JAMA Network JAMA Internal Medicine : Wait Time Modifications for Black Kidney Transplant Candidates
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Mar 9, 2026 L. Ebony Boulware, dean and physician–researcher focused on eliminating race-based medicine in kidney care. Rohan Khazanchi, resident and researcher who studied wait time changes for Black transplant candidates. They discuss removing race from eGFR equations, OPTN policy to recalculate wait time, measured impacts on transplant timing and rates, and other clinical algorithms needing race-free reform.
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Race Modifier Created Objective Harm
- Race is a social construct, not a biological trait, and using it in eGFR equations introduced measurable harms.
- The race modifier assigned higher GFR to Black patients at the same creatinine, delaying diagnoses and transplant eligibility.
OPTN Mandated Retroactive Waitlist Corrections
- The Organ Procurement and Transplantation Network required centers to recalculate eGFR without race and retroactively adjust waitlist time.
- Centers had to identify candidates whose recalculated eGFR crossed the transplant threshold and submit them for wait-time modifications.
Large Wait-Time Gains Translated To More Transplants
- Over 21,000 candidates received wait-time modifications with a median 1.7-year increase in accrual.
- The policy increased transplant rates for Black candidates by 5.3 per 1,000 listings, mainly for deceased-donor transplants listed before dialysis.