What Stops Kidney Patients from Getting on the Transplant Waitlist?

• A new study sheds light on a major but often overlooked hurdle faced by people with kidney failure: getting onto the transplant waitlist in the first place.
  
  Researchers found that nearly half of Americans who are referred for a kidney transplant never even begin the evaluation process required to be considered for a new organ. Even more striking, fewer than one in five successfully complete the assessment and make it onto the national waitlist.
  
  

  Beyond the Waitlist: The Challenges Facing Kidney Transplant Patients

  While previous research has largely focused on patients who have already been placed on the waitlist, this study turns attention to the barriers that arise much earlier in the journey. The findings suggest that many eligible patients are being left behind long before they have a chance to receive a transplant.
  
  The nationwide study, led by researchers at NYU Langone Health, analyzed data from 720,348 patients who were referred for kidney transplantation. It found that people who were unmarried, living with severe obesity, or residing in rural communities were less likely to begin or complete the transplant evaluation process. Older adults, Spanish-speaking patients, and those from lower-income backgrounds also faced significant challenges in moving forward. In addition, patients treated at smaller transplant centers or programs located in the southern United States were less likely to progress through the system.
  
  

  Inside the Complex Journey to a Kidney Transplant

  Overall, the numbers paint a concerning picture: only 19% of referred patients completed the evaluation process and were placed on the waitlist, while 48% never even started the assessment. The researchers say these findings highlight deep inequalities in access to kidney transplantation and underscore the need for interventions that can help patients navigate the complex evaluation process more effectively.
  
  �Our findings suggest that a substantial proportion of people who need a new kidney fall out of the process long before they reach the waitlist, let alone make it to the operating room,� said study lead author Conor Donnelly, MD. �Which transplant center you go to, where you live, and even whether you are married all appear to influence your chances of moving forward to the waitlist for a new kidney.� Dr. Donnelly is a resident and PhD student in NYU Grossman School of Medicine�s Department of Surgery.
  
  Much of this variation may stem from the complexity of the process, which can be difficult for patients to navigate, said Dr. Donnelly. Once a referral for a kidney transplant is made, the patient undergoes a battery of tests to provide a detailed picture of their health.
  
  These tests may include blood work, chest imaging, and cancer screenings, often requiring the patient to make several visits over a period of months while also attending dialysis sessions each week. Only after this process is completed and the candidate is approved are they placed on the waitlist.
  
  Smaller centers with fewer resources and transplant slots may be more selective and risk-averse than larger programs, the researchers said. Also, candidates who are unmarried or lack strong social support may struggle to make repeated trips for evaluations and follow-up appointments. This may help explain why people living in urban areas, where transplant centers are more numerous and often closer to home, are more likely to move forward in the process.
  
  Publishing online in the Journal of the American Society of Nephrology, the study is the largest and most detailed to date to examine where patients drop out of the kidney transplant process, according to the authors. It is simultaneously being presented at the American Transplant Congress, the annual joint meeting of the American Society of Transplantation and the American Society of Transplant Surgeons.
  
  For the study, the team used Epic Cosmos, a dataset of more than 300 million electronic health records from over 1,850 hospitals, including more than a third of all US transplant centers. The researchers focused on adults referred for a kidney transplant between 2014 and 2025, tracking each patient through four stages: referral, evaluation, waitlist, and transplant.
  
  

  How Social and Economic Challenges Shape Transplant Access

  Using statistical models, the researchers analyzed how a wide range of factors, from age and sex to geographic location and medical history, affected the chance of moving from one step to the next. They also examined social vulnerability�a measure of how a person�s living conditions, such as poverty, lack of transportation, and unstable housing, may disadvantage them when they�re trying to get care.
  
  �These results demonstrate that finding ways to reduce barriers to both evaluation and waitlisting could help expand much-needed access to kidney transplantation,� said study co-senior author Allan B. Massie, PhD, an associate professor in the Departments of Surgery and Population Health at NYU Grossman School of Medicine. �Providing patients with better education and support to help them navigate the complex and sometimes grueling process would be a good start.�
  
  �Our findings highlight the need to better support patients in progressing from referral to the waitlist, where many possibly eligible individuals are not ultimately listed,� said study co-senior author Michal A. Mankowski, PhD.
  
  Dr. Mankowski, an assistant professor in the Department of Surgery at NYU Grossman School of Medicine, said the team next plans to extend this research approach to other types of organ transplants, for which the path to the waitlist can look very different.
  
  Reference:

  1. Evaluating Barriers to Kidney Transplantation in the United States - (https:journals.lww.com/jasn/fulltext/9900/evaluating_barriers_to_kidney_transplantation_in.1033.aspx)

  Source-Eurekalert