Last updated: June 26, 2026
Medically reviewed by: NKF Patient Education Team
When you’re on the wait list for a kidney transplant, it helps to know about all the types of kidneys available. Learn about high KDPI and IRD kidneys, including their benefits, risks, and how they might help you get a kidney transplant sooner.
High KDPI and IRD kidneys
You may know that people with kidney failure can get a living donor or a deceased donor transplant.
But there are not enough donor kidneys for all the people who need them.
So, you can consider a kidney that may be less than perfect, but that can still work very well for a long time. These types of kidneys may help you get a kidney sooner:
- High kidney donor profile index (KDPI) kidneys: Kidneys that are expected to work for a shorter time, about 7-10 years. This is compared to about 10-15 years for low KDPI kidneys.
- Increase risk of disease (IRD) kidneys: Kidneys from a deceased donor that have a slightly higher risk of passing on an infection like hepatitis B (HBV), hepatitis C (HCV), or HIV.
Why choose a high KDPI or IRD kidney?
People who are open to these types of kidneys may have a shorter time on the wait list and on dialysis. The shorter your wait, the better for your health. In fact, being on dialysis for 5 or more years can be hard on your body, raising your chance of serious health problems or even death.
Who might benefit from a high KDPI and IRD kidney?
These kidneys may be a good option for people who:
- Are age 50 or older
- Do not do well on dialysis or want to get off dialysis
- Want to shorten their time on the wait list
- Have other health problems that may make it harder to get a transplant in the future
You can agree to accept these types of kidneys but then change your mind at any time.
Understanding high KDPI kidneys
Let’s learn more about these kidneys by first looking at how donor kidneys are scored by the KDPI index.
What is KDPI (Kidney Donor Profile Index)?
KDPI is a scoring system. Every deceased donor kidney gets a score on this index. It rates how well the kidney is expected to work based on information about the deceased donor, such as their:
- Age
- Height
- Weight
- Health history
The scores range from 0 to 100:
- A lower KDPI score means the donor kidney is expected to work for a longer time (10-15 years).
- A higher KDPI score means it is expected to work for a shorter time (7-10 years).
What do KDPI scores mean?
This table describes the 3 KDPI categories of donor kidneys: low, medium, and high.
| Low KDPI kidneys(score under 20) | Medium KDPI kidneys(score 20 - 85) | High KDPI kidneys(score over 85) |
|---|---|---|
| These are kidneys from younger or healthier donors. | This category includes a larger variety of kidneys. | These are kidneys from older donors or those with certain health conditions. |
| Expected to work about 10 - 15 years. | Expected to work about 10 - 15 years. | Expected to work about 7 - 10 years. |
| Less available as there is high demand for this type of kidney. | Most common and there is high demand for this type of kidney. | More available as there is less demand for this type of kidney. |
Usually given to people who are expected to live a long time with their new kidney, including people who:
| The most transplanted kidneys, given to a wide range of people. | Usually given to people who need a transplant more urgently, including people who:
|
IRD kidneys
An increased risk of disease (IRD) kidney is a kidney from a deceased donor that has a slightly higher risk of passing on an infection like hepatitis B (HBV), hepatitis C (HCV), or HIV.
All donor kidneys are carefully tested for infectious diseases. However, if a donor was infected right before they died, the tests may not show it.
Because of this, certain kidneys are labeled as IRD kidneys because they are from deceased donors who may be more likely to have gotten HBV, HCV, or HIV before they died.
These are donors who, in the year before they died, either injected illegal drugs, were in jail or prison, had sex that was considered risky, or were diagnosed or treated for a sexually transmitted infection (STI). This includes people who have died from drug overdoses.
What KDPI scores do IRD kidneys have?
IRD kidneys can have low, medium, or high KDPI scores. Usually, they are in the medium-to-high KDPI range. But like other deceased donor kidneys, the KDPI score depends on information about the deceased donor, such as their age or health history.
IRD kidneys compared with other kidneys
Over the years, research has shown that IRD kidneys are similar to typical kidneys. Compared to other kidneys, IRD kidneys:
- Last as long
- Have about the same chance of a kidney transplant not working right away (delayed graft function)
- Have the same chance of being rejected, which is when the recipient’s immune system attacks the new kidney
What if someone gets an infection from an IRD kidney?
In very rare cases, someone may get an infection from an IRD kidney that tested negative for an infection before being transplanted but later passed the infection to the recipient.
However, the chance of this is very low. It ranges from less than 0.1% (1 in 1,000) for HCV to less than 0.01% (1 in 10,000) for HIV.
Even if the kidney is infected, people can live about the same amount of time as people who get other kidneys. For example, one study compared how long people lived with HCV-infected transplanted kidneys compared to people with normal, uninfected transplanted kidneys:
People lived about the same amount of time with an HCV-infected kidney compared to an uninfected kidney.
Transplant teams monitor IRD kidney recipients for these infections and start treatments as soon as possible after the transplant.
HCV is very curable with 2-3 months of treatment. There are no cures for HBV or HIV, but there are treatments that work very well to control the virus and keep you and your kidney healthy.
Talk with your transplant team to learn more about these treatments.
Steps for considering a high KDPI or IRD kidney
Your transplant doctors will ask if you are open to a high KDPI or IRD kidney during your evaluation and yearly follow-up appointments.
This decision is completely up to you. Saying you are open to a high KDPI kidney does not mean it is the only type of kidney you can get—it just may give you more options and a kidney sooner.
If you are open to accepting a high KDPI or IRD kidney, there are a few steps to go through:
Learn more about your options
Ask your transplant team any questions. They can help you learn about your options and the possible risks and benefits of accepting a high KDPI or IRD kidney.
Here are some websites where you can learn more about your options:
- The Johns Hopkins IRD Kidney Transplant Calculator is a tool that predicts how long someone may live after accepting or declining an IRD kidney, based on their health information. You can enter your own information to help you make decisions about choosing an IRD kidney.
- The Scientific Registry of Transplant Recipients helps you find a transplant center that includes options for high KDPI or IRD kidneys.
Give your written consent to your transplant center
You will need to read and sign a written consent form at your transplant center to be considered for a high KDPI or IRD kidneys. This is an ethical and legal requirement to make sure you fully understand the risks and benefits of these types of kidneys.
To get your written consent, your transplant center will:
- Educate you about the risks and benefits of high KDPI or IRD kidneys
- Answer any of your questions
- Give you a consent form to fill out and sign
- Enter the form into your medical record so you can then be considered for high KDPI and IRD kidneys in addition to other kidneys
If you change your mind about wanting a high KDPI or IRD kidney, you can take back your consent at any time.
Continue to talk with your transplant team
Talking to your transplant team about high KDPI and IRD kidneys is not a one-time event. It is an ongoing conversation as things change, for example:
- Your health status can change.
- Your team’s recommendations for a high KDPI and IRD kidney for you can change.
- You may change your mind about wanting a high KDPI and IRD kidney. Some people first decide to not accept a high KDPI kidney, then after spending a while on the wait list and dialysis, they end up accepting a high KDPI kidney after all.
Continue to ask questions and talk with your team so you can make the best decisions. And if you change your mind—let your team know right away.
Questions to ask your transplant team
Here are some questions you can ask your transplant team to learn more about whether a high KDPI or IRD kidney would be a good choice for you.
About your health
- Based on my current health, what are the risks and benefits of accepting a high KDPI or IRD kidney?
- How would a high KDPI or IRD kidney interact with my other health issues, such as diabetes or high blood pressure?
- What extra tests or screenings would I need to get a high KDPI or IRD kidney?
About transplant center practices
- What is your transplant center's average wait time for a high KDPI or IRD kidney? What is the average wait time for other types of kidneys?
- How does your center’s success rate with high KDPI and IRD kidneys compare to national averages?
- Can I talk to other people from your center who have gotten a high KDPI or IRD kidney transplant?
About care after a transplant
- What special care is available for people after they receive a high KDPI or IRD kidney?
- How does your center manage any health problems that may happen after getting a high KDPI or IRD transplant?
About finances and insurance
- Does my insurance cover the specific treatments and extra medicines that I may need for a high KDPI or IRD kidney?
- Are there any other costs of accepting a high KDPI or IRD kidney?
About support
- Who can I contact if I have more questions about this?
- How can I stay updated on new research or changes in guidelines that might change my transplant options and decisions?