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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.

Before a kidney transplant

In short

For people who can have one, the preferred treatment for kidney failure is a kidney from a living donor, before you need dialysis (a pre-emptive transplant) (KDIGO 2020 transplant, recommendation 1.4). With type 1 diabetes, ask about a simultaneous pancreas-kidney (SPK) transplant, which can bring glucose back to normal (KDIGO 2020 transplant, 8.1.1; ADA 2026 §9). Ask for a referral when your eGFR is under 30, at least 6–12 months before dialysis would be needed. In the US, your waiting time starts when you are on the list with an eGFR of 20 or less, or from the day you started dialysis (OPTN). While you wait, stay transplant-ready.

Your numbers

The timeline

When What Source
eGFR under 30 and expected to reach kidney failure You should be told about, and considered for, a transplant KDIGO 2020, 1.1
At least 6–12 months before dialysis would be needed Referral for evaluation, so living donors can be found and tested KDIGO 2020, 1.1.1
On dialysis already Referral once you are medically stable KDIGO 2020, 1.1.2
eGFR 15–20, or 2-year kidney failure risk over 40 % Plan for a pre-emptive transplant and/or dialysis access KDIGO 2024, practice point 5.4.3
eGFR 20 or less, once registered (or from your first regular dialysis) US waiting time starts to count OPTN, Policy 8.4.A
eGFR under 10, or earlier with symptoms Pre-emptive transplant is recommended for adults KDIGO 2020, 1.4.1
On the list The wait can be months to years NIDDK

Medicare (US, 2026)

Item What it means
Coverage for the transplant can begin the month you are admitted to a Medicare-certified hospital for the transplant (or for tests you need before it), if the transplant happens that month or within the next 2 months; if it is delayed longer, coverage can begin 2 months before the month of the transplant
After the transplant Medicare that you have only because of kidney failure ends 36 months after a successful transplant
Immunosuppressive drug benefit (Part B-ID) helps pay for anti-rejection medicines after that, if you had Medicare for kidney failure at the time of the transplant and have no other cover for these medicines; $121.60 a month (or more with higher income) and a $283 yearly deductible in 2026

Source: Medicare: kidney failure coverage. Amounts change every year; see Costs and benefits.

What changes now

Living donors. A kidney from a living donor does not have to travel and the surgery can be planned (NIDDK). A living donor is someone with two healthy kidneys who chooses to give one (NKF). Ask your transplant center how its living donor program works.

Type 1 diabetes and the pancreas. KDIGO suggests that people with type 1 diabetes and kidney failure be considered for an SPK transplant where it is available (2A), and to be referred to a center that does them (KDIGO 2020 transplant, 8.1.1). The ADA reserves pancreas transplants for people with type 1 diabetes who are also having, or have had, a kidney transplant, or who have repeated DKA or severe lows. A successful pancreas transplant can bring glucose back to normal, but anti-rejection medicines are then needed for life (ADA 2026 §9).

The evaluation. A team with at least a transplant doctor, a surgeon and someone experienced in the emotional and social side decides whether a transplant is right for you (KDIGO 2020 transplant, 1.2). Expect heart, blood, infection and cancer checks. If you are turned down, you can ask another center for a second opinion (1.3.1).

Weight alone should not rule you out. KDIGO suggests that candidates are not excluded only because of obesity (KDIGO 2020 transplant, 7.1.1).

What to do: stay transplant-ready

  • Ask for a referral now if your eGFR is under 30, and ask whether the center does SPK transplants.
  • Tell family and friends that you are looking for a living donor, if you are comfortable doing so.
  • See a dentist and get any problems treated: KDIGO suggests a dental check before a transplant (KDIGO 2020 transplant, 10.4.1).
  • Bring your vaccines up to date. Live vaccines must be given at least 4 weeks before a transplant (KDIGO 2020 transplant, 10.7.2–10.7.2.1).
  • Keep up routine cancer screening for your age (KDIGO 2020 transplant, 11.1.1).
  • Do not smoke or use other tobacco products, before or after the transplant (KDIGO 2020 transplant, 6.2).
  • Keep active and keep your glucose in range.
  • Take every medicine and keep every appointment: the team assesses adherence before listing (KDIGO 2020 transplant, 5.1).
  • Keep your phone charged and on, and your contact details up to date with the center. When a deceased-donor kidney is offered, you must go to the hospital straight away (NIDDK).
  • Keep a bag packed with your medicine list, insulin, glucose meter or CGM supplies and glucose tablets.

Examples

A timeline that works. Your eGFR is 28 in January and your team refers you. The evaluation runs through the spring. You are listed in June with an eGFR of 21. In September your eGFR reaches 20, and your US waiting time starts to count (OPTN). A cousin is tested as a living donor at the same time.

Already on dialysis. You started dialysis 2 years ago and are listed today. Your waiting time counts from the date of your first regular dialysis, not from today (OPTN).

The phone call. It is 2 a.m. and the center has a kidney. Take your packed bag. Check your glucose before you leave and take fast sugar with you. Tell the team when you last ate and took insulin.

Ask your care team

  1. Am I a candidate for a transplant? When should I be referred?
  2. Does the center do simultaneous pancreas-kidney transplants? Would I be a candidate?
  3. How does the living donor program work, and how can someone be tested?
  4. Which tests do I need for the evaluation, and how long will it take?
  5. Can I be listed at more than one center?
  6. How will my insulin be managed around the surgery?

Get help now if…

Call 911 (or your local emergency number)

Chest pain; severe breathlessness; fainting; a low the person cannot treat themselves (give glucagon, then call); possible DKA: blood ketones of 3.0 mmol/L or more, or any ketones with vomiting, deep fast breathing or fruity breath. On dialysis these signs count even under 3.0 (2024 consensus). Full list: Get help now.

Call your transplant center

If you are admitted to hospital, get a serious infection, or change your phone number or address while you are on the list, so your status can be kept 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.