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Pre-implementation notice: New pre-transplant performance metric

Pre-implementation notice: New pre-transplant performance metric


  • Primary Program Administrators, Primary Physicians, Primary Surgeons, Primary Data Coordinators, Primary OPO Administrative Directors, Primary OPO Medical Directors
  • Quality Coordinators, Quality Director/Managers, Compliance Officers, TX Surgeons, TX Physicians, TX Program RFI Users, TX Program Administrators/Managers, TX Program Directors, TX Programs Chiefs, OPO Quality Managers/Coordinators
  • The Board of Directors of the Organ Procurement and Transplantation Network
  • Members of the OPTN Membership and Professional Standards Committee
  • Transplant and OPO OPTN Representatives and OPTN Alternate Representatives

Implementation date

July 25, 2024


A new risk-adjusted performance monitoring metric-the pre-transplant mortality rate ratio– will take effect in July 2024.

At that time, inquiries will be sent to transplant programs based on MPSC evaluation of SRTR reports for program performance on mortality for candidates appearing on the waiting list at any time during the period of January 2022 through December 2023. Read the OPTN policy notice.

What does this metric consider?

The pre-transplant mortality rate ratio indicates whether patients listed at a program are more or less likely to die prior to receiving a transplant than expected.

This risk adjusted metric compares a transplant program’s observed pre-transplant mortality rate to its expected pre-transplant mortality rate, based on mortality of patients with similar characteristics and length of time on the waiting list across the nation.

What patients are included or excluded from the metric?


  • Patients listed at a program before the end of the evaluation interval
  • Patients alive at the beginning of the evaluation interval

There are no patient exclusions in this metric.


The OPTN website has more information about the enhanced transplant performance metrics, including:

  • An overview of the enhanced transplant program performance metrics
  • A policy toolkit with more information, including course information for professional education

Tap into even more resources in UNOS Connect

Also find curated playlists that can deliver new insights into familiar tools to help you improve:

  • UNOS Connect Data & Analytics Playlist
  • UNOS Connect Measuring Transplant Program Performance Playlist

Additional educational resources are in development.


The OPTN Board of Directors approved revised bylaws for transplant program performance monitoring on Dec. 6, 2021. The approved bylaws include four new metrics for evaluation of transplant program performance. Two post-transplant metrics and one of the pre-transplant metrics have already been implemented:

  • 90-day post-transplant graft survival hazard ratio – implemented July 14, 2022
  • One-year post-transplant graft survival conditional on 90-day graft survival hazard ratio – implemented July 14, 2022
  • Offer acceptance rate ratio – implemented July 27, 2023
  • Pre-transplant-waiting mortality rate ratio- will implement July 25, 2024


We understand you may have questions about these changes and are glad to provide any information you need as the community prepares for the implementation of the new performance metrics.

Please contact us at [email protected]

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