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Waiting time modifications for candidates affected by race-inclusive eGFR calculations

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All kidney programs were required to complete the eGFR waiting time policy's requirements and provide the necessary documentation to the OPTN by January 3, 2024.

After January 3, 2024, all kidney programs are required to continue to fulfill the policy's ongoing requirements. Read more details.

The Organ Procurement and Transplantation Network (OPTN) Board of Directors unanimously approved a policy action in December 2022, that requires hospitals to assess their waiting lists and backdate the waiting times of Black kidney transplant candidates who were disadvantaged by previous use of a race-inclusive calculation. This policy took effect January 5, 2023.

  • If you are a Black patient and you need a kidney transplant, this page has information to help you understand what you can expect.
  • If you are a transplant professional, this page has information about what is required of your hospital.

Some Black kidney candidates will be eligible to receive waiting time modifications that increase their waiting times. Waiting time is one of the most important factors in getting a kidney.

As part of the updating waiting times process, transplant hospitals will notify candidates about the policy change. Transplant hospitals will also locate documentation related to each candidate’s medical history and provide it to the OPTN. In some cases, patients may be able to provide this information to the transplant hospital.

Jump to FAQs about waiting time modifications


  • The policy addresses Black kidney candidates who were registered on the national transplant waiting list before the Establish OPTN Requirement for Race-Neutral eGFR Calculations policy took effect on July 27, 2022.
  • The policy allows Black kidney candidates, if they meet specific criteria outlined by the OPTN, to receive the waiting time they would have had if a race-neutral eGFR calculation was used at the time of assessment.

The estimated glomerular filtration rate (eGFR) measures how slowly or quickly kidneys remove a waste product called creatinine from the blood. The eGFR calculation helps doctors understand how sick a kidney patient is. For a number of years, some eGFR calculations included a modifier for patients identified as Black. This practice led to a systemic underestimation of how sick some Black patients really were. In some cases, it meant Black patients had to wait longer to be listed for kidney transplants. In other cases, it delayed when Black candidates qualified to start gaining waiting time, a major factor in the priority that kidney candidates receive. Learn more about race and eGFR.

Removing race variables from eGFR is broadly supported by the National Academies of Sciences, Engineering and Medicine (NASEM), a joint task force of the American Society of Nephrology, and the National Kidney Foundation.


By January 3, 2024, all kidney transplant programs were required to:

  1. Assess their waiting list for all registered adult and pediatric Black/African American kidney candidates that have been affected by the use of race-inclusive eGFR calculations
  2. Submit complete eGFR waiting time modifications for affected adult and pediatric candidates to the OPTN
  3. Notify all registered adult and pediatric kidney transplant candidates, at two points in time:
    1. Before the assessment of your waiting list, for awareness
    2. After the assessment of your waiting list, to notify candidates of eligibility status
  4. Submit attestation documentation to the OPTN confirming your program has:
    1. Assessed your waiting list, submitted modifications and supporting documentation, and notified candidates

Frequently asked questions (FAQ) archive

Find FAQs for professionals and patients for what transplant programs were required to do before January 3, 2024.

  1. Continue to notify (notification 1) all newly registered kidney candidates of the requirements of the transplant program according to the policy
  2. Assess newly registered kidney candidates to determine eligibility
  3. Submit completed waiting time modification requests to the OPTN for every candidate who should have qualified to accrue waiting time sooner

FAQs & education

FAQs for professionals:

What your program needs to know about modifying waiting time for candidates affected by race-inclusive eGFR calculations.

View professionals FAQs

Last updated 3/12/2024

FAQs for patients:

Are you waiting for a kidney transplant? Learn more about what this change might mean for you.

View patient FAQs

eGFR brochure for Black patients (PDF)

Last updated 3/12/2024

Professional education

  • Review policy change impacts and understand policy process needs in an educational offering in the OPTN Learning Management System, known as UNOS Connect
    • KID118: Waiting Time Modifications for Kidney Candidates Affected by Race-Inclusive eGFR Calculations
  • Access a custom reporting tool in the OPTN Computer System (known as UNet℠) Data Services Portal
    • The OPTN Data File “Current Waitlisted African American Candidates” provides a list of current kidney candidates reported with African American/Black as a Race category with wait time qualifying information

During the March 15 webinar, OPTN Kidney Transplantation Committee chair Martha Pavlakis, M.D., walked kidney transplant professionals through the notification and modification process and answered questions from the community.

eGFR webinar Q&A themes (PDF)

eGFR webinar effective practices (PDF)

During the July 12 webinar, panelists from several kidney programs shared effective practices regarding the OPTN eGFR waiting time policy action requiring programs to modify waiting time for candidates affected by race-inclusive eGFR calculations.

More about race-inclusive eGFR calculations

For patients

For professionals at kidney programs

Post-implementation monitoring

Improving equity in access to transplant opportunities for patients is an OPTN strategic goal. OPTN members are expected to comply with requirements in the policy language.

In addition to the compliance monitoring outlined in the policy language, all elements required by policy may be subject to OPTN review, and members are required to provide documentation as requested.

The proposed language will not change the current routine monitoring of OPTN members. The OPTN will review the submission of all required documentation and will refer any transplant programs found not in compliance with the policy requirements at the end of the implementation period to the Membership and Professional Standards Committee (MPSC). The MPSC will review all relevant information to determine if a policy violation has occurred and what type of action is warranted.