JAMA Network: Wait Time Modifications for Black Transplant Candidates Affected by Race-Based Kidney Function Estimation

March 2026

In 2021, national guidelines for the assessment of kidney disease shifted to a race-neutral eGFR calculation in an effort to improve the rate of nephrology referrals and transplant waitlisting among Black patients, many of whom had been deprived of optimal treatment by the previous race-based algorithmic model. In 2023, the Organ Procurement and Transplant Network (OPTN) mandated that US kidney transplants programs submit wait time modifications for Black candidates who had been disadvantaged by these equations.

This study from the Journal of the American Medical Association (JAMA) Network quantifies the impact of that mandate. “From January 2023 through June 2025, a total of 21,119 modification recipients were allocated 51,061 person-years of waitlist time. In interrupted time series analyses, policy implementation was associated with an increase of 5.3 transplants per 1000 Black candidate listings, with significant increases among preemptive and post dialysis candidates and without significant changes in living donor transplant rates or transplant rates among non-Black and/or Hispanic candidates.”