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Race-based calculations eliminated from transplant candidate listing

Race-based calculations eliminated from transplant candidate listing

A widely-supported change in transplant policy will mean increased equity for kidney patients. Information for patients is available to help them understand the changes.

In brief:

  • When doctors try to assess how sick their kidney patients are, they use a common clinical calculation to estimate a person’s glomerular filtration rate (GFR)
  • Some formulas used to estimate GFR include a race variable, which has been shown to disadvantage Black patients with chronic kidney disease
  • The Organ Procurement and Transplantation Network (OPTN) unanimously approved a proposal to require that transplant hospitals only use race-neutral eGFR formulas, effective July 27, 2022
  • This change is expected to increase equity, and has the support of a broad coalition of patients and professionals
  • A FAQ for patients is available about the implementation of the new requirement

What does this new policy do?

It will help increase equity by ensuring that GFR values are more accurately estimated. After it takes effect, calculations used to estimate any future candidates’ GFRs must not include a race variable. This prevents Black candidates’ eGFR values from being artificially increased due to their race. Learn more about eGFR and the impact of race-based adjustments.

I’m already registered to the waiting list, and my GFR has already been calculated. What happens to me?

Transplant programs are allowed to update the date for which a candidate qualified for transplant waiting time, if the program is able to determine the candidate’s current waiting time credit was based on a race-based eGFR. As currently approved, such an adjustment could occur as far back as the date the candidate was initially registered for a transplant.

Read the patient FAQ for more information, and learn who qualifies for waiting time modification.

The community developed this policy together

The Minority Affairs and Kidney Transplantation Committees proposed updating OPTN policy to require eGFR calculations be race-neutral. The Board of Directors approved this policy change on June 27, 2022. This means that any eGFR calculation used for the purposes of transplant must not contain a race-based variable.

The proposed change went out for public comment in January 2022. An earlier request for feedback on reassessing the inclusion of race in eGFR had a public comment period in the summer of 2021.

The removal of race variables from eGFR calculations is 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.

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