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New pre-transplant performance metric to implement July 2024

Published on: Monday, April 15, 2024

A new risk-adjusted pre-transplant performance monitoring metric- the pre-transplant mortality rate ratio- will go into effect July 25, 2024. The OPTN Membership and Professional Standards Committee (MPSC) recognizes that a patient’s goal is to gain access to transplant, not just to a program’s waiting list. The pre-transplant mortality rate ratio metric aims to increase the likelihood that a patient makes it to transplant alive by encouraging improved waiting list management activities and incentivizing more aggressive offer acceptance practices.

This metric is the third and final phase of a comprehensive monitoring system the MPSC developed to more holistically evaluate transplant program performance.

This monitoring system was approved by the OPTN Board of Directors in 2021 and was available for community input during the 2021 Summer comment period.

What does the pre-transplant mortality rate ratio consider?

The pre-transplant mortality rate ratio indicates whether patients listed at a program are more or less likely to die prior to receiving a transplant than expected.

This risk-adjusted metric compares a transplant program’s observed pre-transplant mortality rate to its expected pre-transplant mortality rate, based on mortality of patients with similar characteristics and length of time on the waiting list across the nation.

What patients are included?

  • Patients listed at a program before the end of the evaluation interval
  • Patients alive at the beginning of the evaluation interval

The OPTN will provide additional information on implementation, education, and resources over the next few months.

The importance of risk adjustment

The new metrics will be risk-adjusted, which helps the MPSC account for differences in patients and donors. Risk-adjusting metrics means that transplant programs are not penalized for transplanting more complex patients or accepting more complex organs in order to increase utilization.

Watch a presentation about how risk-adjustment works.


 We are glad to provide any information you need as the community prepares for the implementation of the new performance metrics. Please contact OPTN Contractor staff at