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Early monitoring report shows Black kidney candidates are receiving waiting time modifications after implementation of new policies

Published on: Monday, December 4, 2023

A new data monitoring report evaluates key measures of two community driven policies that recently went into effect. These policies aimed to address inequities for Black kidney candidates by requiring transplant programs to use eGFR calculations1 that do not include race variables and providing a pathway for waiting time modifications for Black kidney candidates who were affected by transplant program use of race-inclusive eGFR calculations.

In the six months since implementation of the waiting time modification policy, more than 6,100 Black candidates have had their waiting times modified. The median (statistical midpoint) of additional waiting time awarded to these candidates was 1.7 years.

NOTE: these numbers are accurate as of July 5, 2023.2 Additional attestations and waiting time modifications have been completed to date, and all kidney programs are required to submit an attestation to the OPTN by Jan. 3, 2024, confirming their program has:

  • Assessed their waiting list, submitted modifications and supporting documentation, and notified candidates

Additional key takeaways

The below key point is from one-year post implementation of the OPTN requirement for race-neutral eGFR calculations.3

  • There were no large changes to the kidney waiting list or to transplant recipients – distributions were similar across the pre and post policy eras

The below key points are from six months post implementation of the waiting time modification policy.

  • 6,103 waiting time modifications were processed with a median (statistical midpoint) of 1.7 years given to modified registrations
  • 491 candidates with a waiting time modification received a deceased donor transplant and 15 received a living donor transplant
  • 12 of the 232 active kidney programs submitted an attestation to the OPTN

Again, many more attestations and waiting time modifications have been completed to date, and all kidney programs are required to submit an attestation by Jan. 3, 2024. 

Policies address inequities for Black kidney candidates

The OPTN Minority Affairs and Kidney Committees co-sponsored these policy proposals that were approved by the OPTN board in June 2022 and Dec. 2022 respectively. The first policy, Establish OPTN Requirement for Race-Neutral eGFR Calculations, went into effect July 27, 2022. The second, Modify Waiting Time for Candidates Affected by Race-Inclusive eGFR calculations, went into effect Jan. 5, 2023.

Improving equity in access to transplant opportunities for patients is an OPTN strategic goal. The removal of race variables from eGFR calculations was broadly supported by organizations including the National Academies of Sciences, Engineering and Medicine, as well as a joint task force of the American Society of Nephrology (ASN) and the National Kidney Foundation (NKF).

Why we monitor data and what’s next

The report was presented to the Kidney and the Minority Affairs Committees on Nov. 20, 2023. The OPTN monitors donation and transplant policies to understand whether changes to the system are meeting the intended goals, and to determine if they are resulting in unintended consequences. The Kidney Transplantation and Minority Affairs Committees will continue to monitor these policies as data is submitted, and subsequent monitoring reports will be released on an ongoing basis as outlined in the briefing papers.

Find additional information, FAQs, and education on this policy in the toolkit on the OPTN website.

1 The estimated glomerular filtration rate, or eGFR for short, measures how slowly or quickly kidneys remove a waste product called creatinine from the blood. This calculation helps doctors understand how sick a kidney patient is.

2 The post-policy era for the OPTN Modify Waiting Time For Candidates Affected by Race-Neutral eGFR Calculations Policy is defined as Jan. 5, 2023 to July 5, 2023.

3 The pre-policy era for the Establish OPTN Requirement for Race-Neutral eGFR Calculations policy is defined as July 27, 2021 to July 26, 2022 and the post policy era is defined as July 27, 2022 to July 26, 2023.