Though receiving a diagnosis for end-stage renal disease or kidney failure is the number one qualifying criteria for a kidney transplant, it alone is not enough to warrant a new kidney. Worldwide, approximately 2.8 million people are undergoing dialysis — the process of purifying blood mechanically for people whose kidneys cannot do it for them — to stay alive. Yet, only 73,000 kidney transplants are performed annually. To say that the competition for a healthy kidney is tough, and the qualifying criteria even more so.
To be considered for a kidney transplant, you must first demonstrate that you meet the initial indicators. If you do, you must then undergo an extensive evaluation by your potential transplant team to determine a) if transplantation is the best treatment option and b) how urgent your current need is. If your team decides transplantation is the best course of action, and once it determines your need, you must then wait to be matched with a kidney, which is a whole other process in and of itself.
Before qualifying a person for a kidney transplant, transplant teams will consider whether a patient really needs one. Initial indicators that a person may need a new organ are as follows:
Despite qualifying based on your medical diagnosis, there are several factors that may ultimately disqualify you from receiving a kidney transplant. Your transplant team may discover these right away by simply sifting through your medical records, or it may discover them well into the evaluation process, and after performing several comprehensive exams and other assessments. Factors that may render you ineligible for a transplant are as follows:
If any of these apply to you, your medical team may determine that the risks of undergoing transplantation do not outweigh the risks.
If you do qualify for a kidney transplant after extensive evaluation — which most people do — your transplant team will then assess your need. Your need is based on an individual estimated post-transplant survival (EPTS) score, which is a score that ranges from 0% to 100%. The purpose of this score is to give transplant teams an idea of how long you will likely need a transplant compared to other candidates. For instance, if you have an EPTS score of 30%, you will likely need a kidney longer than 70% of the other candidates. If your EPTS score is 80%, you will likely need a transplant 20% longer than other people on the list. Candidates with higher scores are less likely to benefit from a kidney transplant. However, candidates with lower scores have higher expected post-transplant longevity. Therefore, the lower the percentage score, the better.
Your transplant team will calculate and recalculate your score on your behalf. When determining your score, your team will consider several factors that dictate for how long you will need a kidney, including the following:
These are just the initial factors your transplant team may consider. To ensure the most accurate spot on the transplant list for you, your team may also consider your lifestyle habits, support system, access to healthcare, possible vices and the like.
Not only does the diseased kidney receive a score but also, so too does the donated kidney. The score associated with the donated kidney is called the kidney donor profile index (KDPI), which is a score based on the health and age of the donor. KDPI scores help transplant teams ascertain for how long a kidney will last. As with EPTS scores, the lower the score, the longer the associated need. For instance, if a donated kidney receives a score of 20%, it means the kidney will likely last a long time and, therefore, should be matched with a person of higher — or longer — need.
Getting onto the transplant list is half the battle. Once on a list, you can expect to wait anywhere between three to five years for an organ, on average. However, in some regions, the wait is even longer. Factors that affect wait time may include but are not limited to the following:
That said, know that you can register on multiple transplant lists. Though the processes for doing so may prove extensive and time consuming, they may be well worth it if it means increasing your odds of receiving a donor organ sooner rather than later.