Getting a kidney transplant starts with a referral from your nephrologist (kidney doctor) to a transplant center, followed by a medical evaluation, placement on a waiting list or finding a living donor, and finally the surgery itself. The entire process from first referral to receiving a kidney can take anywhere from several months to five or more years, depending on your donor source and medical situation. Here’s what each step actually looks like.
Who Qualifies for a Transplant
You’re eligible for a kidney transplant evaluation once your kidney function drops to a GFR of 20 or below. GFR measures how well your kidneys filter waste, and a score under 20 means they’re working at roughly 20% capacity or less. You don’t need to be on dialysis already. In fact, getting evaluated early, before dialysis becomes necessary, can lead to better outcomes.
If your GFR is slightly higher, up to 25, you may still qualify in two situations: your kidney function is declining rapidly (losing at least 10 GFR points per year), or you already have a living donor lined up and ready.
Not everyone with advanced kidney disease is a candidate. Transplant centers will screen for conditions that could make surgery too risky or reduce the benefit of a new kidney. Common disqualifiers include:
- Life expectancy under five years even with a successful transplant
- Extreme obesity with a BMI over 45
- Active cancer or chronic infections that haven’t been treated or controlled
- Severe cardiovascular disease that makes major surgery dangerous
- Active substance use disorders or severe untreated mental health conditions
- Lack of a support system to help with recovery and long-term follow-up care
Some of these are permanent disqualifiers, but others are temporary. Losing weight, completing addiction treatment, or stabilizing a mental health condition can make you eligible later.
Getting Referred to a Transplant Center
Your nephrologist is the person who initiates this process. Once your GFR approaches the threshold, they should discuss transplant as an option and send a referral to one or more transplant centers. If your doctor hasn’t brought it up and your kidney function is declining, ask directly. You have the right to request a referral, and some patients benefit from being proactive about it.
You can also contact transplant centers yourself. Most hospitals with transplant programs have coordinators who can walk you through their intake process. You’re not locked into a single center. In the United States, you’re allowed to be listed at more than one transplant center, a strategy called multiple listing. Transplant rates are higher for patients who list at multiple centers, because organ availability varies significantly by region. Every transplant center is required to tell you that multiple listing is an option.
The Medical Evaluation
Once a transplant center accepts your referral, you’ll go through a thorough evaluation that typically takes several weeks to a few months. The goal is to confirm you’re healthy enough for surgery and to gather the information surgeons need to plan the procedure.
Heart and lung testing is a major component. You’ll get an electrocardiogram to check your heart rhythm, an echocardiogram (a heart ultrasound) to see how well your heart pumps, and sometimes a stress test where you walk on a treadmill while your heart is monitored. Chest imaging checks your lungs for fluid buildup or infection. A vascular scan maps your veins and arteries so surgeons know exactly where to connect the new kidney.
Beyond the physical tests, you’ll meet with a social worker. This isn’t just a formality. They assess whether you have the support system to get through surgery and recovery: someone to drive you to appointments, help at home during the first few weeks, and the ability to take time off work. They also connect you with financial assistance programs, which matters because post-transplant medications are a lifelong expense.
Blood and tissue typing is done during this phase too, which determines your compatibility with potential donors. The transplant team reviews everything together and decides whether to approve you for the waiting list.
Finding a Donor: Living vs. Deceased
There are two paths to a kidney: a living donor or a deceased donor. The outcomes are meaningfully different, and understanding both helps you decide how to approach the process.
Living Donors
A living donor kidney lasts longer and works better from the start. Five-year graft survival (meaning the transplanted kidney is still functioning) is 92% for living donor kidneys compared to 86% for deceased donor kidneys. Patient survival at five years is 86% with a living donor versus 75% with a deceased donor.
Living donors can be family members, friends, coworkers, or even people you’ve never met. The donor goes through their own separate evaluation to make sure donating is safe for them. The surgery is scheduled in advance, which means less time on dialysis and better preparation for both of you.
If you have a willing donor who isn’t a blood type or tissue match, you’re not out of luck. Paired kidney exchange programs match incompatible pairs with other incompatible pairs. For example, if your sister wants to donate to you but has the wrong blood type, she can donate to a stranger whose donor has the right blood type for you, and that donor gives their kidney to you. These chains sometimes involve several pairs and can be started by altruistic donors, people who volunteer to give a kidney to someone they don’t know.
Deceased Donors
If you don’t have a living donor, you’ll be placed on the national waiting list managed by the Organ Procurement and Transplant Network. Wait times vary widely based on your blood type, your location, how long you’ve been on the list, and how sensitized your immune system is to foreign tissue. Median waits for a deceased donor kidney range from roughly three to five years in many regions, but some areas have shorter or longer waits.
Time on the list is calculated from when you were first referred for evaluation or started dialysis, whichever came first. This is another reason early referral matters: your clock starts ticking sooner. When a kidney becomes available and you’re a match, you’ll get a call and need to reach the hospital within hours.
Listing at Multiple Centers
Because organ availability differs so much by geography, listing at more than one transplant center can shorten your wait. A center in a region with fewer candidates on the list may offer you a kidney sooner. The tradeoff is that each center requires its own evaluation, which means repeating tests and traveling. For patients who can manage the logistics, the data shows higher transplant rates for those who list at multiple centers. The U.S. is the only country known to allow this practice.
What Surgery and Recovery Look Like
Kidney transplant surgery takes about three to four hours. The new kidney is placed in your lower abdomen and connected to your blood vessels and bladder. In most cases, your original kidneys are left in place unless there’s a specific reason to remove them.
Hospital stays typically run three to five days. During that time, the transplant team monitors how the new kidney is functioning and starts you on immunosuppressive medications, which prevent your body from rejecting the organ. You’ll need to take these medications for the rest of your life.
After discharge, expect frequent follow-up visits for the first few months, sometimes multiple times per week initially. Most people return to normal activities within four to six weeks, though heavy lifting and strenuous exercise take longer. The first three months are the highest-risk period for rejection, so your medication doses and blood work are monitored closely during this window.
Paying for a Transplant
Medicare covers kidney transplant surgery for people with end-stage renal disease, regardless of age. This is one of the few conditions that qualifies you for Medicare even if you’re under 65. Coverage includes the surgery itself, hospital stay, and related care.
The bigger financial concern for many patients is the cost of immunosuppressive drugs after the transplant. Previously, Medicare coverage for these medications ended 36 months after a successful transplant, leaving many patients unable to afford the drugs that kept their new kidney alive. Starting January 1, 2023, a new Medicare Part B benefit provides continuous coverage for immunosuppressive drugs specifically. This benefit is available to patients whose Medicare was based on end-stage renal disease, and you can enroll or disenroll at any time without penalty. It only covers immunosuppressive medications, not other services or drugs, but it addresses what had been one of the most dangerous gaps in transplant care.
Private insurance, Medicaid, and Veterans Affairs benefits also cover kidney transplants with varying out-of-pocket costs. The social worker assigned during your evaluation is one of your best resources for navigating coverage and finding assistance programs for expenses that insurance doesn’t cover, like travel to the transplant center or lost wages during recovery.