OPTN Board approves waiting time adjustment for kidney transplant candidates affected by race-based calculation

Published on: Thursday, January 5, 2023

St. Louis - The Board of Directors of the Organ Procurement and Transplantation Network, at its meeting Dec. 5, unanimously approved a process intended to improve transplant equity by backdating the waiting times of Black kidney transplant candidates who were disadvantaged by previous use of a race-inclusive calculation to estimate their level of kidney function. The calculation is an estimated glomerular filtration rate (eGFR).

“This action underscores our commitment to equity in access to transplantation for all candidates,” said Jerry McCauley, M.D., M.P.H., president of the board. “We and many other organizations have now prohibited the use of a race-based calculation that has unfairly delayed care for many Black patients with kidney failure. Waiting time for a transplant is a major factor in the priority that kidney candidates receive. Thus, we are acting along with kidney transplant programs nationwide to ensure that any candidates known to have been disadvantaged by a race-inclusive GFR calculation will receive all the waiting time credit for which they qualify, as soon as possible.”

The glomerular filtration rate (GFR) measures how quickly a person’s kidneys remove a waste product called creatinine from the blood. GFR can be either measured directly or estimated (eGFR) using various calculation formulas.

Some eGFR formulas have provided a race variable for people identified as Black. Research has found that race-inclusive eGFR calculations can disadvantage Black people with kidney disease by erroneously estimating that they have a higher level of kidney function than people with a race-neutral eGFR result. See background.

The board action requires all kidney transplant programs, starting January 5, 2023 and within one year, to identify those Black kidney candidates whose current qualifying date was based on the use of a race-inclusive eGFR calculation, and to determine whether a race-neutral eGFR calculation shows they should have qualified sooner to start gaining waiting time for a transplant (even if their waiting time has been based on a different qualifying standard, such as dialysis). Programs must then apply to the OPTN for a waiting time modification for such candidates.

Effective January 5, 2023, kidney transplant programs will start to contact all of their currently registered kidney transplant candidates about the initiative. After the programs request modifications for potentially affected candidates, they will again contact each candidate to let them know whether they qualify for a waiting time adjustment. Once the programs complete those steps, they will document their completion with the OPTN. Programs will have one year to complete the process.

The OPTN will actively support members and transplant candidates with resource information and education, including a resource toolkit and frequently asked question (FAQ) documents. The OPTN will release these resources as soon as possible, with the goal of having several items available by the end of March 2023.

The OPTN Minority Affairs and Kidney Transplantation Committees co-sponsored the proposal approved by the board. The committees and the board will review the effect of the policy over time and consider further follow-up as warranted.