{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T17:02:15Z","timestamp":1789750935367,"version":"4.0.1"},"reference-count":0,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"abstract":"\n Background:<\/jats:title>\n The Increasing Organ Transplant Access (IOTA) model is a mandatory experimental payment model that aims to improve kidney transplant access using financial incentives and penalties for transplant centers randomized to model participation, based primarily on growth in transplant volume.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n We used national transplant registry data to conduct a retrospective cohort study of US kidney transplant centers. We identified centers randomized to IOTA participation based on the published list of center participants. Using a difference-in-differences approach, we compared IOTA participants to non-participants on changes in overall, deceased donor, and living donor kidney transplant volume per 30 days in the period before IOTA randomization status was announced versus the 9 months following IOTA implementation. Separately among IOTA participants and among non-participants, we compared the proportional change in transplant volume when stratifying centers by pre-IOTA transplant volume, organ offer acceptance rate, and transplant rate ratio.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n Among 177 included centers, 97 (55%) were IOTA participants and 80 (45%) non-participants. Most IOTA participants (53%) and non-participants (55%) experienced a fall in overall transplant volume after model implementation. However, IOTA participants exhibited a 5% increase in transplant volume per 30 days, whereas non-participants exhibited a 3% decrease (P=0.01). The difference between groups was seen for deceased donor transplants (participants +5% vs. non-participants -9%, P<0.001), while living donor transplants rose in both groups (+7 vs. +19%, P=0.24). Among IOTA participants, there were no statistically significant differences in changes in transplant volume when comparing centers categorized by pre-IOTA transplant volume, organ offer acceptance rate, or transplant rate ratio.<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Centers randomized to IOTA participation outperformed model non-participants in changes in kidney transplant volume after model implementation, driven by an increase in deceased donor transplant volume among model participants but a fall among non-participants.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.0000001225","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T16:01:38Z","timestamp":1789747298000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Early Changes in Kidney Transplantation following Implementation of the Increasing Organ Transplant Access Model"],"prefix":"10.2215","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1823-0117","authenticated-orcid":false,"given":"Syed Ali","family":"Husain","sequence":"first","affiliation":[{"name":"Department of Surgery, NYU Langone Health, New York, NY, USA"},{"name":"Department of Medicine, Division of Nephrology, NYU Langone Health, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4239-1252","authenticated-orcid":false,"given":"Macey L.","family":"Levan","sequence":"additional","affiliation":[{"name":"Department of Surgery, NYU Langone Health, New York, NY, USA"},{"name":"Department of Population Health, NYU Langone Health, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8130-6945","authenticated-orcid":false,"given":"Madhur","family":"Thakur","sequence":"additional","affiliation":[{"name":"Department of Surgery, NYU Langone Health, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4901-0619","authenticated-orcid":false,"given":"Rhiannon D.","family":"Reed","sequence":"additional","affiliation":[{"name":"Department of Surgery, NYU Langone Health, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0220-8716","authenticated-orcid":false,"given":"Jayme E.","family":"Locke","sequence":"additional","affiliation":[{"name":"Department of Surgery, NYU Langone Health, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8154-8118","authenticated-orcid":false,"given":"Samantha A.","family":"Weiss","sequence":"additional","affiliation":[{"name":"Department of Surgery, NYU Langone Health, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5288-5125","authenticated-orcid":false,"given":"Allan B.","family":"Massie","sequence":"additional","affiliation":[{"name":"Department of Surgery, NYU Langone Health, New York, NY, USA"},{"name":"Department of Population Health, NYU Langone Health, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1924-4801","authenticated-orcid":false,"given":"Dorry L.","family":"Segev","sequence":"additional","affiliation":[{"name":"Department of Surgery, NYU Langone Health, New York, NY, USA"},{"name":"Department of Population Health, NYU Langone Health, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6764-4842","authenticated-orcid":false,"given":"Darren E.","family":"Stewart","sequence":"additional","affiliation":[{"name":"Department of Surgery, NYU Langone Health, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,9,18]]},"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000001225","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T16:01:38Z","timestamp":1789747298000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000001225"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,18]]},"references-count":0,"URL":"https:\/\/doi.org\/10.2215\/cjn.0000001225","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,18]]},"assertion":[{"value":"2026-05-21","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-15","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}