OPTN Registration Fees

On this page:

• What is the OPTN registration fee?
• OPTN registration fee collection: transition and timeline
• Improving transparency

What is the OPTN patient registration fee?

Most of the operating costs of the OPTN are paid for by patient registration fees. These fees are paid by transplant programs for each candidate they add to the national transplant waiting list. The fee amount is set each year by the OPTN Board and approved by HRSA.

New OPTN patient registration fee rate for FY26

On August 25, 2025, HRSA approved the OPTN Board of Directors’ recommended Fiscal Year (FY) 2026 OPTN Patient Registration Fee of $1,036 per transplant candidate. This fee went into effect on October 1, 2025.

OPTN patient registration fee collection: transition and timeline

In November 2025, the new federal funding bill (HR 5371) was signed into law and extends HRSA’s authority to collect OPTN patient registration fees that was originally granted in the 2025 Full-Year Continuing Appropriations and Extensions Act (Sec. 1904 in P.L. 1968). For decades, UNOS, as the sole OPTN contractor, has managed this fee collection process.

Under the new law, HHS has assumed responsibility for collecting these fees, a shift designed to:

• Enhance transparency in how fees are collected and used
• Expand opportunities for multiple best-in-class contractors to support the operations of the OPTN
• Strengthen oversight, performance, and accountability across the network

HRSA has begun sending invoices to transplant centers for OPTN patient registrations that occurred as of September 1, 2025. 

Invoices will be billed around the 15th of each month. Any invoices for patients added to the waitlist before August 31, 2025, should still be paid to the OPTN contractor.

HRSA only bills transplant centers for the OPTN Patient Registration Fee. The OPTN Patient Registration Fee is the only fee transplant centers are required to pay as OPTN members to support the operations of the OPTN under the OPTN Final Rule (42 CFR § 121.5). Any additional fees, such as the UNOS data fee, are payable at the discretion of the Transplant Hospital. Neither HRSA nor the OPTN has a role in billing or collecting those optional fees.

HRSA invoices for registration fees via Pay.gov, a secure, no-cost federal payment platform used by many U.S. government agencies. Currently, transplant centers have the option to pay their invoice via ACH debit or credit card in Pay.gov, or via ACH credit or wire transfer. HRSA will continue to keep transplant centers informed with timely email and webpage updates, detailed guidance, and clear timelines to support a smooth transition. Please see the HRSA Pay.gov User Guide (PDF - 3 MB) for more information for transplant centers. If you are a transplant hospital with questions regarding registration fees, please contact OPTNFeeSupport@hrsa.gov.

Improving transparency

The new law also introduces new transparency measures, providing the transplant community and the public with greater visibility into how registration fees are allocated and spent. These measures ensure registration fees support OPTN operations and, ultimately, improve outcomes for patients and families.

HRSA will continue to update this webpage to share information on the new fee collection process, fees collected, and how fees were used to support OPTN operations.