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The kidney transplant waiting list in the United States

Edmund Huang, MD
Gabriel Danovitch, MD
Section Editor
Daniel C Brennan, MD, FACP
Deputy Editor
Alice M Sheridan, MD


As of January 2015, there were approximately 110,000 patients registered on the United Network for Organ Sharing (UNOS) kidney transplant waiting list in the United States; of these, 60 percent were designated as active status on the waitlist, or eligible for a transplant if a kidney is offered [1]. Registration on this list by individual transplant programs is required before a patient can be allocated a deceased-donor organ.

This topic reviews the composition of and access to the kidney transplant waitlist in the United States, as well as the management of patients while they await kidney transplantation.

The details of the allocation algorithm for deceased-donor kidneys and issues related to the evaluation of the kidney transplant candidate are discussed separately. (See "Organ sharing in kidney transplantation" and "Evaluation of the potential renal transplant recipient".)


Candidates may be registered on the waiting list and accrue time towards deceased-donor kidney transplantation at any time after a diagnosis of irreversible kidney disease is made and the glomerular filtration rate (GFR) decreases to ≤20 mL/min. The GFR can be determined by any modality, including direct measurement or any of the available estimating equations. (See "Assessment of kidney function", section on 'Assessment of GFR'.)

For candidates ≥18 years old, the calculation of waiting time (which is used to prioritize candidates for kidney allocation) is based upon the earliest of the following:


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Literature review current through: Oct 2015. | This topic last updated: Sep 16, 2015.
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  1. http://optn.transplant.hrsa.gov/ (Accessed on April 01, 2015).
  2. Matas AJ, Smith JM, Skeans MA, et al. OPTN/SRTR 2013 Annual Data Report: kidney. Am J Transplant 2015; 15 Suppl 2:1.
  3. http://optn.transplant.hrsa.gov/media/1158/kas_report_02-2015.pdf (Accessed on March 12, 2015).
  4. Danovitch GM, Cohen DJ, Weir MR, et al. Current status of kidney and pancreas transplantation in the United States, 1994-2003. Am J Transplant 2005; 5:904.
  5. Grams ME, Massie AB, Schold JD, et al. Trends in the inactive kidney transplant waitlist and implications for candidate survival. Am J Transplant 2013; 13:1012.
  6. Delmonico FL, McBride MA. Analysis of the wait list and deaths among candidates waiting for a kidney transplant. Transplantation 2008; 86:1678.
  7. Wolfe RA, Ashby VB, Milford EL, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 1999; 341:1725.
  8. Schold JD, Meier-Kriesche HU. Which renal transplant candidates should accept marginal kidneys in exchange for a shorter waiting time on dialysis? Clin J Am Soc Nephrol 2006; 1:532.
  9. Merion RM, Ashby VB, Wolfe RA, et al. Deceased-donor characteristics and the survival benefit of kidney transplantation. JAMA 2005; 294:2726.
  10. Gill JS, Tonelli M, Johnson N, et al. The impact of waiting time and comorbid conditions on the survival benefit of kidney transplantation. Kidney Int 2005; 68:2345.
  11. Winkelmayer WC, Mehta J, Chandraker A, et al. Predialysis nephrologist care and access to kidney transplantation in the United States. Am J Transplant 2007; 7:872.
  12. Gaston RS, Danovitch GM, Adams PL, et al. The report of a national conference on the wait list for kidney transplantation. Am J Transplant 2003; 3:775.
  13. Lentine KL, Costa SP, Weir MR, et al. Cardiac disease evaluation and management among kidney and liver transplantation candidates: a scientific statement from the American Heart Association and the American College of Cardiology Foundation: endorsed by the American Society of Transplant Surgeons, American Society of Transplantation, and National Kidney Foundation. Circulation 2012; 126:617.
  14. Abbud-Filho M, Adams PL, Alberú J, et al. A report of the Lisbon Conference on the care of the kidney transplant recipient. Transplantation 2007; 83:S1.
  15. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130:2215.
  16. Herzog CA, Littrell K, Arko C, et al. Clinical characteristics of dialysis patients with acute myocardial infarction in the United States: a collaborative project of the United States Renal Data System and the National Registry of Myocardial Infarction. Circulation 2007; 116:1465.
  17. Fishbane S. Cardiovascular risk evaluation before kidney transplantation. J Am Soc Nephrol 2005; 16:843.
  18. Stack AG, Martin DR. Association of patient autonomy with increased transplantation and survival among new dialysis patients in the United States. Am J Kidney Dis 2005; 45:730.
  19. Kutner NG, Zhang R, Bowles T, Painter P. Pretransplant physical functioning and kidney patients' risk for posttransplantation hospitalization/death: evidence from a national cohort. Clin J Am Soc Nephrol 2006; 1:837.
  20. McAdams-DeMarco MA, Law A, King E, et al. Frailty and mortality in kidney transplant recipients. Am J Transplant 2015; 15:149.
  21. Reese PP, Bloom RD, Shults J, et al. Functional status and survival after kidney transplantation. Transplantation 2014; 97:189.
  22. Huang E, Shye M, Elashoff D, et al. Incidence of conversion to active waitlist status among temporarily inactive obese renal transplant candidates. Transplantation 2014; 98:177.
  23. Ikizler TA. Resolved: being fat is good for dialysis patients: the Godzilla effect: pro. J Am Soc Nephrol 2008; 19:1059.
  24. Schold JD, Srinivas TR, Guerra G, et al. A "weight-listing" paradox for candidates of renal transplantation? Am J Transplant 2007; 7:550.
  25. Gill JS, Lan J, Dong J, et al. The survival benefit of kidney transplantation in obese patients. Am J Transplant 2013; 13:2083.