Washington, D.C. (May 9, 2024) The long-awaited Increasing Organ Transplant Access (IOTA) Model was released yesterday by the Center for Medicare and Medicaid Innovation (CMMI) focusing on increasing patients’ access to kidney transplantation across the United States. The 6-year, multi-payer model will randomize an estimated 90 transplant centers of the 231 facilities actively performing kidney transplants nationwide. It “aims to increase access to kidney transplants for all people living with end-stage renal disease (ESRD), improve the quality of care for people seeking kidney transplants, reduce disparities among individuals undergoing the process to receive a kidney transplant, and increase the efficiency and capability of transplant hospitals selected to participate.”
“The American Society of Nephrology (ASN) has been advocating for increased investment and reform in the U.S. transplant system for many years” stated ASN President Deidra C. Crews, MD, ScM, FASN. “People with kidney failure deserve to have access to the best therapy—a kidney transplant—maximized at every opportunity. ASN is grateful for the leadership of the Biden-Harris Administration in testing patient-centered changes to how kidney transplant care is delivered, and we welcome the opportunity to review and suggest improvements to the proposed IOTA Model released today.”
The model would provide incentives for transplant hospitals to promote the following goals:
- Maximize the use of deceased donor kidneys. Currently, approximately 30% of donor kidneys go unused annually.
- Improve quality of care before, during and after transplantation.
- Identify more living donors and assist potential living donors through the donation process.
- Create greater equity in access to a kidney transplant by addressing social determinants of health and other barriers to care.
- Improve care coordination and patient-centeredness in the kidney transplant process.
- Reduce Medicare expenditures.
“I am optimistic about this new model benefitting the patients I serve today and into the future,” said transplant nephrologist and ASN Past President Michelle A. Josephson, MD, FASN. “For too long, the journey to receiving a kidney transplant has been a black box for patients and general nephrologists. For many, it can be a challenge to determine which transplant center would be a good fit, to know if a kidney was offered and declined on their behalf or even if a patient is active on the waitlist. This proposed model offers promising components that I believe could help increase access to kidney transplantation by better equipping patients, their families, and their general nephrologists with information that empowers them to more effectively navigate the transplant system.”
The model emphasizes providing greater transparency for patients about their own care and decisions made on their behalf, and for greater public transparency about transplant program criteria, steps for which ASN has strongly advocated.
Today, access to kidney transplants varies along socio-economic, geographic, racial/ethnic, and other lines. CMMI notes that transplants, particularly living donor transplants, are much more common for people with private insurance. The proposed model aims to increase access to kidney transplantation so that it is a more viable option for all adults with kidney failure by adding focus on specific populations that are currently less likely to receive a transplant.
“As a transplant nephrologist, I am particularly gratified to see that this proposed model emphasizes increasing kidney transplant rates overall while simultaneously focusing on boosting access for people who are socioeconomically disadvantaged, a population that has historically had less access to transplantation” said ASN Policy and Advocacy Committee chair Roslyn B. Mannon, MD, FASN.
A kidney transplant is the best therapy for most of the more than 800,000 Americans with kidney failure, providing better outcomes for patients and lower costs to Medicare compared to dialysis, the only other therapy available to manage kidney failure. More than 90,000 people in the United States are waiting for a kidney transplant. In 2023, the US performed 27,000 kidney transplants, far short of meeting the need of the thousands on the kidney transplant waitlist.
About the American Society of Nephrology
Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge and advocating for the highest quality care for patients. ASN has nearly 22,000 members representing 141 countries. For more information, visit www.asn-online.org and follow us on Facebook, X, LinkedIn, and Instagram.
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