A kidney transplant is often considered the best treatment for many people with kidney failure. A healthy transplanted kidney can free patients from regular dialysis sessions, improve their energy levels, and increase their chances of living longer.
However, a major new study has found that for many patients, the dream of receiving a transplant ends long before they ever reach the waiting list.
The study was carried out by researchers at NYU Langone Health and appeared in the Journal of the American Society of Nephrology. The findings reveal a healthcare problem that affects hundreds of thousands of people across the United States.
The kidneys perform essential jobs in the body. They filter waste products from the blood, help control blood pressure, and keep the right balance of fluids and minerals. When the kidneys fail, harmful substances build up in the body. Patients may then need dialysis, which uses a machine to clean the blood, or they may need a kidney transplant.
Although transplantation offers many benefits, becoming eligible for a transplant can be extremely demanding. Researchers analyzed records from 720,348 adults who had been referred for kidney transplantation between 2014 and 2025. The information came from Epic Cosmos, one of the world’s largest collections of electronic medical records.
The researchers followed each patient through several important steps. Patients first received a referral for transplantation. Next, they needed to complete a detailed medical evaluation. If approved, they could then join the transplant waiting list and eventually receive a new kidney.
The study found that this process breaks down for many people. Forty-eight percent of patients never started the evaluation process after being referred. Only 19 percent successfully completed all the necessary assessments and reached the waiting list.
The researchers discovered that certain groups faced greater challenges than others. Older people often had more difficulty moving through the process.
People who lived in rural communities faced extra barriers because transplant centers were farther away and harder to access. Those with lower incomes and Spanish-speaking patients were also less likely to progress.
Marital status appeared to matter as well. Unmarried patients were less likely to complete the evaluation process. Researchers believe that social support plays an important role.
Preparing for transplantation often requires many appointments, repeated testing, and careful follow-up. Having family members or close friends who can provide transportation and emotional support may make the process easier.
The study also found that patients with severe obesity faced additional difficulties. Some transplant centers may be concerned that obesity increases the risk of complications during surgery and recovery. As a result, these patients may need to meet additional health goals before they can be approved.
Another important finding involved the transplant centers themselves. Patients treated at smaller programs and some centers in the southern United States were less likely to reach the waiting list. Researchers think that limited resources and fewer transplant opportunities may partly explain these differences.
The evaluation process itself can be exhausting. Patients may need blood tests, imaging scans, heart examinations, cancer screenings, and appointments with different specialists. Completing all these steps can take months. At the same time, many patients are coping with the physical and emotional burden of kidney failure and regular dialysis treatments.
The researchers say the findings show that healthcare systems need to do more than simply refer patients for transplantation. Patients often need guidance and practical support throughout the process. Better education, transportation assistance, language services, and patient navigation programs could help people overcome many of these barriers.
The study also reminds us that health outcomes are often influenced by factors outside the hospital. Where a person lives, whether they have family support, and their financial situation can all affect their ability to receive advanced medical care.
The findings provide one of the clearest pictures yet of where patients fall behind in the kidney transplant system.
Although the study cannot prove exactly why each patient dropped out of the process, it strongly suggests that social and practical obstacles are preventing many potentially suitable candidates from reaching the waiting list. Addressing these barriers could allow more patients to receive life-saving transplants and reduce inequalities in access to care.
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Source: NYU Langone Health.
