Candidacy Criteria and the Increasing Organ Transplant Access (IOTA) Model

As of July 1, 2025, the Providence St. Joseph Hospital Orange Multi-Organ Transplant Center is participating in the Increasing Organ Transplant Access (IOTA) Model in collaboration with the Centers for Medicare & Medicare Services (CMS) Innovation Center to support chronic kidney disease care.

The IOTA Model aims to increase access to kidney transplantation and the number of kidney transplants, improving health outcomes for people with end-stage renal disease. The focus is on improved care coordination for those seeking kidney transplant evaluation, or on the kidney transplant waitlist, and enhancing quality outcomes for transplant recipients.

Candidacy Criteria

The following information is used to determine patient placement on the organ transplant waiting list. All patients with end-stage renal disease are individually reviewed to determine their candidacy for kidney transplantation.

In accordance with regulatory requirements, the transplant center must use written patient selection criteria in determining a patient’s suitability for placement on the waiting list or a patient’s suitability for transplantation.

Patient selection criteria must ensure fair and non-discriminatory distribution of organs.

Prior to placement on the center’s waiting list, a prospective transplant candidate must have:

  • Age ≥ 18 years
  • Documentation of kidney failure by either:
    • Chronic renal replacement therapy with start date of dialysis documented on form ESRD 2728
    • Creatinine clearance or eGFR ≤ 20 ml/min, measured or calculated
  • Medical and surgical consultation by Transplant Center Medical Director with emphasis on the following:
    • History of heart disease
    • History of poor circulation
    • History of severe lung disease
    • History of diverticulitis
    • History of stomach ulcer or duodenal ulcer
    • History of non-adherence to medical advice
    • History of substance abuse and/or alcohol abuse
    • History of pancreatitis
    • History of cancer
    • History of infections
    • History of immune system disease
    • History of liver disease
    • History of clotting disorder
    • BMI ≥ 40 (BMI alone is not a contraindication but may be significant in combination with other risk factors.)
  • Psycho-social consultation by Transplant Social Worker with an emphasis on the following:
    • Social, personal, housing, vocational, financial and environmental supports
    • Coping abilities and strategies, including bereavement
    • Understanding of the risks and benefits of transplantation
    • Ability to adhere to a therapeutic regimen
    • Mental health history, including substance or alcohol use or abuse and how it may impact the success or failure of organ transplantation
  • Dietary consultation by Transplant Dietitian
  • Financial clearance and consultation by Transplant Financial Coordinator
  • Completion of minimum listing criteria, if applicable
    • Medical Director consultation
    • Psycho-social consultation
    • On chronic renal replacement therapy or creatinine clearance or eGFR measured or calculated ≤ 20 ml/min
    • Two ABO blood type tests documented, done at different times
    • Human leukocyte antigen (HLA) testing
  • Other
    • Patients who are pre-dialysis may be listed at the discretion of the Medical Director if they meet minimal listing criteria. However, they will not be eligible for organ offers until the entire evaluation is complete.

Offer Acceptance Criteria

When evaluating a potential organ offer, our transplant team considers several medical and logistical factors to ensure the best possible clinical outcome. These include, but are not limited to:

  • Donor age, social and medical history
  • Cause of donor death and organ function (e.g., kidney function tests, kidney biopsy results)
  • Compatibility with your blood type and tissue match
  • Donor kidney quality metrics such as the Kidney Donor Profile Index (KDPI)
  • Infectious disease screening and infection risk profile
  • Cold ischemia time (how long the kidney is on ice and preserved) and organ transportation logistics
  • Recipient-specific considerations (e.g., other health risk factors, surgical risk, time on the waitlist, and readiness)

The Providence St. Joseph Multi-Organ Transplant Center may also review other organ offers, such as those from donors with hepatitis B or C, or from donors with increased risk for certain infections, in accordance with federal regulations and patient documented consent.

Please note that the transplant team makes each decision on a case-by-case basis, balancing medical urgency, organ quality, and safety to provide the best opportunity for a successful transplant.