Abstract: FR-PO1123
Effect of Increasing Organ Transplant Access Model on Kidney Transplantation
Session Information
- Transplantation: Clinical - Transplant Access, Recipient Evaluation, Living Donors, Pregnancy, and More
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Thakur, Madhur, NYU Langone Health, New York, New York, United States
- Stewart, Darren E., NYU Langone Health, New York, New York, United States
- Levan, Macey L., NYU Langone Health, New York, New York, United States
- Reed, Rhiannon D., NYU Langone Health, New York, New York, United States
- Locke, Jayme E., NYU Langone Health, New York, New York, United States
- Weiss, Samantha A., NYU Langone Health, New York, New York, United States
- Massie, Allan, NYU Langone Health, New York, New York, United States
- Segev, Dorry L., NYU Langone Health, New York, New York, United States
- Husain, Syed Ali, NYU Langone Health, New York, New York, United States
Background
CMS’s Increasing Organ Transplant Access (IOTA) model, implemented on 07/01/2025, seeks to improve kidney transplant access using financial incentives and penalties for transplant centers based on transplant volume, offer acceptance, and post-transplant outcomes. About half of U.S. kidney transplant centers were randomly selected as mandatory IOTA participants. We examined the early impacts of IOTA on kidney transplant volume.
Methods
We conducted a retrospective cohort study using Organ Procurement and Transplantation Network data. The study compared IOTA participants (97 centers) to non-participants (80 centers) on changes in overall, deceased, and living donor kidney transplant volume in the 6 months pre vs. post implementation. Among IOTA centers, we compared the change in transplant volume stratified by pre-IOTA organ offer acceptance rate (OAR) and transplant rate ratio (TRR) tertiles.
Results
After IOTA implementation, both participants and non-participants showed reduced total volume of transplants (IOTA: -1% vs non-IOTA: -6%, p = 0.03), driven by fewer deceased donor transplants (-3% vs -12%, p<0.001). However, living donor transplants rose in both groups (+6% vs +15%, p = 0.08). Among deceased donor transplants, a smaller decline was observed among IOTA centers in both KDRI < 1.5 (-4% vs -11%, p=0.03) and KDRI > 1.5 (-2% vs -13%, p=0.02) transplants. An increase in transplant volume was only seen among IOTA centers in the lowest tertiles of baseline organ OAR (low +6.1% vs mid -3.0% vs high -2.6%) and TRR (low +3.9% vs mid -1% vs high -4.5%). (Figure)
Conclusion
During the 6 months after model implementation, IOTA centers outperformed non-IOTA centers in changes in kidney transplant volume, driven by a smaller decline in deceased donor transplant volume among model participants. Model effectiveness appears to be limited to more conservative centers at baseline.
Acknowledgment
The data reported here have been supplied by the United Network for Organ Sharing as the contractor for the Organ Procurement and Transplantation Network. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the OPTN or the U.S. Government.
Changes in Kidney Transplant Volume Following IOTA Implementation Among Model Participants by Organ Offer Acceptance Ratio, and Transplant Rate Ratio.