Evaluation

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What is transplant evaluation?

Transplant evaluation is a process in which you to talk with members of a kidney transplant program and get many tests for a transplant. It can be complex and may take multiple days. 

Basic steps of transplant evaluation

Transplant centers across the U.S. may have some differences in their evaluation process, but usually it has 3 main steps: 

• Get referred to a kidney transplant program
• Have an initial visit with the transplant team 
• Complete your evaluation to see if you can be placed on the waiting list to get a transplant 

When should I be referred to a transplant center for evaluation?

Ideally, your nephrologist will refer you when you are in Stage IV Chronic Kidney Disease (CKD), at an eGFR of 20-25 cc/min. This allows you to be listed on the deceased donor list or plan for a living donor transplant when you are still healthy enough for a good recovery from transplant surgery. 

If you have kidney disease, ask your primary care doctor and kidney doctor (nephrologist) questions about: 

• Your lab results 
• The stage and expected outcome (prognosis) of your kidney disease
• If you should make plans for dialysis or a transplant 
• If so, when you should be referred to a transplant center for evaluation

If you are a dialysis patient, ask the dialysis staff if you can be considered for a kidney transplant. 

Will I be referred to a transplant center for evaluation?

Not all patients will be referred to a transplant center by their doctors. And some patients are referred very late in their kidney disease (end-stage kidney disease or ESKD). Your doctor may delay your referral for transplant evaluation for reasons such as: 

• They want you to become healthier on dialysis before referring you to a transplant center
• You have a medical condition or other issues that make it less likely you will be approved as a transplant candidate, including:
  • Poor strength or endurance
  • Needing to use oxygen
  • A body size not ideal for the transplant surgery
  • Severe heart or vascular disease
  • Having cancer
  • Not able to follow the medical plan after a transplant
  • Actively using illegal drugs
  • Lack of social support
  • Lack of transportation or not able to travel to a transplant center
• Or they do not know you are interested in getting a kidney transplant 

To improve your chances of timely referral for transplant evaluation, it is important that you continue to discuss your kidney disease with your nephrologist and other healthcare providers. 

How do I get referred to a transplant center for evaluation?

Usually, your kidney doctor (nephrologist), dialysis center, or primary care physician (PCP) will refer you to a transplant program. However, you may also contact the transplant center yourself. 

Schedule your evaluation

Once you are referred, the transplant center will: 

• Get some information from you by completing a paper packet or giving it by phone or online. They may ask to get some of your medical records before they schedule your initial evaluation visit.
• Confirm your insurance coverage 
• Schedule you for an initial visit 

Complete your transplant evaluation as soon as you can

Once you are referred to a transplant center, take action. This shows that you are interested and gets you on the waiting list sooner if you qualify. 

1. Schedule your evaluation 
2. Complete it as soon as you can

Common things that stand in the way of completing your evaluation may include: 

• Challenges communicating with your transplant team 
• Cultural or religious beliefs about medical treatments such as transplants
• Negative past experiences with healthcare 
• Financial concerns 
• Feeling overwhelmed by the amount of information about the transplant process and what is expected of you
• Not getting all the tests you need

To improve your chances of successfully completing the transplant evaluation in a timely manner, go to all your appointments with the transplant center. They will give you a list of tests and referrals that you must complete before you can be placed on the transplant waiting list. Delays in getting these tests may lower your chances for a kidney transplant. 

If you have questions or concerns about evaluation, please reach out to the transplant center.  Good communication with the transplant team can help navigate and complete your evaluation process.