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What is the OPTN registration fee?

Most of the operating costs of the OPTN are paid for by patient registration fees. These fees are paid by transplant programs for each candidate they add to the national transplant waiting list. The fee amount is set each year by the OPTN Board and approved by HRSA.

New OPTN registration fee rate for FY26

On August 25, 2025, HRSA approved the OPTN Board of Directors’ recommended Fiscal Year (FY) 2026 Patient Registration Fee of $1,036 per transplant candidate. This fee will go into effect on October 1, 2025.

HRSA’s decision is based on the following considerations:

  1. For the past three years HRSA has not approved a fee increase based on the availability of funds in the OPTN operating accounts.
  2. The OPTN has expended the available funds, now requiring additional resources to cover the costs of OPTN operations.
  3. The recommended fee includes funding to address critical priorities including:
    1. HRSA directives (i.e., allocation out of sequence, donation after circulatory death policy, normothermic regional perfusion);
    2. Secretarial Data Directives; and
    3. Enhancing the security and stability of the OPTN IT system.

HRSA will begin to bill transplant centers in October 2025 for transplant candidates added to the OPTN waiting list after August 31, 2025.

  • October 2025 invoices (for candidates added between September 1–30, 2025) will reflect the Fiscal Year 2025 (current) fee amount of $868 per candidate.
  • November 2025 invoices (for candidates added between October 1–31, 2025) will reflect the Fiscal Year 2026 (new) fee of $1,036 per candidate.

OPTN registration fee collection: transition and timeline

In March 2025, Congress passed the 2025 Full-Year Continuing Appropriations and Extensions Act (Sec. 1904 in P.L. 1968) which includes a key provision affecting the organ transplantation community. Section 1904 grants HHS explicit legal authority to directly collect and distribute registration fees from OPTN member institutions. For decades, UNOS, as the sole OPTN contractor, has managed this fee collection process.

Under the new law, HHS will now assume responsibility for collecting these fees, a shift designed to:

  • Enhance transparency in how fees are collected and used
  • Expand opportunities for multiple best-in-class contractors to support the operations of the OPTN
  • Strengthen oversight, performance, and accountability across the network

HRSA has initiated this transition by reaching out to transplant hospitals to confirm their billing points of contact and provide information on the transition to the new fee collection process. During this period, transplant hospitals should continue to pay the fees to the OPTN contractor until HRSA provides further instructions. HRSA anticipates beginning to invoice transplant hospitals in October 2025 for OPTN patient registration fees for transplant candidates added to the waiting list after August 31st, 2025.

HRSA anticipates collecting registration fees via Pay.gov, a secure, no-cost federal payment platform used by many U.S. government agencies. HRSA will keep transplant hospitals informed with timely email and webpage updates, detailed guidance, and clear timelines to support a smooth transition. If you are a transplant hospital with questions regarding registration fees, please contact OPTNFeeSupport@hrsa.gov.

Improving transparency

The new law also introduces new transparency measures, providing the transplant community and the public with greater visibility into how registration fees are allocated and spent. These measures ensure registration fees support OPTN operations and, ultimately, improve outcomes for patients and families.

HRSA will continue to update this webpage to share information on the new fee collection process, fees collected, and how fees were used to support OPTN operations.