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Patient Selection Criteria at Kidney Transplant Programs and Waitlist Outcomes

Announced on

06/16/2025

| Last Modified on

03/06/2026

| Project Number: OEI-01-23-00293

Status Completed Agency Centers for Medicare and Medicaid Services

OBJECTIVE

Transplant programs within a hospital that has a Medicare provider agreement must meet the Medicare Conditions of Participation (CoPs) for CMS to grant approval to provide transplant services. The CoPs for transplant programs include a requirement that programs use written patient selection criteria to determine a patient’s suitability for placement on the transplant waiting list. However, CMS does not define patient selection criteria, which raises questions about what they include, how they vary, and why patients fail to meet them. This study will provide information about transplant programs’ patient selection criteria for adult kidney transplants and the reasons that patients are not added to the waitlist following an evaluation for transplant.

TIMELINE

• June 16, 2025 Announced
• March 6, 2026 Complete Patient Selection Criteria at Kidney Transplant Programs and Waitlist Outcomes complete. Report Published

REPORT PUBLISHED

#### Psychosocial Characteristics and Their Association With Kidney Transplant Programs Waitlist Rates (OEI-01-23-00293) 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).
  No recommendations were issued as a part of this report. Work Plan Type Office of Evaluation and Inspections HHS Agencies Centers for Medicare and Medicaid Services Issue Areas Hospitals Managed Care Quality of Care Target Groups Other Minorities Financial Groups Medicare A Medicare B Medicare C