Why Most U.S. Patients Never Make It to the Kidney Transplant List

For individuals with kidney failure, receiving a kidney transplant can be life-altering. A successful transplant allows someone to live longer, feel healthier, and spend less time undergoing dialysis treatments.

However, obtaining a new kidney often involves a lengthy and challenging process. A recent study indicates that many people never even get close to receiving a transplant because they drop out of the process well before reaching the official waiting list.

The research, conducted by scientists at NYU Langone Health, was published in the Journal of the American Society of Nephrology and was also presented at the American Transplant Congress, a major conference for transplant professionals in the U.S.

Kidney failure occurs when the kidneys can no longer efficiently remove waste and excess fluids from the body. Those affected often need dialysis multiple times a week or a transplant to survive. While transplants can significantly improve quality of life compared to long-term dialysis, getting on the transplant waiting list is far from straightforward.

The study analyzed medical data from 720,348 adults referred for a kidney transplant between 2014 and 2025. The data was sourced from Epic Cosmos, a comprehensive database containing electronic health records from over 1,850 hospitals and more than a third of U.S. transplant centers.

The findings were revealing. Nearly half of all individuals referred for a transplant never started the evaluation process. Even fewer completed all the necessary steps and made it onto the waiting list. Only 19% of referred patients completed the evaluation and were listed for a transplant.

The researchers explored various factors influencing patient progress. They discovered that older adults, unmarried individuals, those with severe obesity, Spanish speakers, and lower-income patients were less likely to advance through the process.

People in rural areas also faced lower odds of reaching the waiting list. Patients receiving care at smaller transplant centers or centers in the southern United States were less likely to complete the process as well.

These disparities stem from complex reasons. Being referred is just the first step. Patients typically need to undergo numerous medical tests to determine their suitability for surgery.

These tests might include blood work, imaging, cancer screenings, and assessments of heart and lung health. Patients often must visit transplant centers multiple times over several months. During this period, many still attend dialysis and manage other health issues.

For some, the demands can become overwhelming. Transportation can be a barrier, especially for those living far from transplant facilities. Taking time off work or arranging childcare also poses challenges.

Additionally, some patients lack family or friends who can support them in attending appointments and managing the process.

The study suggests that transplant centers with fewer resources may be more selective or cautious when choosing candidates. Larger cities, where centers are more accessible, likely see more patients progressing further in the process.

In conclusion, the researchers emphasize that many individuals who could benefit from a transplant are being excluded early on. Improved patient education, transportation assistance, and guidance through the evaluation process could dramatically increase the number of people who make it onto that waiting list.

This research highlights an often-overlooked part of transplantation—many barriers occur long before patients are listed. While previous studies primarily focused on outcomes after listing, this study points out that initial hurdles may be the most significant obstacle.

Though the study doesn’t prove that any specific factor directly causes patients to drop out, it clearly shows how social and logistical challenges can restrict access to transplants.

Enhancing support systems and reducing barriers could help more patients reach the transplant stage and ultimately receive the kidneys they need.

If you’re interested in kidney health, consider exploring studies on how to protect your kidneys from diabetes or how coffee consumption might reduce the risk of kidney injury.

For additional health tips, review recent research on foods that could prevent kidney stone recurrence and data suggesting that eating nuts is linked to lower chances of chronic kidney disease and mortality.

Source: NYU Langone Health.