If you have advanced kidney disease, or you’re on dialysis, you may be hoping a kidney transplant will improve the quality and quantity of your life. We want those outcomes for you as well. Unfortunately, not everyone is a candidate for transplant. Thanks to our transplant specialists’ extensive experience, we are often able to accept into our kidney transplant program people who have been turned away elsewhere due to their complex medical conditions.
Kidney Transplant Evaluation
The best way to find out if you are a candidate for a kidney transplant is through our one-day evaluation. We do evaluations three days a week, and appointments are usually available in less than a month.
You’ll Work with a Pre-Transplant Coordinator
A nurse with special training in organ transplants will be your point of contact throughout the process. We’ll also ask you to bring with you to your evaluation one or two people who are willing to serve as your caregivers before, during, and after transplant.
You’ll See Several Doctors in One Day
Once you and your caregivers arrive at our clinic, you’ll stay in one place and our specialists will come to you. You’ll be seen -- all in one day -- by a:
- Transplant surgeon
- Social worker
- Financial counselor
You may also see a psychologist on your evaluation day.
Following your evaluation, you will need to have tests to assess your overall health. The following tests can be done at Duke or closer to home:
- CT scan
- Stress test
- Chest X-ray
If you’re not up-to-date on the recommended cancer screenings for your age and gender, you’ll also need to have those screenings. Examples include:
- PAP smear
- Prostate cancer screening
Your transplant coordinator can help you arrange to have these tests at Duke or closer to your home.
If you are interested in making an appointment for an evaluation, please ask your nephrologist to submit a referral.
We Consider Every Candidate Individually
During your kidney transplant evaluation, we look carefully at your medical and personal circumstances, and we compare them to established guidelines. The guidelines help us identify risks and concerns, but they also leave room for our doctors’ judgment, based on their knowledge and experience.
Some of the Factors We Consider
Even if you think some items on this list might rule you out, don’t assume you’re not a candidate. Instead, contact us to request an evaluation. Our transplant experts will consider your unique situation and let you know whether a transplant might be safe and beneficial for you.
Here are some of the things we look for in kidney transplant candidates:
- Kidney failure stage: eGFR below 20mL/min/1.73m2
- Younger than 70 years OR older than 70 years with either a potential living donor or 1+ years of dialysis
- U.S. citizen or legal alien for deceased-donor organ only (does not apply to living donor transplant)
- Consistent and reliable caregivers who can provide transportation and help you get essential medications
- Ability to get to Duke University Hospital quickly after we notify you of an available kidney
- Resources to support your post-transplant care, including medication costs, travel, and lodging expenses, and medical devices
If you have HIV, we also look for:
- CD4 count consistently greater than 200
- Clinical approval by Duke infectious disease doctor
Kidney transplant surgery is performed at Duke University Hospital. Pre- and post-transplant appointments take place at our nephrology clinics in Durham.
You may not be a candidate for a kidney transplant if one or more of these conditions apply:
- A history of cancer of the type or stage that could affect your survival or that of the donated kidney
- Body mass index (BMI) above 40
- Liver disease unless you have approval from Duke liver specialists
- Active alcohol or other substance abuse
- Issues with urinary bladder self-catheterization. This is necessary if your urinary drainage is poor
- A history of not following medical recommendations, including not taking medications or not receiving dialysis treatment as directed. A marker of this might be if your phosphorous is consistently above goal.
- Any heart condition that would make transplant surgery unsafe or compromise your survival after transplant.
- Had a stroke or transient ischemic attack within the past six months
- Severe restrictive or obstructive pulmonary disease
- Systemic infection
- Non-healing ulcers or wound
- An untreated or uncontrolled psychiatric disorder that could affect your ability to care for yourself.
- Frailty or condition that would make surgery, your recovery, or your ability to bounce back from transplant complications especially risky
Once you’ve completed your evaluation and all needed tests and screenings, your transplant coordinator will present your case to our selection committee. We’ll notify you of the committee’s decision.