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

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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 Jan. 5, 2022.

  • 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

Background

  • The new 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 new 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.

Policy

All kidney transplant programs have until Jan. 3, 2024 to:

  • Send a notification informing all kidney candidates on their waiting list of the requirements of the program according to the policy
  • Assess their respective kidney waiting lists to identify all affected Black kidney candidates
    • Affected candidates who may be eligible include:
    • Determine whether a race-neutral eGFR calculation shows candidates should have qualified sooner to start gaining waiting time for a transplant
    • Submit completed waiting time modification requests to the OPTN for every candidate who should have qualified to gain waiting time sooner
    • Send a second notification to inform each kidney candidate of their eligibility status
    • Provide an attestation to the OPTN that the above requirements have been met

FAQs & professional 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

FAQs for patients:

Patient resources in development

Professional education

  • Review policy change impacts, understand policy process needs, and get sample notification and attestation language 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.

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.