ASN and AST Take Joint Step Towards Transplant Nephrology Training

ACGME accreditation would advance transplant nephrology as a distinct medical sub-subspecialty and foster broad nationwide adoption of uniformly rigorous transplant nephrology training.  

Update: October 15, 2024

ACGME Approves Transplant Nephrology Accreditation 
Learn more about why ASN and AST pursued accreditation, what comes next for programs, and future benefits of ACGME recognition for transplant nephrologists and patients at ASN Kidney Week on Friday, October 25 from 1:00 – 2:00 p.m. PDT. 

In a major advancement for the sub-subspecialty of transplant nephrology, the Accreditation Council for Graduate Medical Education (ACGME) approved an application for transplant nephrology accreditation submitted jointly by ASN and the American Society of Transplantation. 

“The [ASN-AST] proposal meets the criteria established by the ACGME for recognition of a new subspecialty,” wrote ACGME President and Chief Executive Officer Thomas Nasca, MD, FASN, in his letter affirming approval to the two societies. 

“We believe this represents a critical first step towards ensuring optimal education of future transplant nephrology trainees, stabilizing our workforce, and improving the quality of care we deliver to hundreds of thousands of US kidney and pancreas transplant candidates and recipients nationwide,” said ASN-AST Task Force on ACGME Accreditation for Transplant Nephrology Chair Roy D. Bloom, MD, FASN. 

ACGME’s early October 2024 decision means that ASN and AST will begin working closely with ACGME Review Committee for Internal Medicine (RC-IM) to begin writing the program requirements and application. While the exact timeline remains to be finalized by ACGME, it is likely that programs would apply to ACGME for accreditation in 2025 and initiate the first class of trainees in July 2026.

Dr. Bloom and task force vice chair Neeraj Singh, MD, FASN, will be co-leading an informal informational session about ACGME accreditation during ASN Kidney Week from 1:00 – 2:00 p.m. on Friday, October 25 in the ASN Communities Lounge, located in the Exhibit Hall. 

More background on ASN and AST’s pursuit of ACGME funding and its implications for nephrology are below and will be discussed during the Kidney Week session in the ASN Communities Lounge. 


Update: June 18, 2024

ACGME approved the ASN-AST application for transplant nephrology accreditation to move onto the next step in the process: a public comment period. The public comment period portal, which can be accessed via the following link, will remain open until Friday, August 2, 2024: https://www.acgme.org/programs-and-institutions/programs/new-specialty-or-subspecialty-proposals/

ASN and AST are in the process of planning two town halls to share more information about the accreditation effort and answer questions. Stay tuned for those dates and times. 


May 14, 2024

Kidney transplantation is the optimal therapy for many patients with kidney failure, and the growing recognition of this fact within the U.S. government has yielded numerous federal initiatives to increase patients’ access to kidney transplants, such as the Advancing American Kidney Health Initiative (2019), the ESRD Treatment Choices (ETC) model (2021), the Organ Procurement and Transplantation Network Modernization Initiative and the Securing the U.S. OPTN Act (2023), and the Increasing Organ Transplant Access (IOTA) model (2024), among others. 

Increasing the number of patients who benefit from kidney transplantation calls for the highest quality of possible care at each step of the journey: before, during, and after their kidney transplant. Managing kidney transplant candidates, recipients, and living donors has become increasingly complex over time as scientific and clinical advancements have made it possible to transplant people who would never have been considered candidates in the past. 

The joint American Society of Nephrology (ASN) and the American Society of Transplantation (AST) Task Force on ACGME Accreditation for Transplant Nephrology (see Table 1), which aims to ensure every kidney transplant recipient and donor receives optimal care, applied in early 2024 for recognition of transplant nephrology as an accredited sub-subspecialty of nephrology. In their application to the Accreditation Council for Graduate Medical Education (ACGME), ASN and AST laid out how the clinical practice and focus of adult transplant nephrology is distinct from that of general adult nephrology. Between the growth of the kidney transplant patient population and the increasing complexity of patients as well as the landscape of transplant care delivery, many transplant nephrologists’ clinical practice is now solely dedicated to organ transplantation, primarily kidney-focused. By supporting a broad nationwide adoption of uniformly rigorous transplant nephrology training, ASN and AST hope to improve the quality of care provided to patients in both pre- and post-transplant phase.

General nephrologists have always had and will continue to have an important role to play in transplant care in the multidisciplinary kidney care team, such as helping identify candidates who might benefit, supporting people on dialysis in remaining healthy enough for transplantation, and assisting in longer-term post-transplant care. Transplant nephrologists complement general nephrologists in addressing aspects of care that are uniquely transplant-related, such as counseling candidates on their options to transplant, providing nephrological management in the perioperative setting, managing immunosuppression, and detecting and addressing transplant-related complications.

ACGME accreditation will open the door to many possible benefits for transplant nephrology that are not available to sub-subspecialties that lack accreditation. For example, transplant nephrology could obtain Centers for Medicare and Medicaid Services (CMS) designation. ACGME accreditation is required to obtain CMS Provider Enrollment, Chain, and Ownership System (PECOS) designation for any specialty, and CMS reimbursement rates for medical services are often tied to specialty designations. This means that CMS could identify transplant nephrologists—which is not possible today—and value their unique contributions in future value-based care models. Furthermore, the American Medical Association (AMA)’s Relative Value Scale Update Committee could consider the creation of new current procedural terminology code and relative value units associated with transplant nephrology. 

In addition, ACGME accreditation can support growth in transplant nephrology fellowship programs and positions as it will remove current disincentives for programs to offer positions to trainees on a J-1 visa (e.g., to obtain Non-Standard Training Recognition from ACGME) and could help support the funding of transplant fellows through graduate medical education funds from Medicare.

At present, trainees wishing to pursue a third year of training to specialize in transplant nephrology must first successfully complete the two-year general nephrology training program, a structure ASN and AST envision will remain in place should ACGME accreditation be awarded.

Importantly, ASN and AST are especially eager to ensure that ACGME certification of transplant nephrology does not result in the unintended consequence of additional exam (and financial) burden for transplant nephrologists. Contrary to widespread belief, ACGME accreditation does not require the development of another initial certification exam or additional maintenance of certification exams. ASN and AST have identified a spectrum of options that could potentially address concerns regarding additional exam burden as well as create opportunities for transplant nephrologists to demonstrate their excellence in their chosen field. Should ACGME grant transplant nephrology ACGME accreditation, ASN and AST are committed to working closely with the transplant nephrology community to determine the most appropriate approach to initial and ongoing certification.

Should the ASN-AST application for accreditation for transplant nephrology pass an initial ACGME review, it will be posted for a 45-day public comment period in June 2024, followed by additional review and consideration by various ACGME entities. ASN and AST will also host a series of town halls in advance of the public comment period deadline; details will be forthcoming. 

If you have questions or comments regarding this effort, please share them with ASN and AST at policy@asn-online.org.

Table 1. ASN-AST Task Force on ACGME Accreditation for Transplant Nephrology

• Deborah, B. Adey, MD, FAST
  San Francisco, CA
• Roy D. Bloom, MD, Chair
  Philadelphia, PA
• Beatrice P. Concepcion, MD, MS, FASN
  Chicago, IL
• Gaurav Gupta, MD
  Richmond, VA
• Michelle A. Josephson, MD, FASN, Nonvoting Ex Officio, ASN Past President
• Vineeta Kumar, MD, FASN, FAST
  Birmingham, AL
• Mark G. Parker, MD, FASN
  Portland, ME
• Deirdre Sawinski, MD, FAST, Nonvoting Ex Officio
  AST Board of Directors, Councilor-at-Large
• Neeraj Singh, MD, MBA, FASN, Vice Chair
  Shreveport, LA

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