Yes, most people with severe kidney disease can get a kidney transplant, though you’ll need to meet specific medical criteria and go through an evaluation process first. The key threshold is kidney function: your glomerular filtration rate (GFR), a measure of how well your kidneys filter waste, generally needs to be at or below 20 mL/min to qualify. For context, healthy kidneys filter at about 90 to 120 mL/min, so transplant candidacy begins when you’ve lost roughly 80% of your kidney function.
Who Qualifies for a Kidney Transplant
The primary requirement is severely reduced kidney function, confirmed by a GFR at or below 20 mL/min. If your GFR is slightly higher, up to about 25 mL/min, you may still qualify in two situations: your kidney function is declining rapidly (losing at least 10 mL/min per year), or you already have a living donor lined up. People already on dialysis for end-stage kidney disease are also candidates.
Age alone won’t disqualify you. There is no universal upper age limit for kidney transplants, though centers may set their own thresholds. Many programs evaluate patients in their 70s and beyond, focusing on overall health rather than a number on a birthday card. The main concern for older candidates is heart and blood vessel disease, which is the primary reason patients over 60 are turned down.
What Could Disqualify You
Certain conditions make transplant surgery too risky. The absolute disqualifiers are severe heart or lung disease that would make you unable to tolerate surgery, active cancer, active infections, active drug abuse, and uncontrolled psychiatric illness. These aren’t negotiable because the surgery itself and the lifelong medications afterward would pose serious danger.
Other factors are evaluated on a case-by-case basis. A BMI over 40 is a relative contraindication at most centers. A history of missing dialysis sessions or not taking medications as prescribed can raise concerns, since transplant success depends heavily on sticking to a strict drug regimen afterward. If you’ve had cancer in the past, most centers require you to be cancer-free for two to five years before listing you, depending on the type of cancer. The reasoning: the anti-rejection medications you’ll take suppress your immune system, which could allow a dormant cancer to return.
The Evaluation Process
Getting listed for a transplant isn’t a single appointment. It’s a thorough workup designed to make sure your body can handle the surgery and the long-term medication. Expect the process to take weeks to months.
Heart screening is the most critical piece. At minimum, you’ll get an electrocardiogram (a recording of your heart’s electrical activity) and an echocardiogram (an ultrasound of your heart). Many centers also use stress tests, where you exercise on a treadmill or receive medication that simulates exercise while doctors monitor your heart’s response. One practical benchmark some centers use: if you can walk four blocks and climb two flights of stairs without significant difficulty, that’s a reasonable indicator of surgical fitness. Older patients or those with risk factors may need more advanced imaging or even a procedure to look directly at their heart arteries.
Beyond the heart, the evaluation includes blood work, imaging of your kidneys and abdomen, cancer screenings, dental exams, and a psychological assessment. The transplant team wants to confirm you understand what’s involved and have the support system to manage recovery and lifelong medication.
Living Donors vs. Deceased Donors
Kidneys come from two sources: living donors and deceased donors. The difference between them is significant, and it goes beyond just wait times.
Kidneys from living donors last substantially longer. In a large study spanning nearly five decades, kidneys from living donors had a median survival of 11.3 years compared to 4.3 years for deceased donor kidneys. At the 10-year mark, about 53% of living donor kidneys were still functioning, versus roughly 33% of deceased donor kidneys. Recipients of living donor kidneys also had better survival rates overall, with a 45% lower risk of death compared to deceased donor recipients.
A living donor can be a family member, friend, spouse, or even an altruistic stranger. The donor needs to be in good health, with a GFR above 70 mL/min, no diabetes, no uncontrolled high blood pressure, and a BMI under 40. Living donation also allows the surgery to be scheduled at the best time for both people, rather than happening on short notice when a deceased donor organ becomes available.
When Your Donor Isn’t a Match
If someone wants to donate to you but turns out to be incompatible (due to blood type or other immune factors), paired exchange programs offer a workaround. Your incompatible donor gives a kidney to a stranger whose donor is incompatible with them, and that stranger’s donor gives a kidney to you. These swaps can involve two pairs or sometimes chain together many pairs across the country, dramatically expanding the pool of possible matches.
How Long the Wait Takes
If you don’t have a living donor and need a kidney from the deceased donor waitlist, the average wait is three to five years at most transplant centers. In some parts of the country, it can stretch longer. Several factors affect your spot: your blood type plays a major role, since rarer blood types are harder to match. Your level of antibodies against foreign tissue, time already spent on dialysis, and geographic location all factor in as well.
One important detail many people don’t realize: you can be listed at more than one transplant center. Wait times vary significantly by region, so listing at a second center in a different area could shorten your wait. This does mean undergoing the evaluation process again at that center, but it’s a legitimate strategy.
What Happens After the Transplant
A successful transplant isn’t the finish line. It’s the beginning of a lifelong commitment to anti-rejection medications. Your immune system will always see the new kidney as foreign, and without these drugs, it will attack and destroy the organ. You’ll take a combination of medications that suppress different parts of your immune response, typically including a steroid, a drug that prevents immune cells from multiplying, and a drug that blocks a specific activation signal in immune cells.
These medications work, but they come with tradeoffs. Common side effects include high blood pressure, increased blood sugar (some people develop diabetes after transplant), stomach problems, and changes in hair or gum growth. Because your immune system is dialed down, you’ll be more vulnerable to infections and have a slightly higher long-term risk of certain cancers, particularly skin cancer. Regular follow-up visits, blood work, and cancer screenings become a permanent part of your routine.
Insurance and Cost Coverage
In the United States, Medicare covers kidney transplant surgery for people with end-stage kidney disease, regardless of age. This coverage extends for 36 months after the transplant. After that 36-month window, Medicare coverage ends unless you qualify for Medicare through another reason, such as age (65 or older) or a disability.
The critical concern for many patients is what happens to their anti-rejection drug coverage after those 36 months. Starting in January 2023, a new federal provision allows people whose Medicare kidney disease coverage expires to continue enrolling in Medicare Part B specifically for immunosuppressive drug coverage, with no time limit. This closed a dangerous gap that previously left some transplant recipients unable to afford the medications keeping their kidney alive. If you have private insurance or Medicaid, coverage terms vary, but most plans cover transplant surgery and at least some portion of ongoing medications.