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Dear OPTN Members,
On behalf of the OPTN Board of Directors, we are writing to let you know that on August 11, 2026, the Health Resources and Services Administration (HRSA) approved the OPTN Board of Directors' recommended Fiscal Year (FY) 2027 OPTN Patient Registration Fee. The new fee, which will go into effect October 1, 2026, will increase from $1,036 to $1,268 per transplant candidate.
It is important to note that the OPTN Registration Fee does not represent a direct charge to patients. It can be considered a pre-transplant cost to the listing transplant center.
The increased fee for FY 2027 was necessary for several reasons:
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OPTN registration fee remained unchanged for many years. While the OPTN fee increased in FY 2026, it had previously remained unchanged between FY 2022 and FY 2025, even as operating costs continued to rise due to inflation and other factors. During this time, the funding gap was covered by drawing down surplus funds in the OPTN operating account. Now that those funds have been exhausted, an increase to the fee is necessary to reflect the true, ongoing cost of operating the OPTN.
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OPTN operations are evolving. The Securing the OPTN Act 2023 mandated the transition to a multi-vendor environment to support OPTN activities. Some costs that were formerly covered by federal appropriations will now be covered by registration fees. For instance, the Board Support Contract and portions of the Scientific Registry of Transplant Recipient (SRTR) contract were moved this year away from appropriations and into the OPTN budget. Additionally, while federal appropriations are covering numerous investments in infrastructure improvements to the OPTN (e.g., an overhauled OPTN website and creation of a secure collaboration platform for the OPTN Board, Committees, and other volunteers), the maintenance and continued operations of these systems will be supported by registration fees.
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The fees will support critical policy development, review, and implementation work. There are important policies and policy proposals that are sufficiently mature that the board would like to move forward this fiscal year. In addition, funds need to be available to carry out any Secretarial, HRSA and/or Board directed initiatives. Because policy implementation occurs through federal contracts, per the Antideficiency Act, the full lifecycle cost of each policy project, from development to evaluation/monitoring, must be accounted for in the fiscal year that the Board approves the project.
How are the fees determined?
Registration fees are determined annually by adding the:
- Estimated cost to operate the OPTN (summation of the multi-vendor contracts) for the fiscal year, including development of policies.
- Estimated cost of policy work for the fiscal year. The Board of Directors considered the estimated cost of implementing Board-approved policy projects, required Secretarial Directives, and new and unplanned directives and policies. The set-aside for unplanned policy needs ensures the OPTN can swiftly address emerging patient safety or compliance issues.
- Reserve set aside ($0 for this coming FY 2027). Building reserve contributions will be a priority beginning in FY 2028 to help cover unanticipated operating shortfalls and/or unplanned expenses.
The sum of all projected costs is then divided by the number of projected waitlist registrations for the upcoming fiscal year. Projections are made by HRSA based on their forecasting methodology and these projections are reviewed by the OPTN Board. This registration fee recommendation is vetted by the OPTN Finance Committee, voted on by the full OPTN Board after full consideration for potential amendments, and forwarded to the Secretary of Health by HRSA for approval or rejection.
The new fee-setting process reflects HRSA’s and the OPTN’s commitment to transparency and strong financial stewardship. Policy development and implementation occur through vendor contracts. With more budget transparency, OPTN is better able to track the full lifecycle costs of policy projects. The OPTN Finance Committee is working closely with HRSA to develop a transparent financial tracking methodology to have better budgetary line-of-sight during the fiscal year.
What OPTN members need to know:
- The FY 2027 fee amount takes effect October 1, 2026, for transplant candidates added to the waitlist on or after that date.
- Prompt payment of fees enables the OPTN to continue providing the critical services that patients and families depend on. Payment of registration fees is also an OPTN membership requirement for transplant hospitals under OPTN Management and Membership Policy F.2.d.
- HRSA invoices OPTN transplant hospitals each month through Pay.gov, and hospitals have 30 days to submit payment. Payment can be made via wire transfer, ACH credit, ACH debit, or credit card.
- HRSA has been working closely with transplant hospitals over the past few months to ensure they can comply with the new payment direction and methodology. It is critical to make sure payments are not delinquent.
- Beginning October 2026, HRSA will begin publishing quarterly fee collection data for each transplant center, as well as the OPTN services that the fees support, on the OPTN Registration Fee web page, as required by statute.
Thank you for your continued support and dedication to the OPTN.
Alan Reed, MD
OPTN Board Treasurer
John C. Magee, MD
OPTN Board President
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