Kidney transplant program specific reporting and transplant metrics.

Area of Science:

• Nephrology
• Transplant Surgery
• Health Policy

Background:

• Kidney transplantation is regulated by the Secretary of HHS under the NOTA and Final Rule.
• Transplant programs are evaluated every six months based on a 2.5-year outcome period.
• Current Bayesian metrics flag over 10% of kidney transplant programs as underperformers biannually.

Purpose of the Study:

• To review the impact of current and proposed kidney transplant metrics.
• To discuss the implications of proposed changes on transplant centers and patient outcomes.
• To advocate for a more adaptive regulatory environment in kidney transplantation.

Main Methods:

• Analysis of current kidney transplant evaluation metrics.
• Review of newly proposed transplant metrics for public comment (Summer 2021).
• Assessment of the correlation between transplant center flagging and transplantation rates.

Main Results:

• Proposed metrics are expected to flag over 10% of kidney transplant programs.
• Transplant center flagging is linked to reduced transplantation rates due to conservative patient and organ acceptance.
• Waiting list mortality is a proposed metric, yet centers have limited influence over it.

Conclusions:

• Current and proposed regulations, enforced by HRSA, OPTN, and SRTR, contribute to high organ discard rates and limit transplants for at-risk patients.
• Proposed metrics may penalize transplant centers unfairly, potentially increasing waiting list mortality.
• HRSA should foster a regulatory environment that supports innovation and expands transplant opportunities for end-stage renal disease patients.