Kidney transplant eligibility and evaluation
Begin your kidney transplant journey
Our comprehensive kidney transplant evaluation allows us to get to know you and understand your health. The team behind Penn Medicine kidney transplant performs nearly 200 kidney transplants each year, so we know what to look for when we’re determining whether a transplant is a good option.
To be considered for an evaluation at Penn Medicine, you or your provider must first submit your referral through our secure referral portal. If you meet the requirements, you will be scheduled to be evaluated by our kidney transplant team. Your kidney transplant evaluation visit takes about a day. While you’re with us, your transplant team performs medical tests and gives you a complete overview of the transplant process.
Kidney transplant requirements
As part of the kidney transplant evaluation process, we look at you as an individual, but there are some general requirements for qualifying for a transplant. We explain kidney transplant criteria in detail during your visit with us.
Basic kidney transplant criteria include:
- Patient is on chronic dialysis
- Chronic kidney disease with a glomerular filtration rate (GFR) less than or equal to 20 milliliters/minute
- Referral from your physician
We also consider your overall physical and emotional health and make sure you understand what to expect from kidney transplant recovery and the kind of lifelong care a transplanted kidney requires. Serious illnesses such as advanced lung disease, cancer, or uncontrolled HIV infection may make a kidney transplant inappropriate.
Even if you think you don’t meet the criteria for kidney transplant eligibility, we encourage you to schedule an appointment with us. We strive to make kidney transplants accessible to as many people as possible. Our team has decades of experience helping people—even those with high-risk conditions—benefit from kidney transplant.
Kidney transplant evaluation process
You can complete your kidney transplant evaluation meetings, exams, and medical tests in one day. Within about a week of your evaluation, we’ll let you know whether you’re a candidate for the kidney transplant waiting list.
Your kidney transplant evaluation includes:
Your transplant nurse coordinator is your personal guide through the evaluation process. During your visit, you’ll meet with a transplant nephrologist (kidney disease specialist).They review your medical records, determine what testing you’ll need, and answer all your questions about the transplant process.
You’ll meet with members of our transplant support team, which includes a:
- Financial coordinator: expert in transplant financing who reviews your medical coverage and discusses costs
- Social worker: support resource who talks to you about your personal background, mental health, and available social support
- Nutritionist: expert on how diet supports your health before and after transplant
Our team will order tests and exams that help us determine if you’re a good candidate for kidney transplant, including:
- Blood tests
- Cancer screening
- Chest x-ray
- Electrocardiogram (EKG)
- Lab screening for viral diseases
- Tissue-typing tests
The kidney transplant team meets to review your evaluation and testing. We’ll give you one of three results:
- Approval: You meet requirements to be placed on the national waiting list for kidney transplant. If you wish to proceed, we will place you on the waiting list for kidney transplant surgery.
- Not eligible at this time: You may need to meet additional criteria to become eligible for a new kidney. If kidney transplantation is your goal, we can help you take the steps to become eligible.
- Denial: You aren’t eligible for a kidney transplant. We’re here to discuss all of your options and provide the support and care you need.
Why someone might not be eligible for a kidney transplant
Sometimes, even when a kidney transplant seems like the best option, doctors may determine it's not the right path for a patient. This decision is always made with the patient's overall health and well-being as the top priority. Here are some of the reasons why someone might not be eligible.
Severe health problems
In some situations, a patient's current health status presents significant risks that make a kidney transplant unsafe or unlikely to succeed. These include:
- A bad infection that isn’t getting better
- A liver that is too diseased to allow for a combined liver and kidney transplant
- A heart that is too weak for a combined heart and kidney transplant
- Cancer that has not been treated or has spread
- Drug use or high alcohol consumption
- Smoking or vaping
- HIV that is not controlled with medicine
- Serious mental health instability
- Lung problems that require oxygen support some of the time
- Multiple serious health issues, leading doctors to believe a transplant could cause more harm than benefit
- Weakness that requires frequent assistance with walking and standing, beyond what's expected from a temporary injury
- Inability to take medicines needed after a transplant
Other health-related concerns requiring more information
Beyond severe health issues, other factors require careful evaluation by the medical team to determine if a kidney transplant is the right choice. These conditions are reviewed on a case-by-case basis:
- Recent cancer treatment where it’s too soon to confirm if the patient is cured
- Severe, uncorrectable heart or lung conditions
- A history of struggling to follow doctor's orders
- Previously failed kidney transplant due to a recurrence of their original kidney disease
- No health insurance to cover the transplant
- Body mass index is too high (over BMI of 42)
- No family or friends to help them after surgery
- Poor blood flow in their legs
- Stroke or mini-stroke
- Poor nutrition that has led to significant weakness
- Very low blood pressure
- Very high blood pressure that medicine doesn’t help
- Fluid buildup that is causing harm to the heart and lungs
- Liver damage
- Difficulty managing emotions or behavior
- Active blood vessel disease (for example, lupus)
- Unexplained weight loss
- A wound that has not healed for a long time
- Health problems that might not allow them to live for more than another 5 years
- Dementia (memory and thinking problems)
- Unwillingness to receive blood during or after surgery, and unwillingness to try a “bloodless” method
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