Transplant Institute
The Transplant Institute, part of the Department of Surgery, offers nationally recognized patient care, research programs, and education and training opportunities.
Eligibility & Evaluation for Kidney Transplant
Meeting the qualifications for getting a new kidney
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Criteria for Kidney Transplant & Beginning the Transplant Process
Getting a kidney transplant is a major life event. It can help you live longer and better and may even save your life. But a transplant requires a long-term commitment that can be challenging.
To make sure you’re ready physically and emotionally, Transplant Institute staff consult with your referring physicians and do a careful evaluation. We want to be certain that transplant surgery will be safe and beneficial for you. Ensuring that a kidney transplant is the right option for you can help you get the best results.
Am I Eligible for Kidney Transplant?
To be eligible for a kidney transplant, you must have chronic kidney disease that will not improve with other treatments. When deciding if you qualify for a transplant, we look carefully at how well your kidney is functioning as well as factors such as your general health, emotional well-being and ability to manage medication and care plans. Often, those getting a kidney are — or about to be — receiving dialysis.
When possible, it’s best to have a kidney transplant before you have dialysis or spend a long time receiving the treatment. Living kidney donation is the best way to avoid dialysis.
A living donor also may help you need dialysis for less time than you would be if waiting for a deceased donor kidney. Studies show that a transplanted kidney from a living donor functions longer. It also could help you live longer, compared to having dialysis before your transplant.
You can consider living kidney donation even if you’ve been on dialysis a long time. We can schedule your transplant at a convenient time for you and your donor.
If you have incurable cancer or advanced heart or lung disease, you will not be eligible for transplant. And if you have scarring of your liver (cirrhosis), we may only consider you for a kidney transplant if you’re eligible for a liver transplant.
Here are other things that might prevent you from getting a kidney transplant:
- Active drug and/or alcohol abuse
- An uncontrolled or untreated psychiatric condition
- Failure to follow recommended treatments, such as missing dialysis sessions or ending dialysis sessions early against medical advice
- Inadequate social support
- Other active illness(es) that would compromise the success of your transplant:
- Infection
- Limited physical mobility without the likelihood for success rehabilitation
- Obesity
- Recent cancer
- Severe peripheral vascular disease
More About Kidney Transplant Eligibility & Evaluation
Your Initial Screening
When we first meet with you, we:
- Decide if you are healthy enough to receive a new kidney.
- Help you identify people who might provide a living donor kidney for you.
- Explore the options of a living or deceased donor kidney transplant.
Evaluation & Medical Tests
If you pass the initial screening, you meet with members of our team and have a number of tests. This is an outpatient process, meaning you don’t need to stay in the hospital overnight. We perform many of your tests at the Transplant Institute. But you may be able to do some of them at a hospital or clinic closer to your home.
These and other health care professionals will meet with you:
- Transplant nephrologists (medical kidney specialists)
- Transplant nurse coordinator
- Transplant surgeon
- Social worker
- Nutritionist
- Psychologist
If you have diabetes, or a history or heart problems, you also meet with a cardiologist to determine which heart tests you need. If you have hepatitis, you must meet with a hepatologist (a doctor who specializes in liver care.
Kidney transplant testing will include several steps.
Lab Testing
Lab work will include blood tests for these conditions:
- Blood type
- Liver and kidney function
- Tissue typing
- Any viruses you may have been exposed to, such as hepatitis and human immunodeficiency virus (HIV)
Blood and tissue typing help us know who can donate their kidney to you. One thing we look at is your human leukocyte antigen (HLA) type. HLAs are proteins in your blood that are key to transplant matching.
HLA typing was very important in the past. But with modern transplant medicines, the effect of matching on the success of a kidney transplant isn’t as important unless you have a brother or sister who’s a perfect match. We also check your blood for antibodies against HLAs. This helps us determine how hard it will be to find a suitable donor.
If we find a potential donor for you, we perform a test call a “crossmatch.” The test involves mixing the liquid portion of your blood with white blood cells from your potential donor. If you have antibodies in your blood that attack your potential donor’s cells, it’s known as a positive crossmatch. A positive crossmatch means you can’t receive a kidney from that donor without several special procedures and medications. We perform this test at least twice before any live donor transplant.
Your transplant coordinator schedules all appointments for tissue typing and crossmatch blood tests for you. If you have a potential living donor, the coordinator schedules those tests separately. All results are confidential. We cannot share them without the explicit verbal or writer permission of the person tested. There are no exceptions.
Other Testing
Chest X-rays can see if your lungs are healthy.
Heart and vascular tests look for heart problems or evidence of past heart damage. These may include:
- Cardiac catheterization (if you have coronary artery disease).
- Echocardiogram that shows how well your heart is working.
- Electrocardiogram (EKG or ECG) that shows your heart’s electrical signals.
- Stress test, which uses exercise or medications to stress your heart so physicians can check for evidence of coronary artery disease.
- Vascular studies such as an angiogram to assess blood flow to your legs.
If you are a woman over 40, you will need a mammogram to look for signs of breast cancer. And if you are a woman, you will need a Pap smear to check for cervical cancer. If you’re a man older than 50, we require a prostate-specific antigen (PSA) test to screen for prostate cancer. Everyone older than 50 needs a colonoscopy to look for colon cancer.
Preparing for Transplant
The evaluation period gives you and your family a chance to meet our transplant teams. If we determine you qualify as a kidney recipient, it’s up to you to decide whether you want to move forward with the transplant at Beth Israel Deaconess Medical Center (BIDMC).
If you decide to proceed, we explain what to expect and help you prepare. Please remember, you’re free to withdraw from the program at any time. If you have questions or concerns, we’re here to answer them and to provide guidance and support to you and your family.
