New policy allows for waiting time adjustments for those disadvantaged by the use of race-based measures of kidney health
Black patients disadvantaged by a race-based measure of kidney health will now be eligible to receive modifications to their waiting time, potentially improving their prioritization for transplant, according to a new policy passed by the Organ Procurement and Transplantation Network (OPTN) Board. United Network for Organ Sharing (UNOS), the organization that powers the nation’s donation and transplant system, serves as the OPTN under federal contract.
The new policy went into effect today, January 5, 2023.
The change was unanimously approved by the OPTN Board on December 5, 2022. The policy is intended to address disparities in waiting times faced by Black patients on the kidney transplant waitlist. Some of these patients were disadvantaged by the earlier use of a measure that took race into account when measuring kidney function.
For years, some calculations (known as eGFR) included a modifier for Black patients based on outdated assumptions about race and biology. This practice led to the severity of kidney disease in Black patients being systemically underestimated. It may have also negatively affected when Black patients got added to the national waitlist.
In June 2022, the OPTN Board approved a policy that required transplant hospitals no longer use race-based calculations when estimating a patient’s kidney health.
“This action underscores our commitment to equity in access to transplantation for all candidates,” said Jerry McCauley, M.D., M.P.H., president of the board. “We and many other organizations have now prohibited the use of a race-based calculation that has unfairly delayed care for many Black patients with kidney failure. Waiting time for a transplant is a major factor in the priority that kidney candidates receive. Thus, we are acting along with kidney transplant programs nationwide to ensure that any candidates known to have been disadvantaged by a race-inclusive GFR calculation will receive all the waiting time credit for which they qualify, as soon as possible.”
“So many African-Americans have been affected by the use of race-inclusive calculations, and have become very ill or have died waiting for the opportunity to list for a kidney transplant,” said Precious McCowan, a kidney recipient and donor mother who serves on the OPTN Kidney Transplantation Committee, which developed and co-sponsored the policy with the OPTN Minority Affairs Committee. “With the new policy change, I envision more African-Americans having an equal opportunity to list for kidney transplantation.”
Transplant programs must comply with the policy by January 3, 2024, which will include reviewing their lists of waitlisted candidates to identify those who may have been impacted by the use of the race-based calculation.