Evaluation for Kidney Transplant

There are a few reasons why you should start your transplant evaluation sooner than later:

• Waitlist time: The sooner you are evaluated, the sooner you may be added to the national waitlist. How long you have had kidney failure is one of the main factors in how long you may be waiting for a kidney.
• Finding a living donor: While there isn’t a right or wrong time to start sharing that you need a kidney, many people are the most comfortable sharing after their evaluation once they’ve been approved for transplant. If someone you know wants to be a living donor, starting early gives them more time to go through their own evaluation. Some transplant centers allow your potential donor to get evaluated at the same time as you. If they are not a match, you can explore paired donation programs.
• If someone is considering being your living donor, there are special programs that may help them with costs related to traveling and taking time off of work for the evaluation and recovery, including but not limited to:
  • Travel costs (gas, flights, hotels)
  • Lost wages if they’re working and need to take time off for surgery and recovery
  • Childcare or dependent care while they recover
• Health planning: Some people need extra testing, lifestyle changes (like quitting smoking or losing weight), or treatment for other health conditions before they can move forward with getting approved for transplant. Starting early gives you time to meet those goals.

A kidney transplant takes a team of people working together. Each person you meet during the evaluation helps to keep you safe, with the goal of having a successful transplant:

• Transplant coordinator (nurse): Your main point of contact who will guide you through the process, provide education, schedule tests, and answer day-to-day questions.
• Nephrologist: Talks to you about how your kidneys are working and reviews your health history.
• Surgeon:  Asks you about any surgeries that you’ve had in the past, talks with you more about the transplant surgery and answers questions if you have any.
• Pharmacist: Works with the team to review your medicines and prescribe anti-rejection medicines after transplant to keep your body from rejecting your new kidney.
• Social worker: Supports your emotional health, connects you with available financial programs and assesses your caregiving, time off from work and other needs for surgery and recovery.
• Dietitian: Talks to you about how what you eat and drink affects your kidney health. They can also help set goals for losing or maintaining a healthy weight, if needed.
• Financial counselor: Explains health insurance coverage and out-of-pocket costs.

As part of your evaluation, you may need different tests. These tests give your team a clear picture of your health and help them decide if a transplant is right for you. They also help with matching you to a donor. Your transplant team will tell you which tests you’ll need. 

Blood tests

• Blood type and HLA typing (tissue match): Finds your blood type and special markers on your cells. This shows which donors are most likely to be a good match.
• Antibody screen (PRA): Measures how likely your body is to “fight off” or reject a donor kidney.
• Infection testing: Screens for infections such as hepatitis B and C, HIV, and syphilis. These must be treated or monitored before transplant, but do not mean you cannot get a transplant.

Heart and lung tests

• Electrocardiogram (ECG or EKG): A test that looks at your heart’s rhythm using small sticky patches on your chest.
• Echocardiogram (heart ultrasound): Uses sound waves to take a picture of your heart and see how well it pumps. This can sometimes be combined with a stress test, where you walk on a treadmill to check how your heart works while you’re active.
• Chest imaging (X-ray or scan): Creates a picture of your lungs to check for problems like fluid buildup or infection.

Cancer screening (based on age and risk)

• Colon, breast, cervical, prostate, skin, and other screenings: Looks for signs of early cancer. These may include a colonoscopy (a test using a camera to look at your colon) or mammogram (breast X-ray), depending on your age and history.

Other tests

• Dental clearance: A dental exam to make sure you don’t have cavities or gum infections that could spread after surgery.
• Vascular imaging (blood vessel scan): Uses pictures of your veins and arteries to help surgeons plan where to connect your new kidney.

There are two types of kidney transplants: from a living donor and from a deceased donor.

Living donor transplant

A living donor kidney transplant comes from a person who is living and donates one of their two kidneys to someone in need. There are many benefits to having a living donor kidney transplant.

• A shorter wait – Having a living donor means you no longer have to wait on dialysis. If you have kidney failure and can find a donor before you need dialysis, you may be able to get a preemptive transplant, meaning you don’t have to go on dialysis at all.
• Lasts longer - On average, a kidney from a living donor lasts about 15 to 20 years, compared to 7 to 10 years for a kidney from a deceased donor. Some will last longer; others will last less. Also, living donor kidneys often do better than deceased donor kidneys, such as working right away.
• Better timing – With a living donor, it is possible to plan the surgery day and time at a time that works best for the pair and the transplant team. This way, both the kidney patient and their living donor can be at their healthiest.

Deceased donor transplant

If you do not have a living donor, you can receive a kidney from a deceased donor. These kidneys are placed through the national waitlist.

• Wait time: How long you wait depends on many factors, including your blood type, antibody levels, how long you’ve been on dialysis, and where you live.
• Availability: Because the number of people waiting for a kidney is greater than the number of kidneys available, this option can take up to several years.
• Underutilized kidneys: These types of kidneys might be a good option if you are older, if you wish to get off dialysis, or if you don’t do well on dialysis and can help you get a kidney more quickly. Talk with your transplant doctor about high KDPI (kidney donor profile index) and IRD (increased risk of disease) kidneys at your evaluation to learn more.

Both living and deceased donor transplants save lives. Your team will talk with you about your options, help you decide which type of kidney fits your situation, and guide you through the process.

Once you’ve been approved for the waitlist at one center, you can choose to get evaluated and approved for the waitlist at more transplant centers. This is called “multi-listing.” Doing this may increase your chances of getting called for a deceased donor kidney faster. 

Oftentimes, if you’ve had tests done at one transplant center, they’ll be able to transfer the results to other centers as long as they’ve been done within 1 year. If you’re thinking about multi-listing, you can compare transplant centers to help you decide which centers you’d like to get evaluated at. 

Your transplant team will let you know if there are any additional tests or steps you need to take before they can meet to decide if transplant is the best treatment choice for you. Your nurse coordinator will contact you to let you know if you’ve been approved for the waitlist.

If the team finds something that doesn’t completely rule you out from getting a transplant, they will ask that you come back within a certain timeframe (usually 3-6 months) to see if any improvements have been made. For example, this may happen if you need to lose weight, quit smoking or if an infection needs time to heal. 

You might feel let down if you’re asked to wait, but it’s important to remember that this process is all about keeping you healthy and safe. A transplant is more likely to work and be successful if your body is as healthy as possible.

• Bring your ID, insurance card, and a list of medicines you’re taking
• Bring a support person, if possible, like a friend or family member
• Eat and drink as instructed for any tests
• Ask what the parking options are and if they provide parking vouchers (free parking)
• Write down your questions before your appointment

• Am I a good candidate for a transplant right now? If not, what do I need to do?
• What tests do I still need and why?
• What are my personal risks during and after surgery?
• How long is the wait for a kidney at this center?
• Do you participate in any national paired exchange programs, like NKR or APKD?
• How will my costs and medicines be covered?

• NKF Peers: Connect one on one with an NKF Peer mentor who can share their experience and answer any questions about dialysis, transplant or finding a living donor.
• Online Communities: a safe and supportive place where patients can share experiences, ask questions, and get answers related to kidney disease, transplant and living donation
• NKF Cares: if you have any questions about getting on the waitlist and resources to help you get a kidney, NKF Cares can help.