Organ procurement and transplant board votes to establish race-neutral eGFR equation
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The Organ Procurement and Transplant Network Board of Directors has unanimously voted to remove the race coefficient from eGFR equations.
Several organizations have called for the removal of the race coefficient because it puts Black patients on the transplant list at a disadvantage. Following the vote by its board, the Organ Procurement and Transplant Network (OPTN) will be implementing a race-neutral eGFR equation within 30 days.
Healio connected with Matthew Cooper, MD, president of OPTN, to discuss how the decision by the board will be implemented and what it will mean for kidney transplant candidates.
Healio: How will a race-neutral eGFR equation impact the future of kidney transplantation?
Cooper: Once the Black race coefficient is prohibited from use in eGFR calculations for all potential candidates, Black kidney candidates’ eGFR values will be more reflective of their actual kidney function. The goal of requiring transplant programs to use race-neutral eGFR calculations is to increase equity in access to transplantation for Black kidney candidates by more accurately estimating their GFR values and allowing earlier access to transplant wait lists.
Healio: When will the changes be implemented?
Cooper: The OPTN Board of Directors has approved a swift 30-day implementation, meaning the policy will be implemented on July 27, 2022.
Healio: Now that the board has voted to remove the race-specific coefficient from eGFR calculations, what policy changes can transplant hospitals expect to make?
Cooper: All OPTN-member transplant hospitals will be required to ensure that all candidates being considered for kidney transplantation are evaluated using a race-neutral eGFR equation, which will assure equity in access and listing.
Healio: How can hospitals make the transition to a race-neutral equation as smooth as possible?
Cooper: Transplant hospitals should take steps before the July 27 implementation to understand what calculations the hospitals currently employ to estimate GFR and take any actions needed to comply with these changes.
These could involve a program-wide notification of the policy change, training and education for transplant hospital staff, collaboration with referring nephrologists and laboratory partners to ensure use of race-neutral eGFR calculations, and updates to electronic medical records systems.
Healio: Many Black transplant candidates have lost waiting time because of race-inclusive calculations. What can these candidates expect now that the race-neutral equation has been approved?
Cooper: The OPTN Minority Affairs and Kidney Transplantation Committees have reconvened to develop a proposal to provide transplant hospitals with the opportunity to identify and apply for modification of waiting time for candidates who were registered and began their waiting time using a race-inclusive eGFR calculation. They hope to put a proposal out for public comment during the next cycle, which begins August 2.
Healio: How did the public comment page for the proposal impact the decision by the board to remove the race-specific coefficient from eGFR calculations?
Cooper: This proposal received widespread support, indicating the community’s readiness to eliminate the Black race variable from eGFR calculations. Much of this feedback referenced race as a social construct that is not appropriate for use in clinical decision-making and supported the removal of the Black race coefficient based on improved equity and access to transplantation for patients who have been historically disadvantaged.
The board discussed and considered this feedback, as well as an endorsement of the proposal from National Kidney Foundation/American Society of Nephrology, and unanimously approved the requirement.
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