What the study found
The study found that the 2023 wait time modification policy was associated with higher kidney transplant rates among Black candidates, especially those who were preemptive or already on dialysis. The authors report that the policy was not associated with a significant overall transplant-rate change for other racial and ethnic groups.
Why the authors say this matters
The authors conclude that correcting harms from race-based medicine may be a promising way to address racial inequities in kidney transplant access. They frame the policy as a response to the use of race-based kidney function estimates, which had delayed referral and waitlisting for Black patients.
What the researchers tested
The researchers used a quasi-experimental design with interrupted time series analysis. They analyzed an Organ Procurement and Transplantation Network database of all U.S. adult kidney candidates actively waitlisted from January 2022 through June 2025, and examined transplant rates by race and ethnicity, dialysis status, and whether transplants came from living or deceased donors.
What worked and what didn't
Among Black candidates, policy implementation was associated with an increase of 5.3 transplants per 1000 listings, followed by a decreasing trend over time. Among all other candidates, there was no significant immediate change in overall transplant rate, though a decreasing trend was also reported afterward. In secondary analyses, the policy was associated with increased overall and deceased-donor transplant rates among Black preemptive and postdialysis candidates, while no significant changes were seen in living-donor transplants for either group or in deceased-donor transplants for non-Black and/or Hispanic candidates.
What to keep in mind
This was an observational, quasi-experimental study, so the results describe associations rather than direct proof of cause and effect. The summary provided does not describe all potential limitations in detail, beyond the use of adjusted time-series methods and the specific U.S. waitlisted adult kidney-candidate population studied.
Key points
- The OPTN wait time modification policy was associated with increased kidney transplant rates among Black candidates.
- The increase was reported for Black preemptive and postdialysis candidates.
- No significant overall transplant-rate change was found for candidates in other racial and ethnic groups.
- From January 2023 through June 2025, 21,119 candidates received wait time modifications.
- The modifications added a median of 1.7 years of waitlist time.
Disclosure
- Research title:
- Wait time modification policy was linked to higher transplant rates for Black candidates
- Authors:
- Rohan Khazanchi, Aaron Fleishman, Nwamaka D. Eneanya, Kenneth A. Michelson, James A. Diao, Michelle Morse, Martha Pavlakis
- Institutions:
- Beth Israel Deaconess Medical Center, Beth Israel Deaconess Medical Center, Boston Children's Hospital, Brigham and Women's Hospital, Brigham and Women's Hospital, Emory University, Harvard University, Harvard University, Harvard University, Harvard University, Lurie Children's Hospital, New York City Department of Health and Mental Hygiene
- Publication date:
- 2026-03-09
- OpenAlex record:
- View
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