Key points:
- OPTN Board to take up recommendation June 27
- If approved, implementation may occur within 30 days
- Transplant programs and labs should be aware of the pending action and consider options for transition
At its next in-person meeting, the Board of Directors of the Organ Procurement and Transplantation Network (OPTN) will consider a proposal to require transplant hospitals to use race-neutral calculations when estimating a patient’s glomerular filtration rates (GFR). This proposed change aims to reduce health disparities and address inequities for Black kidney candidates by more accurately estimating their GFR values. The board will next meet in Richmond, Va., June 26-27, 2022.
GFR is a measure of how quickly a person’s kidneys remove a waste product called creatinine from the blood. GFR can be measured directly or estimated (eGFR) using various calculations. These calculations help doctors understand how sick a kidney patient is. Inclusion of a race variable in some eGFR calculators has resulted in disparities in medical practice and treatment, and is understood to have been a contributing factor in systematic underestimation of kidney disease in Black patients. Read frequently asked questions about the use of race in estimating GFR.
Within the field of transplantation, the use of race-inclusive eGFR calculations has the potential to delay both the referral for kidney transplantation and the initiation of qualifying waiting time on the OPTN waiting list. The need to remove race variables from eGFR calculations has gained national attention. The OPTN Minority Affairs and Kidney Transplantation Committees’ co-sponsored proposal to require race-neutral calculations is in line with recent recommendations from the National Academies of Sciences, Engineering and Medicine. The removal of race variables from eGFR calculations is also supported by recommendations from the American Society of Nephrology (ASN) and National Kidney Foundation (NKF), who formed a joint taskforce that released a report in 2021 and participated in a listening session with the OPTN in 2022. Improving equity in access to transplant opportunities for patients is an OPTN strategic goal.
Rapid implementation expected if approved
Many transplant hospitals and laboratories have already switched to race-neutral calculations. If approved at the board’s June 27 meeting, the community should expect a rapid implementation within 30 days. Upon implementation, which could occur as early as July 27, 2022, transplant hospitals will be required to use race-neutral eGFR calculations.
Transplant hospitals and laboratories should take steps now to understand changes
If adopted by the board, this change will affect transplant hospitals operations. At implementation, transplant hospitals will not be permitted to use eGFR calculations that include race as a variable.
Transplant hospitals should take steps now to understand what calculations they use to estimate GFR, and understand what actions they would need to take to comply with these changes.
This could involve:
- Program-wide notification of the policy change
- Training and education for transplant hospital staff
- Collaboration with laboratory partners to ensure use of race-neutral eGFR calculations
- Updates to Electronic Medical Records (EMR) systems
This list is not inclusive of all measures a transplant program might expect to take in order to comply with the requirement to use race-neutral eGFR calculations.
Transition procedures: Current transplant hospital purview for modifying candidate eGFR waiting time
The OPTN plans to make transplant hospitals aware of the transition actions they may take immediately for the population of candidates negatively affected by race-inclusive eGFR calculations as described below. Transplant hospital participation in these procedures is optional.
If a transplant hospital:
- Registered a candidate to the waiting list without a qualifying eGFR value, and at a later date used a race-inclusive eGFR calculation to qualify the candidate to begin accruing waiting time
Then the transplant hospital may:
- Recalculate the candidate’s eGFR using a race-neutral calculation and update the candidate’s qualifying eGFR date in the OPTN computer system
Participating transplant hospitals will be responsible for the identification of candidates who qualify for immediate eGFR waiting time modification on their transplant waiting lists.
This could involve:
- Using OPTN data to identify potentially affected candidates
- Reviewing potentially affected candidates’ registration dates and calculations used to estimate GFR
When a candidate’s qualifying eGFR is updated in the OPTN computer system, they are able to gain back any waiting time accrued up until the listing date.
Patient impact: Addressing listed candidates affected by race-inclusive eGFR calculations
There may be Black candidates registered for transplant who lost waiting time as a result of race-inclusive calculations. During the public comment period for the proposal, the OPTN received feedback regarding waiting time modifications for candidates affected by race-inclusive eGFR calculations. Currently, the eGFR workgroup is developing a pathway for Black candidates whose eGFRs were affected to regain lost waiting time.
This follow-on proposal would give transplant hospitals the opportunity to 1) identify potentially affected Black candidates on their kidney waiting lists and 2) apply for modification of these candidates’ waiting time.
If the follow-on proposal is approved by the board, it could provide these candidates an earlier start date for accruing qualified waiting time, which would allow them to regain any waiting time lost due to use of race-inclusive eGFR calculations. The eGFR workgroup plans to propose these changes no later than the summer 2022 public comment period.
Learn more about the proposal to require race-neutral calculations
Public comment for the proposal, Establish OPTN Requirement for Race-Neutral eGFR Calculations, was open Jan. 27-March 23, 2022. Review the proposal and read the comments.
As part of the policy development process, the Minority Affairs Committee and Kidney Transplantation Committee reviewed the community feedback and incorporated appropriate changes before sending the proposal to the board. Learn more about the policy development process.
Questions?
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