A national policy intervention implemented to address inequities caused by race-based kidney function equations was associated with an increase in organ transplant rates among Black patients, according to a recent study published in JAMA Internal Medicine.
“This argues for the need to sustain such policies and shows that it is possible to right the wrongs retroactively, which is a powerful idea,” said Kenneth Michelson, MD, MPH, associate professor of Pediatrics in the Division of Emergency Medicine and a co-author of the study.
Until 2021, national guidelines used to determine kidney function upheld race-based clinical algorithms that assigned higher kidney function to Black patients, which would in turn cause delays in referrals and increase transplant waitlist time for these patients.
In 2023, the Organ Procurement and Transplantation Network (OPTN), which manages the U.S.’s organ transplantation system, mandated that U.S. kidney transplants programs submit wait time modifications for Black organ transplant candidates affected by these equations.
Whether this wait time modification policy has since increased the number of organ transplants for Black patients, however, remained unclear up until now.
“The formula used to determine kidney function for many years included an adjustment only for Black patients that made their kidney function appear better than it really was, which made them less eligible for kidney transplants,” Michelson said.
In the current study, the investigators analyzed patient data from the OPTN database including more than 180,000 U.S. adult patients who were waitlisted for a kidney transplant between January 2022 and January 2025.
Of the patients, 37.8 percent were women and 62.2 percent were men, 31.1 percent were Black and 68.9 percent were from other racial and ethnic groups.
An interrupted time series analysis evaluated the association of the wait time modification policy implementation with changes in transplant rates using generalized estimating equations adjusted for secular trends, time-varying and time-invariant confounding factors, and a first-order autoregressive covariance structure.
The investigators found that, from January 2023 through June 2025, a total of 21,119 transplant candidates received wait time modifications, adding an average of 1.7 years and a total of 51,061 person-years of waitlist time.
Interrupted time series analyses also showed that among Black candidates, the implementation of the wait time modification policy was associated with an increase of 5.3 transplants per 1,000 candidate listings.
The investigators also found significant increases among preemptive and post-dialysis candidates and no significant changes in living donor transplant rates or transplant rates among non-Black and/or Hispanic candidates.
“We found that the policy was associated with an increase in transplants among Black candidates. What was surprising was that it did not seem to negatively impact transplants for anybody else, which was a very positive finding,” Michelson said.
Michelson said the findings support the need for medical societies, health systems, clinicians and policymakers to sustain such wait time modification policies to address racial kidney transplant inequities.
“Future work should monitor broader and longer-term effects, and policymakers should consider additional interventions to mitigate heterogeneity in modification uptake and redress inequities among candidates with inadequate access to healthcare prior to being waitlisted,” the authors wrote.
This work was supported by the BIDMC Equity in Kidney Transplantation Fund.
