Psychosocial Characteristics and Their Association With Kidney Transplant Programs Waitlist Rates

Report Materials

• Full Report (PDF, 1.2 MB)
• Report Highlights (PDF, 191.0 KB)

Why OIG Did This Review

• Donated kidneys are scarce-only 15 percent of patients on the waitlist receive one.1 Transplant programs are responsible for determining which patients are suitable candidates for transplantation.2
• Medicare-certified transplant programs must use medical and psychosocial patient selection criteria to access to the waitlist. However, CMS does not define patient selection criteria and instead allows each program to develop its own criteria, which include medical and psychosocial criteria, and can cover aspects of a patient's life such as substance use and compliance with treatment.
• This data snapshot offers data regarding psychosocial patient selection criteria used by kidney transplant programs in 2023. It also presents data from our analysis of a random sample of patients evaluated at these programs, using these criteria, and their wait list outcomes.

What OIG Found

On the basis of our analysis of psychosocial patient selection criteria from kidney transplant programs and a random sample of patients evaluated at these programs:

The most common psychosocial patient selection criteria relate to five topics: (1) substance use, (2) compliance with and adherence to medical treatment, (3) mental health, (4) ability to pay for transplant- related costs, and (5) social and family support.

Half of all patients evaluated for a kidney transplant in 2023 were not added to the waitlist.

• Of the 52 percent of patients not added to the waitlist, half failed to meet at least one psychosocial criterion.
• Compliance with or adherence to medical treatment is the most common psychosocial criterion that patients did not meet.

Patients under age 65 and those with private insurance were most likely to be added to the waitlist for kidney transplant.

• Fifty-two percent of adult patients under age 65, and 37 percent of patients 65 and older were added to the waitlist.
• Sixty percent of privately insured patients were added to the waitlist, and 54 percent of Medicaid patients and 41 percent for Medicare patients were added to the waitlist.
• Among Medicare patients, patients enrolled in Medicare fee-for-service were added to the waitlist at a higher rate (47 percent) than patients enrolled in Medicare Advantage (32 percent).