Why transplant
For most patients with end-stage renal disease, a kidney transplant produces meaningfully better outcomes than dialysis: longer life expectancy, fewer dietary restrictions, more energy, and the ability to travel and work without dialysis schedules. Transplantation is not a cure — it requires lifelong medications and monitoring — but it is the closest thing modern medicine offers to restoring kidney function.
Eligibility
Most patients with Stage 5 CKD (eGFR under 20) can be evaluated for transplantation. Common considerations include:
- Overall health status (especially heart and vascular health)
- Active cancer (typically requires a cancer-free interval)
- Active infection that needs to be controlled first
- Substance use disorder requiring treatment
- A clear support system to manage post-transplant care
Age alone is rarely a barrier — selected patients in their 70s and even 80s are transplanted with good results.
The evaluation process
Transplant evaluation typically takes several months and includes:
- Comprehensive medical history and physical examination
- Cardiac stress testing
- Cancer screenings appropriate for age
- Blood tests including blood type and tissue typing (HLA)
- Dental evaluation and clearance
- Psychosocial evaluation
- Education sessions about the procedure and post-transplant life
Once approved, patients are listed on the national transplant waiting list (UNOS) and matched to deceased donors based on blood type, tissue match, time on the list, and other factors.
Living donor vs. deceased donor
Living donors
A living donor can be a family member, friend, or altruistic stranger. Living-donor kidneys generally last longer (15–20+ years on average) and have better outcomes than deceased-donor kidneys. Living donation also avoids the years of waiting list time. Donors are evaluated thoroughly and most can return to normal activities within weeks.
Deceased donors
Deceased-donor kidneys come from organ donors who have died. Wait times in the US average 3–5 years, varying significantly by region and blood type. Outcomes are still generally excellent.
Paired exchange
If a willing living donor is incompatible with the intended recipient, a paired exchange program can match them with another donor-recipient pair to allow both transplants to proceed.
The transplant surgery
The new kidney is placed in the lower abdomen — the original kidneys are typically left in place. The surgery takes about 3–5 hours, and most patients are in the hospital for 3–5 days afterward.
Life after transplant
A new kidney requires lifelong immunosuppressive medications to prevent rejection. Common regimens include tacrolimus, mycophenolate, and prednisone. These medications increase the risk of infection and certain cancers, so close monitoring is essential. Most patients return to normal activity within 1–3 months and many return to full-time work, exercise, and travel. Long-term outcomes have steadily improved over decades, and many patients now keep their first kidney transplant for 15–20 years or longer.