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Pre-implementation notice: New transplant performance metric to go into effect July 27

Pre-implementation notice: New transplant performance metric to go into effect July 27

Implementation date

July 27, 2023


A new risk-adjusted pre-transplant performance monitoring metric – the offer acceptance rate ratio – will take effect July 27, 2023.

At that time, inquiries will be sent to transplant programs based on MPSC evaluation of SRTR reports for program performance on organ offers received from January 2022 through December 2022. Read the OPTN policy notice.

What does the offer acceptance metric consider?

This risk-adjusted metric compares a program’s observed offer acceptance rate to the program’s expected offer acceptance rate, based on similar offers across the nation.

  • The offer acceptance rate ratio indicates whether a program was more or less likely to accept offers than expected.
  • “Expected acceptances” is the risk-adjusted number of transplants predicted at the program from the offers received. The metric is risk-adjusted for:
    • Donor characteristics
    • Donor-candidate interactions
    • Candidate characteristics
    • The sequence number of the offer received
    • The distance of the potential recipient from the donor
  • A program’s offer acceptance rate ratio includes offers to candidates on a single waitlist for organs that are eventually accepted and transplanted.

What’s excluded?

  • Match runs that have no acceptances, any missed or bypassed responses, offers to multi-organ candidates (other than kidney-pancreas candidates) and offers that occurred after the last acceptance in a match run are excluded from the calculation.
  • Multiple match runs from the same donor are combined and duplicate offers are excluded.


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
  • A PDF resource on effective practices related to offer acceptance

Tap even more resources in UNOS Connect

These curated playlists in UNOS Connect can deliver new insights into familiar tools to help you improve:

  • UNOS Connect Data & Analytics Playlist
  • UNOS Connect Measuring Transplant Program Performance Playlist
  • OPTN Offer Acceptance Collaborative Playlist – CEPTCs available

Learn from your peers

83 transplant hospitals from across the country are taking part in an OPTN collaborative focused on effective practices related to offer acceptance.

Recorded presentations from the hybrid kickoff event and additional webinars held during the collaborative are accessible in UNOS Connect, and offer you access to a range of thought leadership on system performance.


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 have already been implemented:

  • 90-day post-transplant graft survival rate – implemented July 14, 2022
  • One-year post-transplant graft survival conditional on 90-day graft survival rate –  implemented July 14, 2022

Future implementations

Evaluation of programs based on a fourth criteria, the pre-transplant mortality rate, will begin no earlier than July 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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