Getting a kidney means receiving a transplant, either from a living donor or from a deceased donor through the national waitlist. The process starts with a referral from your nephrologist once your kidney function drops to a specific level, and from there you’ll go through medical evaluation, get listed, and either find a living donor or wait for a match. Most people in the U.S. wait three to five years for a deceased donor kidney, though a living donor can cut that timeline dramatically.
Who Qualifies for a Transplant
You become eligible for a kidney transplant when your glomerular filtration rate (a measure of how well your kidneys filter waste) falls to about 20 mL/min or below. For context, healthy kidneys filter at roughly 90 to 120 mL/min, so 20 represents severely reduced function. If your GFR is slightly higher, up to 25, you may still qualify if your kidney function is declining rapidly (losing at least 10 points per year) or if you already have a living donor lined up.
People already on dialysis for end-stage kidney disease automatically meet the threshold. In fact, getting evaluated and listed before you need dialysis is ideal because your wait time on the list starts accruing from the moment you’re added, not from the moment you begin dialysis.
The Evaluation Process
Before you can be placed on the waitlist, a transplant center needs to confirm you’re healthy enough to survive the surgery and the lifelong medication that follows. This evaluation is thorough and can take several weeks to complete. Expect blood work, a chest X-ray, CT scan, EKG, echocardiogram, a stress test on a treadmill or exercise bike, a colonoscopy, and a dental exam. The transplant team will also review your full medical history and current medications.
The goal isn’t just to check boxes. The team is looking for conditions that could make the transplant too risky, like active infections, uncontrolled heart disease, or certain cancers. If something comes up, it doesn’t necessarily disqualify you permanently. You may be asked to address the issue first and then return for reevaluation.
Two Paths: Living Donor or Waitlist
There are two ways to receive a kidney, and pursuing both at the same time is common.
The Deceased Donor Waitlist
Once you pass evaluation, your transplant center submits your information to the national organ-sharing system run by UNOS (the United Network for Organ Sharing). When a deceased donor kidney becomes available, a computer generates a ranked list of candidates for that specific organ. Your position depends on several factors:
- Wait time: how long you’ve been on the list
- Immune compatibility: a score reflecting how sensitized your immune system is to foreign tissue
- Blood type match
- Distance from the donor hospital
- Predicted survival benefit: how much the transplant would extend your life compared to staying on dialysis
- Pediatric status: children are essentially first in line for organs from other children
Most people wait three to five years. Wait times vary by region, blood type, and immune sensitivity. You can use the Scientific Registry of Transplant Recipients tool to see estimated wait times for someone with your specific health profile, based on 2024 data. Some people register at multiple transplant centers in different regions to improve their odds, though this means undergoing evaluation at each one.
Finding a Living Donor
A living donor kidney is the best option in almost every measurable way. One-year graft survival for living donor kidneys is about 98%, compared to 92% for deceased donor kidneys. At the five-year mark, living donor kidneys survive at roughly 88.5% versus 77% for deceased donor organs. Living donation also lets you schedule the surgery, often before you ever need dialysis.
A living donor must be over 18, in good physical and mental health, and free of conditions like uncontrolled high blood pressure, diabetes, cancer, or certain infections. Potential donors go through their own evaluation, including a 24-hour urine collection to assess kidney function. The donor’s hospital stay is typically two to three days, and most donors return to normal activities within a few weeks.
It’s worth knowing that donating a kidney does carry long-term risks, including a slightly higher chance of developing high blood pressure or reduced kidney function over time. These risks are relatively small, but donors should understand them fully before committing.
What If Your Donor Isn’t Compatible
Having a willing donor who turns out to be a poor blood type or immune match isn’t the dead end it used to be. Kidney paired donation programs let you swap donors with another pair in the same situation. Your donor gives to their recipient, and their donor gives to you.
These swaps can also form longer chains. A single altruistic donor (someone donating without a specific recipient in mind) can kick off a sequence where each donor in a pair gives to the next pair’s recipient, sometimes linking five, ten, or more transplants in a single chain. If you have an incompatible donor, your transplant center can enter you into one of these exchange pools. It expands your options significantly.
What Surgery and Recovery Look Like
The transplant surgery itself takes about three to four hours. The new kidney is placed in your lower abdomen and connected to your blood vessels and bladder. Your original kidneys are usually left in place unless there’s a specific reason to remove them.
Plan on a hospital stay of three to five days. In many cases, the new kidney starts working immediately, though deceased donor kidneys sometimes need a few days or weeks to “wake up,” during which you may still need dialysis. Within a few weeks of discharge, most recipients return to normal daily activities.
Life After Transplant
A transplanted kidney is foreign tissue, and your immune system will try to attack it. To prevent rejection, you’ll take anti-rejection medications for as long as the kidney functions. These drugs suppress your immune system, which means they work but come with trade-offs.
The most commonly used medications can raise your blood pressure, increase cholesterol, and elevate your blood sugar, sometimes enough to cause post-transplant diabetes. Long-term steroid use contributes to bone thinning and increases fracture risk. Because your immune system is deliberately weakened, you’ll also be more susceptible to infections and have a somewhat higher risk of certain cancers, particularly skin cancer. Your transplant team will monitor you closely with regular blood work and checkups, especially in the first year.
None of this means life after transplant is grim. Most recipients describe it as a dramatic improvement over dialysis. But it requires ongoing attention to your health, consistent medication, and regular follow-up appointments for the rest of your life.
Paying for a Transplant
Medicare covers kidney transplants for people with end-stage kidney disease, regardless of age. This includes the surgery, hospitalization, and initial medications. However, there’s an important coverage gap to understand. If you qualified for Medicare solely because of kidney failure (not because of age or another disability), most of your Medicare benefits end 36 months after the transplant.
The one exception: a law now extends Medicare coverage for anti-rejection drugs indefinitely, even after that 36-month cutoff. But this extension applies only to the medications themselves. It does not cover lab work, doctor visits, or other transplant-related care beyond the three-year mark. If you’ll lose Medicare coverage at that point, you’ll need a plan for ongoing insurance, whether through an employer, the marketplace, or Medicaid. Losing access to anti-rejection drugs or skipping them due to cost is one of the leading preventable causes of transplant failure.
Steps You Can Take Now
If your kidney function is declining, ask your nephrologist about a transplant referral early. Getting evaluated and listed before you reach dialysis gives you a head start on wait time. Start conversations with family and friends about living donation. Many people are willing to be tested but won’t bring it up themselves.
You can also register at more than one transplant center, contact the National Kidney Foundation or American Kidney Fund for financial assistance programs, and use the SRTR waitlist calculator to get a personalized estimate of your expected wait time based on your blood type, location, and health profile.