Getting a Kidney Transplant: From Referral to Being Listed

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Step 1: Getting Referred to a Transplant Center

The first step is getting connected to a transplant center. You can:

• Ask your kidney doctor (nephrologist) for a referral, or

• Contact a transplant center yourself (this is called a self-referral).

Having chronic kidney disease or being on dialysis does not automatically put you on the transplant list. You only get on the waitlist by working directly with a transplant center and completing their evaluation.

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Step 2: Choosing a Transplant Center

Not all centers are the same, and you are allowed to choose. When comparing centers, consider:

• Insurance and cost: Does the center take your insurance, and what out-of-pocket costs might you have?

• Location and transportation: How easily can you get there for multiple visits, surgery, and follow-up?

• Living donor options: Does the center do living donor transplants and paired kidney exchange if your donor isn’t a match?

• Support services: Do they offer support groups, education sessions, or peer connections?

You can also be listed at more than one transplant center (multi-listing), which can sometimes shorten your wait.

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Step 3: The Transplant Evaluation

To be considered for a kidney transplant, you must complete a full evaluation at the transplant center. This usually takes one or two full days and may include:

• Blood and urine tests, imaging (like chest X-ray or heart tests), and cancer screenings

• Meetings with a nephrologist, transplant surgeon, nurse coordinator, social worker, and dietitian

• Questions about your medical history, mental health, social support, and ability to follow a treatment plan

The goals are to:

• Make sure you’re healthy enough for surgery and a lifetime of medicines

• Identify any problems that need to be addressed first (like smoking, untreated infections, or uncontrolled heart disease)

• Confirm that you have enough support and understanding to care for your new kidney

Sometimes the team may recommend a combined kidney-pancreas transplant for people with certain causes of kidney disease, such as Type 1 diabetes.

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Step 4: Understanding Costs and Insurance

Before you move forward, a financial coordinator will review your insurance and benefits. They help you understand coverage for:

• Evaluation and testing

• Transplant surgery and hospital stay

• Follow-up visits and lab work

• Transplant medications

In many cases, your insurance also covers the medical costs for a living kidney donor. You’ll still need to plan for copays, deductibles, and other out-of-pocket expenses. Social workers and financial counselors can help you explore assistance programs if needed.

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Step 5: Your Transplant Team

You won’t walk this path alone. Your transplant care team usually includes:

• Nephrologist (kidney doctor)

• Transplant surgeon

• Nurse coordinator

• Dietitian

• Social worker or counselor

• Financial coordinator

They help you get ready for transplant, stay healthy while you wait, guide you through surgery and the hospital stay, and follow you long term after transplant

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Step 6: Multi-Listing at More Than One Center

You can be evaluated and, if approved, listed at more than one transplant center at the same time. This is called multi-listing and can sometimes increase your chances of receiving a kidney sooner.

• Many test results can be shared between centers if they were done within about a year, though each center will still want to see you in person.

• Different centers may have different rules about age, weight, or medical conditions, so being turned down at one center doesn’t always mean you’ll be turned down everywhere.

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Step 7: Why Some People Are Not Approved

Sometimes a center decides someone is not ready—or not currently safe—for transplant. Reasons can include:

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• Active cancer or serious infections

• Severe heart or lung disease

• Ongoing substance use issues

• Not having enough support or not being able to follow medical instructions

In many cases, this is not a permanent “no.” The team may ask you to work on specific goals—like quitting smoking, losing weight, or seeing a therapist—and come back in a few months. You also always have the right to seek evaluation at a different center.

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Step 8: Being Approved and Listed

After your evaluation, the transplant team reviews everything together and decides if you are approved. If you are:

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• You’ll be added to the kidney transplant waitlist for a deceased donor kidney, and

• You can begin—or continue—sharing your story to explore living donation as well.

From there, your job is to:

• Stay as healthy as possible

• Keep all appointments with your kidney doctor and transplant center

• Keep your contact information up to date

• Follow a kidney-friendly eating plan and medication schedule

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Questions You Can Ask

To your kidney doctor:

• “Do you have a transplant center you recommend for me?”

To the transplant team:

• “How long does the evaluation usually take, and how many visits will I need?”

• “Do you see any health issues that might make transplant risky for me?”

• “Does your center offer paired kidney exchange for living donors?”

• “What costs should I expect during the evaluation and after transplant?”

Kidney Konnect can help you turn these steps into easy-to-use checklists and question guides for your appointments. Would it help if the next piece we create is a one-page “Getting Ready for Your Transplant Evaluation” checklist you can give to patients or post as a downloadable PDF?