Kidney transplantation is widely considered the most effective treatment for many people living with end-stage kidney disease. A successful transplant can improve quality of life, reduce dependence on dialysis, and increase long-term survival. However, new research suggests that a large number of patients never make it far enough in the transplant process to even join the national waiting list.
A recent study found that fewer than one in five patients referred for a kidney transplant successfully completed all required evaluations and were placed on a transplant waiting list. The findings highlight significant challenges within the healthcare system and reveal how factors such as income, age, location, and social support can influence access to life-saving treatment.
For many patients, receiving a referral for a kidney transplant is only the beginning of a long and complex journey. Before being considered eligible for a transplant, patients must complete an extensive medical evaluation process.
This process often includes:
Completing these requirements can take months and often requires frequent visits to healthcare facilities. For patients already coping with serious illness, the process can be physically, emotionally, and financially demanding.
According to the study, nearly half of all referred patients never started the evaluation process at all. As a result, many potentially eligible candidates never reached the stage where they could be considered for a transplant.
Researchers analyzed data from more than 720,000 patients who were referred for kidney transplantation between 2014 and 2025. The study utilized over 300 million electronic health records collected from more than 1,850 hospitals across the United States, including many transplant centers.
The investigation tracked patients through multiple stages of the transplant pathway, including referral, evaluation, waitlist placement, and eventual transplantation.
The results were striking. Only 19% of referred patients successfully completed the evaluation process and secured a place on the transplant waiting list. Nearly 48% never initiated the evaluation process after receiving a referral.
These findings suggest that substantial barriers exist long before patients have an opportunity to receive a donor organ.
The study identified several groups that were less likely to advance through the transplant process.
Patients facing the highest challenges included:
Older individuals were less likely to begin or complete evaluations. This may be due to existing health conditions, transportation difficulties, or concerns about surgical eligibility.
Financial challenges can significantly affect access to healthcare services. Costs associated with transportation, missed work, caregiving responsibilities, and medical appointments can create obstacles throughout the transplant evaluation process.
People living in rural communities often have limited access to transplant centers. Longer travel distances can make repeated appointments difficult and increase the burden on patients and their families.
Researchers found that marital status appeared to influence progression through the transplant system. Patients without strong social support networks may struggle with transportation, appointment scheduling, and post-transplant care planning.
Language barriers may create additional challenges when navigating a complex healthcare system. Communication difficulties can impact understanding of requirements, appointment scheduling, and access to educational resources.
Location also appears to play an important role in transplant opportunities.
Patients living in urban areas generally had better chances of moving through the evaluation process. Urban residents often live closer to transplant centers, making appointments and follow-up visits more manageable.
By comparison, patients living in the Southern United States were less likely to advance through the transplant pathway. Researchers suggest that regional differences in healthcare infrastructure and transplant center availability may contribute to these disparities.
The findings raise concerns about healthcare equity and whether patients across different regions receive equal opportunities to pursue transplantation.
Another notable finding involved transplant center size.
Researchers observed that smaller centers with fewer available transplant opportunities may be more selective when evaluating candidates. Limited resources and fewer available transplant slots may encourage stricter screening practices.
While patient safety and successful outcomes remain important priorities, these practices may unintentionally limit access for some individuals who could potentially benefit from transplantation.
Understanding how institutional factors affect patient outcomes may help healthcare systems develop more consistent standards nationwide.
Kidney disease remains a significant public health challenge in the United States.
According to national transplant data, approximately 90,000 people are currently waiting for a kidney transplant. Sadly, many patients die before a suitable organ becomes available.
Every day, multiple individuals on the transplant waiting list lose their lives while waiting for a donor kidney. This reality underscores the importance of ensuring that eligible patients can successfully navigate the transplant evaluation process.
Reducing barriers before waitlist placement could help more patients access transplantation and improve overall outcomes.
Experts believe several strategies could help address these challenges.
Many patients may not fully understand the transplant process or the steps required after referral. Providing clear educational materials and guidance could encourage more patients to begin evaluations.
Patient navigators can help individuals schedule appointments, coordinate testing, and understand medical requirements. These programs may be especially valuable for vulnerable populations.
Travel remains a significant challenge for many patients. Transportation support services could reduce missed appointments and improve evaluation completion rates.
Expanding multilingual services and culturally appropriate education materials may help reduce barriers for non-English-speaking patients.
Telehealth services and outreach programs may improve access for patients who live far from transplant centers.
Kidney transplantation offers hope and improved quality of life for thousands of patients with advanced kidney disease. However, new research reveals that many individuals never make it past the earliest stages of the transplant process.
The study found that less than 20% of referred patients successfully completed evaluations and reached the transplant waiting list. Factors such as age, income, geographic location, language, marital status, and healthcare access all appear to influence a patient's chances of moving forward.
Healthcare experts believe that reducing administrative, financial, and logistical barriers could help more patients access transplantation. By improving education, support services, and healthcare equity, the medical community may be able to expand access to this life-saving treatment and improve outcomes for patients nationwide.
Donnelly C., Massie A., et al. Findings presented at the American Transplant Congress and published online in Clinical Research (June 2026). NYU Langone Health news release dated June 20, 2026.
This article is intended for informational and educational purposes only and should not be considered medical advice. The information presented reflects findings from population-based research and may not apply to individual circumstances. Patients should consult qualified healthcare professionals for personalized medical guidance, diagnosis, treatment decisions, and transplant eligibility assessments.
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