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New pre-transplant performance metric now in effect, offer acceptance rate ratio

Published on: Thursday, September 14, 2023

A new risk-adjusted pre-transplant performance monitoring metric- the offer acceptance ratio- went into effect on July 27, 2023. Monitoring of offer acceptance will increase organ transplants by:

  • Prioritizing offer acceptance as a marker of transplant hospital performance
  • Incentivizing utilization of offer acceptance screening/offer filter tools
  • Improving system efficiency
  • Encouraging evaluation and broadening of transplant program offer acceptance criteria

This metric is Phase 2 of a comprehensive monitoring system developed by the Membership and Professional Standards Committee (MPSC) to more holistically evaluate transplant program performance. Phase 1 took effect July 14, 2022, which included two new post-transplant metrics, the 90-day graft survival hazard ratio and the 1-year conditional on 90-day graft survival hazard ratio. The Board of Directors of the Organ Procurement and Transplantation Network (OPTN) approved these changes December 2022.

An additional metric, pre-transplant (waitlist) mortality rate, will be implemented in July 2024.

What does the offer acceptance metric consider?

This risk-adjusted metric compares a program’s observed offer acceptance rate to the program’s expected offer acceptance rate, based on similar offers across the nation.

  • The offer acceptance rate ratio indicates whether a program was more or less likely to accept offers than expected.
  • “Expected acceptances” is the risk-adjusted number of transplants predicted at the program from the offers received.

The metric is risk-adjusted for:

  • Donor characteristics
  • Donor-candidate interactions
  • Candidate characteristics
  • The sequence number of the offer received
  • The distance of the potential recipient from the donor

A program’s offer acceptance rate ratio takes into account offers to candidates on a single waitlist for organs that are eventually accepted and transplanted.

What’s excluded?

  • Match runs that have no acceptances, any missed or bypassed responses
  • Offers to multi-organ candidates (other than kidney-pancreas candidates)
  • Offers that occurred after the last acceptance in a match run are excluded from the calculation
  • Multiple match runs from the same donor are combined and duplicate offers are excluded

What happens next?

Inquiries will be sent to transplant programs based on MPSC evaluation of SRTR reports for program performance on organ offers received from January 2022 through December 2022. Transplant programs will receive a letter informing them that they have been identified for review and providing information about available data, resources, and support. The letter also will request information about their program’s offer acceptance practices and any efforts they have already made to improve. The MPSC will review the responses and provide feedback and monitoring of the program’s progress. Read the OPTN policy notice.

A policy toolkit has more information and resources for transplant professionals about the new system, including policy documents and education.


Please contact OPTN contractor staff at for more information about performance monitoring.