Kidney transplant eligibility and evaluation

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.

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