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.
Supporting Media
Presentation
Proposed changes
This proposal adds the following more explicit requirements for transplant programs:
- In addition to the existing requirement for transplant programs to determine eligibility of all kidney candidates, programs must notify candidates of their eligibility
- 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
- 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
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- Removal of outdated attestation language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)
Provide feedback
Comments
Region 7 | 03/04/2025
Sentiment: 2 strongly support, 4 support, 4 neutral/abstain, 0 oppose, 0 strongly oppose
This was not discussed during the meeting, but attendees were able to submit comments with their sentiment. The region was supportive of this proposal. One attendee commented: “This proposal should hopefully ensure that all candidates left who don't understand the modification are notified.”
Anonymous | 03/03/2025
I think transparency is important in the area of organ donation. I have many patients that are unaware of this process, but are interested in understanding how the system works. I am not sure dating back to Jan 2024 is the best use of our resources, but maybe picking a future date would make more sense logistically. I think we need to keep in mind limited time and resources and balance this with the transparency going forward.
Region 3 | 03/03/2025
Sentiment: 4 strongly support, 6 support, 4 neutral/abstain, 0 oppose, 0 strongly oppose
Comments: None
Region 5 | 02/28/2025
Sentiment: 8 strongly support, 13 support, 5 neutral/abstain, 2 oppose, 1 strongly oppose
Comments: There was mixed feedback on this proposal. While some in the region strongly action to further equality among patients, others commented that this proposal will create an extra burden for transplant programs. One member suggested the committee focus on moving forward in anticipation of overarching changes for transplant.
Carle Porter | 02/21/2025
As a black man myself, I was terrified to know that my kidneys were failing and I choose to be on the transplant list. Because as a black man I knew what I was going to face. I was more scared of transplant than dialysis knowing that I was going to be subjected to systematic issues that were put in place centuries before my existence. The disparity is real for African Americans and kidney transplant! For me the apologies need to be as loud as the disrespects. Quietly brushing the hate, unfairness and lack of empathy under the rug needs to be openly acknowledged.
Those who may perpetuate and believe in those ideals need to be removed. I know a few people at UCDAVIS that could use some reeducation about how to interact with patients that don't look like them.
I knew I was going to face discrimination because I always do, in everything, everywhere so why would transplant be any different? That being said I feel overwhelming fear that as a black man with O blood that transplant will never happen or at the very least I wait SO long it won't matter OR I die first. The race-inclusion should be announced publicly where everyone can see and transplant coordinators, nurses, technicians even dialysis centers should be notified and educated! There is no reason that I a patient should know more about the inner working of transplant than my coordinators and dialysis center!
I shouldn't feel a sense of hopelessness waiting for transplant knowing there are are other racial groups not waiting nearly as long as 7, 8, 10, 15 years!? Then to wait all that time, just to be told NO? People are dying by the thousands and we aren't just casualties of war, meaningless lives to be discarded because society said they don't want us around! We are human beings and we have value too!
Lastly, I asked my transplant coordinator at UCDAVIS specifically about race-based inclusion and without them even knowing what it was told me I didn't qualify. But come to find out, I did getting a year and half. On smaller levels a lot of these centers have freedom to make decisions for people's lives.
Marquise Ruffin | 02/16/2025
I agree that transparency and clear language should be used when it comes to eGFR wait times. The documentation of all races should accounted for.
Margaret Sullivan | 02/03/2025
Proposal 3.7.D.i. applies the notification rule to all candidates registered on or after January 4, 2024, thus, once again going backwards. This is an unnecessary time-consuming burden on the members of the team of the transplant program. We need to focus on moving forward with all the regulatory changes coming to transplant form all entities.
Robert Goodman | 01/21/2025
While I am not a member of a minority, I fully support getting the most out of the changes that have already taken and for those being proposed. Racial disparities should not be systemic, institutionalized or made part of the protocol for evaluating patients for transplant.