HHS seeks comment on efforts to improve organ transplant equity, dialysis care

Photo: Pramote Polyamate/Getty Images

The U.S. Department of Health and Human Services, through the Centers for Medicare and Medicaid Services, is soliciting public feedback on potential changes to rulemaking it’s considering to improve both the organ transplantation system and dialysis care — part of a broader effort to introduce more equity into the healthcare system.

The formal Request for Information issued by the agency stems from a Biden Administration goal of improving health outcomes for the roughly 106,000 people who are living with organ failure and are awaiting a transplant.

CMS, for its part, said it is focused on identifying potential system-wide improvements that would increase organ donations, improve transplants, enhance the quality of care in dialysis facilities, increase access to dialysis services and advance equity in organ donation and transplantation.

Critical to these improvements, said CMS, is the collaborative relationship among Organ Procurement Organizations (OPOs), donor hospitals, transplant programs and End-Stage Renal Disease (ESRD) facilities to ensure that organs are successfully recovered and transplanted. The government considers these providers and suppliers as integral to the nation’s transplant ecosystem.


According to data provided by CMS and HHS, communities of color have much higher rates of high blood pressure, diabetes, obesity and heart disease, all of which increase the risk for kidney disease. Black Americans are almost four times more likely, and Latinos are 1.3 times more likely, to have kidney failure compared to white Americans. 

Despite the higher risk, the data shows that Black and Latino patients on dialysis are less likely to be placed on the transplant waitlist and have a lower likelihood of transplantation. 

Because of these inequities, CMS’ RFI asks the public for specific ideas on advancing equity within the organ transplantation system, particularly on potential changes to the health and safety standards for transplant programs, ESRD facilities and OPO operations.  

The RFI seeks feedback from those on organ transplant waitlists, transplant recipients, their families, living donors and those who sign up to be posthumous donors, families of donors, chronic kidney disease and ESRD patients. 

The feedback, the agencies said, will help inform future regulatory requirements that transplant programs, OPOs, and ESRD providers and suppliers would need to meet to participate in the Medicare and Medicaid programs.


It’s been a little over a year since CMS, then under the auspices of the Trump Administration, released policy promoting more dialysis treatment in the home by allowing the use of certain new equipment to qualify for an additional Medicare payment.

That policy was meant to encourage the development of new and innovative home dialysis machines that give Medicare beneficiaries with end-stage renal disease more treatment options in the home.

Approximately 68% of Medicare beneficiaries with ESRD also suffer from diabetes, the agency said at the time. These Medicare beneficiaries can join a prescription drug plan that will offer many types of insulin at a maximum copayment of $35 for a 30-day supply.

Private companies and insurers are also making efforts to improve dialysis care. In August, Fresenius Medical Care North America and Cigna expanded their partnership for at least two years to provide members with end-stage renal disease access to more than 2,600 dialysis centers and home dialysis options.

The value-based care arrangement has incentives to align reimbursement with improved performance, and reduce the cost of care for people living with kidney failure or end-stage renal disease. It’s part of Cigna’s value-based care model, Collaborative Care.


“Today’s announcement supports the President’s Executive Orders to advance health equity and improve health outcomes for people in need of a life-saving transplant and dialysis,” said HHS Secretary Xavier Becerra. “We want to hear from diverse stakeholders, especially the patients and their families. Your feedback is essential to our work in ensuring equal access to vital resources.”

“Organ donation is a precious gift, and we owe it to recipients, donors, those awaiting organs, and their loved ones to ensure our transplantation system is safe, efficient and equitable,” said CMS Administrator Chiquita Brooks-LaSure. “We are seeking input on ways to improve organ donation and transplantation and are committed to engaging all stakeholders throughout our policy development process. This effort is extremely important for supporting organ transplants for communities of color, individuals with disabilities and other historically underserved populations.”

Twitter: @JELagasse
Email the writer: [email protected]