For people with kidney failure, a kidney transplant can be life-changing. A successful transplant can allow someone to live longer, feel better, and spend less time receiving dialysis treatments.
Yet getting a new kidney is often a long and difficult journey. A new study suggests that many people never get close to receiving a transplant because they drop out of the process long before they reach the official waiting list.
The research was led by scientists at NYU Langone Health and was published in the Journal of the American Society of Nephrology. The findings were also presented at the American Transplant Congress, a major meeting for transplant experts in the United States.
Kidney failure happens when the kidneys can no longer remove waste and extra fluid from the body. People with kidney failure often need dialysis several times each week or require a kidney transplant to survive. Although transplantation can offer a better quality of life than long-term dialysis for many patients, getting onto the transplant waiting list is far from simple.
The researchers examined medical information from 720,348 adults who had been referred for a kidney transplant between 2014 and 2025. The data came from Epic Cosmos, a large database containing electronic health records from more than 1,850 hospitals and over one-third of transplant centers in the United States.
The results were striking. Almost half of all patients who were referred for a transplant never even started the evaluation process. Even fewer completed all the required steps and made it onto the waiting list. Only 19 percent of referred patients finished the evaluation and were placed on the list.
To understand why so many people dropped out, the researchers studied many factors that might influence a patient’s progress. They found that older adults, people who were unmarried, those with severe obesity, Spanish-speaking patients, and people with lower incomes were less likely to move forward.
People living in rural communities also had lower chances of reaching the waiting list. Patients who received care at smaller transplant programs or at centers in the southern United States were also less likely to complete the process.
The reasons behind these differences are complex. Being referred for a transplant is only the beginning. Patients usually need numerous medical tests to determine whether they are healthy enough for surgery.
These tests may include blood tests, imaging scans, cancer screening, and examinations of heart and lung function. Patients often need to make several visits to the transplant center over many months. During this time, many are still attending dialysis sessions several times each week and coping with other health problems.
For some people, these demands can become overwhelming. Transportation may be difficult, especially for those who live far away from transplant centers. Taking time away from work or finding childcare can also be challenging.
Some people may not have family members or friends who can help them attend appointments and provide support throughout the process.
The researchers suggest that transplant centers with fewer resources may also be more cautious when selecting patients. In larger cities, transplant centers are often closer together and easier to reach, which may explain why urban patients tend to progress further in the process.
At the end of the study, the researchers emphasized that many people who might benefit from a kidney transplant are being left behind before they even have a chance to join the waiting list. They believe that better patient education, improved transportation support, and more help with navigating the complicated evaluation process could make a significant difference.
The findings are important because they shift attention to a part of transplantation that has received relatively little study. Many previous studies have focused on what happens after patients are placed on the waiting list. This research shows that one of the biggest barriers may occur much earlier.
The study does not prove that any single factor directly causes patients to leave the process. However, it clearly shows that social and practical challenges can strongly influence access to transplantation.
The findings suggest that improving support systems and reducing barriers could help more people reach the waiting list and eventually receive the kidney transplant they need.
If you care about kidney health, please read studies about how to protect your kidneys from diabetes, and drinking coffee could help reduce risk of kidney injury.
For more health information, please see recent studies about foods that may prevent recurrence of kidney stones, and eating nuts linked to lower risk of chronic kidney disease and death.
Source: NYU Langone Health.
