Kidney transplantation offers hope and a better quality of life for individuals with kidney failure. However, navigating the path to a transplant involves many decisions, timelines, and steps. Knowing when and how to start the process is crucial for maximizing your chances of success. Here’s a breakdown of the key considerations, including timing, eligibility, and financial planning, to help you make informed decisions.*

Getting Evaluated for a Transplant: Timing Matters

The process of seeking a kidney transplant begins with an evaluation at a transplant center. This step is not automatic; it requires proactive effort on your part. If your kidney function is steadily declining and dialysis appears likely within two to three years, this is the optimal time to start the evaluation. 

Early action is especially critical for those pursuing a “preemptive transplant” — receiving a kidney before dialysis is needed. Studies suggest that preemptive transplants, often enabled by a living donor, lead to better outcomes compared to those done after dialysis begins.

If you don’t have a living donor readily available, you can search for one or pursue a deceased (also called a cadaver) kidney transplant by joining the national waiting list. Once on the list, your waiting time credit begins when your glomerular filtration rate (GFR) falls to 20 mL/min or lower. 

While waiting for a kidney, keep in mind that deceased kidney wait times can stretch into years, making preemptive preparation all the more advantageous.

Key Steps and Costs in the Process

Contrary to popular belief, your kidney doctor does not automatically add you to the transplant waiting list. You need to ask for a referral to a transplant center.

It’s also essential to understand the financial aspects of the procedure. 

• Costs are substantial, covering everything from surgery to lifelong anti-rejection medications. 
• Employer health plans often provide primary coverage, with Medicare acting as secondary insurance. 
• For living donors, Medicare covers evaluation costs but not additional expenses like travel or lost wages.
• While Medicare covers 80% of these expenses for three years, extended coverage is available for individuals who are elderly or disabled. 

To avoid financial surprises, work closely with your dialysis or transplant center to understand what your insurance covers, along with any out-of-pocket expenses.

Life After Transplant: Managing Expectations

A kidney transplant is a treatment, not a cure. Post-transplant, you’ll need to adhere to a lifelong regimen of immunosuppressive medications to prevent organ rejection. Regular doctor visits and health monitoring are also essential. If a transplant fails, you can return to dialysis, depending on your medical history.

For those unable to pursue a transplant, dialysis can sustain life indefinitely, with some individuals thriving on it for decades. Success on dialysis depends on several factors, including:

• Overall health, 
• Quality of care, and 
• Patient engagement in treatment decisions. 

Staying informed, maintaining a positive outlook, and seeking support from kidney patient organizations can significantly improve outcomes.

Understanding the steps, timing, and financial implications of a kidney transplant empowers you to make the best decisions for your health. By planning ahead and staying proactive, you can navigate this complex process with confidence.

*DaVita Kidney Care. (n.d.) Going from Dialysis to Kidney Transplant. Retrieved from https://www.davita.com/treatment-services/transplant/going-from-dialysis-to-kidney-transplant 

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