Most Kidney Transplant Candidates Never Make It to Waiting List, Study Finds

Why it matters locally: The findings of this national study on kidney transplant referral bottlenecks have direct implications for the roughly 9.3 million residents of New Jersey, as the state is part of the national organ transplant system. Local and regional differences in evaluation practices identified by the study could affect access to transplantation for New Jersey patients with end-stage renal disease.

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Researchers examining kidney transplant referrals across the United States discovered that the majority of patients referred for transplantation never complete the evaluation process required to join the waiting list for a new organ. The study, titled "Individual and Center Level Determinants of Progression from Kidney Transplant Referral to Kidney Transplantation in the United States: A National EHR Study," analyzed electronic health records from transplant centers to track patient progression from initial referral through evaluation and onto transplant waiting lists. Dr. presented the findings Saturday at the American Transplant Congress in Boston, examining both individual patient factors and center-level characteristics that either facilitate or impede candidates' advancement through the transplant evaluation pipeline. The research used data from electronic health records across multiple transplant centers to identify which patients referred by their nephrologists or primary care physicians advanced through the steps necessary to be listed for transplantation. Researchers examined patient demographics, medical histories, insurance status, and transplant center practices to determine what distinguished those who completed evaluation from those who did not. The gap between referral and transplant listing represents a critical bottleneck in the organ transplant system. Patients with end-stage renal disease require either dialysis or a functioning kidney transplant to survive, yet many referred candidates exit the evaluation process before becoming eligible for organ allocation. Transplant centers must conduct extensive medical testing and psychological evaluation before approving candidates for waiting lists. The process typically spans months and involves multiple appointments across different departments. Some patients do not complete these requirements, while others may be deemed ineligible during evaluation based on medical contraindications or comorbidities. The study examined both barriers specific to individual patients and systemic factors at transplant centers that affect whether referred candidates advance. Center-level determinants might include staffing levels, appointment availability, coordination between departments, or referral patterns from referring physicians. Understanding these barriers carries implications for kidney transplant policy and practice. The United States maintains a single national waiting list for deceased donor kidneys managed by the Organ Procurement and Transplantation Network, yet local and regional differences in evaluation practices may affect access to transplantation. Researchers found variation among centers in how many referred patients progressed to listing, suggesting that patients' chances of transplantation depend partly on where their evaluation occurs. Identifying which center practices and patient characteristics correlate with successful progression could help clinicians and administrators improve the transplant referral process. The findings come amid ongoing efforts to expand the kidney transplant donor pool and improve outcomes for patients with end-stage renal disease. Approximately 90,000 Americans await kidney transplants, yet only about 17,000 kidney transplants occur annually from both deceased and living donors. Researchers presented the study at the American Transplant Congress, the annual meeting of transplant professionals in the United States and abroad.