to the waitlist before August 31, 2025, should still be paid to the OPTN contractor.

HRSA will only bill transplant centers for the OPTN Patient Registration Fee. The OPTN Patient Registration Fee is the only fee transplant centers are required to pay as OPTN members to support the operations of the OPTN under the OPTN Final Rule (42 CFR § 121.5). Any additional fees, such as the UNOS data fee, are payable at the discretion of the Transplant Hospital. Neither HRSA nor the OPTN has a role in billing or collecting those optional fees.

HRSA anticipates collecting registration fees via Pay.gov, a secure, no-cost federal payment platform used by many U.S. government agencies. HRSA will continue to keep transplant hospitals informed with timely email and webpage updates, detailed guidance, and clear timelines to support a smooth transition. Please see the HRSA Pay.gov User Guide for more information for transplant centers. If you are a transplant hospital with questions regarding registration fees, please contact OPTNFeeSupport@hrsa.gov.

Improving transparency

The new law also introduces new transparency measures, providing the transplant community and the public with greater visibility into how registration fees are allocated and spent. These measures ensure registration fees support OPTN operations and, ultimately, improve outcomes for patients and families.

HRSA will continue to update this webpage to share information on the new fee collection process, fees collected, and how fees were used to support OPTN operations.