Monitor Ongoing eGFR Modification Policy Requirements

At a glance

Background

OPTN policy requires all transplant programs to use race-neutral eGFR calculations and details the requirements for transplant programs to submit waiting time modifications for eligible kidney candidates affected by race-inclusive eGFR calculations. Currently, transplant programs are required to notify candidates that programs are responsible for reviewing their waitlist for eligible candidates and must apply for modifications for all candidates deemed eligible. This proposal includes additional requirements for programs to notify candidates of their eligibility and of the outcome of any wait time modification applications submitted for the candidate. Additionally, this proposal requires transplant programs to document, in writing, protocols demonstrating how programs will determine eligibility of candidates, including how programs plan to confirm a candidate’s race, how the program will meet all the notification requirements, and what sources the program will review for supporting documentation of a candidate’s eligibility.

Presentation

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Proposed changes

This proposal adds the following more explicit requirements for transplant programs:

1. In addition to the existing requirement for transplant programs to determine eligibility of all kidney candidates, programs must notify candidates of their eligibility
2. In addition to the existing requirement to submit wait time modification applications on behalf of candidates, programs must notify candidates of the outcome of an application
3. A requirement to document, in writing, protocols for the following:
   • Confirming candidate race
   • Notifying candidates of requirements within the policy
   • Seeking supporting documentation of eligibility, including at a minimum what sources will be reviewed
   The transplant hospital must document that above processes were completed, including the results of the review of sources, in the candidate’s medical record.

This proposal also clarifies the current policy requirements, including:

• Additional language supporting the existing requirement that all kidney candidates must be assessed for eligibility
• Removal of outdated attestation language

Anticipated impact

• What it's expected to do
  • Require transplant programs to have specific, written protocols and thorough documentation to address the requirements in policy.
  • Require transplant programs to meet updated, more explicit notification requirements for all candidates registered on or after January 4, 2024.

Terms to know

• eGFR: Estimated Glomerular Filtration Rate. A measure used to determine kidney function, the GFR indicates the kidney's ability to filter and remove waste products.
• MAC: Minority Affairs Committee. The standing OPTN committee charged with identifying issues which impact organ procurement, allocation and transplantation of minorities. As necessary, the committee conducts research related to specific issues under consideration. The committee provides input and recommendations to the Board of Directors to ensure that issues and needs particular to minority populations are met.
• Waiting Time: The amount of time a candidate is on the Wait List. Waiting times can be influenced by many factors.
• Site Survey: Field reviews of OPTN members to determine compliance with OPTN Policies. The site survey results are reviewed during the peer review process of the OPTN Membership and Professional Standards Committee.

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Read the full proposal (PDF)