OPTN Board approves elimination of race-based calculation for transplant candidate listing

Published on: Tuesday, June 28, 2022

Richmond, Va. - The Board of Directors of the Organ Procurement and Transplantation Network, at its meeting June 27, unanimously approved a measure to require transplant hospitals to use a race-neutral calculation when estimating a patient’s level of kidney function. The action, to take effect July 27, will ensure that all candidates are consistently assessed in an equitable fashion.

“This is an important step forward, in keeping with broad efforts to provide equitable healthcare for all,” said Matthew Cooper, M.D., president of the board. “Communities of color are disproportionately affected by end-stage kidney disease, so we must do all we can within our power to ensure that they receive the utmost access to lifesaving care.”

The action will require all transplant hospitals to use race-neutral calculations when estimating a candidate’s glomerular filtration rate (GFR) for any purpose covered by OPTN policy. GFR is a measure of how quickly a person’s kidneys remove a waste product called creatinine from the blood. GFR can be measured directly or estimated (eGFR) using various calculations.

For a number of years, some eGFR calculations have included a modifier for patients identified as Black. This practice has led to a systemic underestimation of kidney disease severity for many Black patients. Specifically in organ transplantation, it may have negatively affected the timing of transplant listing or the date at which candidates qualify to begin waiting time for a transplant.

The board action permits transplant programs to update the date for which a candidate qualified for transplant waiting time, if the program is able to determine the candidate’s current waiting time credit was based on a race-based eGFR. As currently approved, such an adjustment could occur as far back as the date the candidate was initially listed for a transplant.

The OPTN will further study the potential of providing additional waiting time credit if it would predate the time at which the candidate was listed for a transplant. This will be developed as a proposal and presented for public comment in late summer 2022.

The OPTN Minority Affairs and Kidney Transplantation Committees co-sponsored the proposal approved by the board. The removal of race variables from eGFR calculations has been broadly supported by institutions 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). Improving equity in access to transplant opportunities for patients is an OPTN strategic goal.