Establish OPTN Requirement for Race- Neutral eGFR Calculations

At a glance

Current policy

Transplant hospitals use a formula called Estimated Glomerular Filtration Rate (eGFR) to determine how well their patients’ kidneys are functioning. Kidney transplant candidates’ eGFR values are used as a qualifying threshold throughout OPTN policy, including one of the ways candidates can initiate waiting time. Some hospitals use formulas that include a Black race coefficient, which can overestimate eGFR values and lead to delayed treatment. Current OPTN policy allows hospitals to use equations that both include and exclude the race coefficient.

FAQs about the OPTN requirements for race-neutral eGFR calculations

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Supporting media

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Presentation

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Proposed changes

• The OPTN will update its policy to require eGFR calculations not include race as a variable.
• All policies that include reference to eGFR will be updated. These include:
  • Policy 1.2: Definitions
  • Policy 3.6.B.i: Non-function of a Transplanted Kidney
  • Policy 8.4.A: Waiting Time for Candidates Registered at Age 18 Years or Older
  • Policy 8.5.G: Prioritization for Liver Recipients on the Kidney Waiting List
  • Policy 9.5.H: Requirements for Primary Hyperoxaluria MELD or PELD Score Exceptions
  • Policy 9.9.B: Liver-Kidney Candidate Eligibility for Candidates 18 Years or Older
  • Policy 13.6.A: Requirements for Match Run Eligibility for Candidates
  • Policy 13.7.G: OPTN KPD Waiting Time Reinstatement

Anticipated impact

• What it's expected to do
  • Increase GFR estimation accuracy and access to transplantation for Black kidney candidates.
  • Allow more Black kidney candidates to meet the qualifying eGFR thresholds in the appropriate timeframe.
  • Allow transplant hospitals to use the most up-to-date methods to calculate eGFR as they are developed.
• What it won't do
  • The new policy won’t tell hospitals which formula to use, as long as the formula doesn’t include a race variable.

Terms to know

• Estimated glomerular filtration rate (eGFR): A tool used to measure how well a patient’s kidneys are functioning.
• Black Race coefficient: A factor that is used in some eGFR calculations. It was developed based on a study that recent research shows may not be reliable or valid.
• Qualifying threshold: The level or value that has to be reached before a candidate can begin waiting time.

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