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Draft: not yet reviewed by a clinician

Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.

Getting referred for a transplant

In short

A kidney transplant is the treatment that gives most people the longest and fullest life, and a kidney from a living donor, before dialysis, is the best of all for those who can have one (KDIGO 2020 transplant, recommendation 1.4). Nobody is put on a waiting list automatically: first you are referred, then a transplant center evaluates you (NKF). KDIGO says everyone with an eGFR under 30 who is expected to reach kidney failure should be told about transplant and considered for it, and referred at least 6–12 months before dialysis is likely to be needed (KDIGO 2020 transplant, 1.1–1.1.1). So ask early. With type 1 diabetes, KDIGO suggests considering a pancreas-kidney transplant (8.1.1), so ask to be referred to a center that does them. This page walks through the steps.

Your numbers

What Number Source
When to ask about transplant eGFR under 30 and expected to reach kidney failure; referral at least 6–12 months before dialysis would be needed KDIGO 2020 1.1, 1.1.1
Already on dialysis Ask as soon as you are medically stable KDIGO 2020 1.1.2
When US waiting time starts The earliest of: the date you are registered with an eGFR of 20 or less; the date your eGFR falls to 20 or less after you are registered; the date you started regular dialysis OPTN Policy 8.4.A
Pre-emptive transplant (adults) The transplant itself is recommended before dialysis, when eGFR is under 10 or earlier with symptoms; referral and work-up start long before KDIGO 2020 1.4.1
Time on the list A few months to years NIDDK
How long a kidney lasts, on average About 15–20 years from a living donor; 8–12 years from a deceased donor NKF
Medicare after a transplant Coverage based on kidney failure ends 36 months after the transplant Medicare
Medicare immunosuppressive drug benefit (Part B-ID), 2026 For people who had Medicare for kidney failure when they had the transplant and have no other cover for these medicines: $121.60 a month (more with higher income), a $283 yearly deductible, then 20 % of the cost Medicare; CMS

The steps

  1. Referral. Your kidney doctor or dialysis unit refers you, or you contact a transplant center yourself (NKF). In the US, a dialysis unit must assess whether you are suitable for a transplant referral, and write down the reason if you are not referred (42 CFR 494.80). KDIGO also says you should be told the reason (KDIGO 2020, 1.1.3.2).
  2. Evaluation. A team with at least a transplant doctor, a surgeon and someone experienced in the emotional and social side meets you (KDIGO 2020, 1.2). Expect blood tests, heart tests and checks of other organs (NIDDK), cancer screening, a dental check, infection tests and vaccines, and a talk about your support at home (KDIGO 2020, 4.1, 10.4.1).
  3. Decision. If you are accepted, the center registers you on the national list. If you are turned down, you can ask another center for a second opinion (KDIGO 2020, 1.3.1).
  4. Waiting. Keep your phone on and your details up to date. When a deceased-donor kidney is offered, you must go to the hospital straight away (NIDDK).
  5. Living donor work-up. This can run alongside your own evaluation, so the surgery can be planned (KDIGO 2020, 1.1.1).

Living donors

  • A living donor is someone with two healthy kidneys who chooses to give one. They do not have to be related to you (NKF).
  • A kidney from a living donor does not have to travel, and the surgery can be booked ahead (NIDDK). On average it also lasts longer (NKF).
  • Ask your center how a possible donor gets started, and how donor costs are covered.

Type 1 diabetes: ask about the pancreas

KDIGO suggests that people with type 1 diabetes and kidney failure be considered for a simultaneous pancreas-kidney (SPK) transplant where it is available (KDIGO 2020, 8.1.1), so ask to be referred to a center that does them. The ADA keeps pancreas transplants for people with type 1 diabetes who are having, or have already had, a kidney transplant, or who have repeated DKA or severe lows. A working pancreas can bring glucose back to normal, but anti-rejection medicines are needed for life (ADA 2026 §9). Not every center does pancreas transplants, so ask before you choose one.

Listing at more than one center

OPTN policy allows you to be listed at more than one transplant hospital, but each hospital decides whether to accept you. It usually helps only if the hospitals are in different areas. For a kidney, your waiting time counts from when you started dialysis and is the same at each center that has that date. You may pay for extra tests, travel and lodging, so check with your insurer first (UNOS).

What to do

  • Ask your kidney doctor for a transplant referral once your eGFR is under 30. If it does not happen, ask why, or contact a center yourself.
  • Ask whether the center does pancreas-kidney transplants.
  • Tell family and friends you are looking for a living donor, if you are comfortable doing so.
  • Keep a folder with your latest labs, medicine list, insulin plan and insurance details.
  • Get a dental check and bring your vaccines up to date (KDIGO 2020, 10.4.1, 10.7).
  • Ask your insurer what they pay for: the evaluation, the surgery, anti-rejection medicines, and travel to a center further away.
  • If you are on dialysis, make sure your unit has sent your dialysis start date to the center: it sets your US waiting time (OPTN).

Examples

Referral before dialysis. Your eGFR is 26. Your team refers you, and you are registered when your eGFR is 21. Your waiting time starts on the date a test shows your eGFR at 20 or less (OPTN). Meanwhile, a friend is tested as a living donor, and the surgery is booked before you need dialysis.

Listed on dialysis. You started dialysis 3 years ago but were never referred. You ask your unit, and you are listed this year. Your waiting time counts from your first dialysis, so you already have 3 years (OPTN; UNOS).

Two centers. Your nearest center has long waits. You ask a center in another region to evaluate you as well. Your insurer agrees to pay for the second evaluation. You keep both centers updated with your labs and phone number (UNOS).

Ask your care team

  1. Can you refer me for a transplant evaluation now? Which centers do pancreas-kidney transplants?
  2. What tests will the evaluation need, and how long will it take?
  3. How can a family member or friend find out about being a living donor?
  4. If my donor is not a match, do you offer paired exchange?
  5. Can I be listed at more than one center? Would that help me?
  6. What will my insurance pay for, before and after the transplant?

Get help now if…

Call 911 (or your local emergency number)

Chest pain; severe breathlessness; fainting; a low blood glucose the person cannot treat themselves (give glucagon, then call). Full list: Get help now.

Call your transplant center

If you are admitted to hospital, have a serious infection, or change your phone number or address while you are listed, so your status stays up to date.

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-06. Prices and benefit amounts as of 2026-10-06.