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Implementation notice: Waiting time modifications for candidates affected by race-inclusive eGFR calculations

Implementation notice: Waiting time modifications for candidates affected by race-inclusive eGFR calculations

*Last updated Jan. 27, 2023

Audience: (Please share this notice with anyone in your organization who would benefit from it.)

  • Kidney Primary Program Administrators, Primary Data Coordinators, Primary Physicians and Primary Surgeons
  • Kidney TX Directors, Administrators and Managers, Surgeons and Physicans
  • Kidney Quality Directors and Managers, Quality Coordinators and Compliance Officers
  • Kidney Data Coordinators, Clinical Coordinators and Clinical Support Staff
  • OPTN Representatives and Alternate Representatives
  • The OPTN Board of Directors
  • The OPTN Kidney Transplantation Committee
  • The OPTN Minority Affairs Committee

Implementation date

  • Jan. 5, 2023


A policy action is now in effect that requires transplant programs to assess their waiting lists and submit waiting time modifications for Black candidates affected by race-inclusive eGFR calculations. Programs must complete the process and provide the necessary documentation to the OPTN by Jan. 3, 2024. Read the policy notice for OPTN Policy 3.7.D Waiting Time Modifications for Kidney Candidates Affected by Race-Inclusive eGFR Calculations.

Additional information

Programs must notify all of their currently listed candidates before and after assessment of their waiting lists, as well as submit documentation to the OPTN attesting to the completion of their candidate review, notification of candidates, and submission of modification applications. The Board of Directors of the Organ Procurement and Transplantation Network unanimously approved this policy action on Dec. 5, 2022.

What you need to know

All kidney transplant programs have until Jan. 3, 2024 to:

  • Assess their respective kidney waiting lists to identify all affected Black kidney candidates
    • Affected candidates who may be eligible include:
      • Those who are registered to the OPTN waiting list and are currently accruing waiting time with criteria in OPTN Policy 8.4.A: Waiting Time for Candidates Registered at Age 18 or Older 
      • Those who are registered to the OPTN waiting list, but have not yet qualified for waiting time accrual
    • To help programs identify those candidates registered as Black or African American, a custom reporting tool is accessible in the Data Services Portal. Find more details below.
  • Determine whether a race-neutral eGFR calculation shows they should have qualified sooner to start gaining waiting time for a transplant
  • Submit completed waiting time modification requests to the OPTN for those candidates
  • Send two separate notifications to all kidney candidates on their respective waiting lists
    • The first notification will be sent before the program’s assessment of their list, to inform all kidney candidates of the requirements of the program according to the policy
    • The second notification will be sent after the program’s assessment of their list, to inform each kidney candidate of their eligibility status
  • Provide an attestation to the OPTN that these requirements have been met

Professional education includes sample candidate notification and attestation language. Find more information below.

Criteria needed for waiting time adjustments

To apply for a waiting time adjustment for a candidate registered as Black or African American in the OPTN Computer System, the program must provide documentation demonstrating that with a race-inclusive calculation, the candidate’s eGFR was over 20 mL/min, but with a race-neutral calculation it would have been 20 mL/min or less.

This could include a date prior to the time the candidate was first registered on the OPTN waiting list.

Waiting time modification forms

An eGFR Waiting Time Modification Form is available in UNet℠ on the Forms/Tools page, and can be accessed through the Resources tab on the Secure Enterprise (UNet) homepage.

Programs are required to complete an eGFR Waiting Time Modification form for each affected candidate, including both pediatric and adult candidates.

Programs can identify candidates with a center-specific custom reporting tool 

Access the custom reporting tool through the Secure Enterprise homepage:

  • Data Services>OPTN Data Files>Current Waitlisted African American Candidates
  • The report is also visible in the Announcements and Notifications section of Data Services

This report is updated weekly.

Education now available

Resources are now available to help kidney programs comply with this policy action.

  • Read frequently asked questions (for transplant professionals) on the OPTN website
  • Review policy change impacts, understand policy process needs, and get sample notification and attestation language in an educational offering in UNOS Connect
    • KID118: Waiting Time Modifications for Kidney Candidates Affected by Race-Inclusive eGFR Calculations
  • Access a custom reporting tool in the UNet℠ Data Services Portal
    • The OPTN Data File “Current Waitlisted African American Candidates” provides a list of current kidney candidates reported with African American/Black as a Race category with wait time qualifying information

Additional resources are in development

The OPTN is actively preparing a broad range of additional resources to help guide candidates and programs through this process.

Please contact [email protected] with any questions about this policy action.


The OPTN Minority Affairs and Kidney Transplantation Committees co-sponsored the proposal approved by the board. In June 2022, the board prohibited the use of any race-based eGFR calculation for any purpose within OPTN policy. This action did not include waiting time reinstatement for any date prior to the candidate’s initial registration on the OPTN waiting list. This subsequent action addresses waiting time reinstatement for those affected candidates.

The removal of race variables from eGFR calculations has been broadly supported by institutions including the National Academies of Sciences, Engineering and Medicine, as well as a joint task force of the American Society of Nephrology (ASN) and the National Kidney Foundation (NKF). Improving equity in access to transplant opportunities for patients is an OPTN strategic goal.

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