Evaluating the Impact of Organ Allocation Policies on Black Patients: A Single-Center Analysis

Race-inclusive estimated glomerular filtration rate (eGFR) equations historically delayed kidney transplant referral and waitlist eligibility for Black patients. OPTN Policy 3.7D was implemented to allow retrospective wait time modification for candidates adversely affected by race-based eGFR calculations. We evaluated the implementation of this policy and its impact at a single transplant center.

We performed a retrospective cohort study of adult Black kidney transplant candidates at the University of Florida Health Transplant Center reviewed for OPTN Policy 3.7D eligibility between December 2023 and January 2024. Candidates were categorized as eligible for wait time modification, ineligible with sufficient historical documentation, or ineligible due to insufficient documentation or nonresponse. Demographic characteristics, clinical variables, waitlist time, and transplant outcomes were compared using descriptive and nonparametric analyses.

Of 162 candidates reviewed, 46 (28.4%) met criteria for wait time modification. 84 candidates (52.0%) provided historical documentation but were ineligible, 30 (18.5%) lacked sufficient documentation or did not respond, and 2 were excluded due to age less than 18 (1.25%). Eligible candidates had significantly shorter median waitlist time prior to policy implementation compared with ineligible candidates (746 vs. 1506 days; p<0.001) and were more likely to be female (p = 0.044). No significant differences in baseline clinical characteristics were observed between transplanted and non-transplanted candidates within either eligibility group. Among ineligible candidates, those without historical documentation had longer waitlist times than those with documentation (2289 vs. 1576 days; p = 0.0067).

Implementation of OPTN Policy 3.7D enabled meaningful restoration of wait time for a subset of Black kidney transplant candidates. However, the policy's impact was limited by strict eligibility criteria and reliance on historical documentation. These findings highlight both the benefit and the structural constraints of retrospective equity-focused transplant policy interventions.