Wait List

Advances in kidney transplant surgery and anti-rejection medicines have produced very good success rates for kidney transplants. However, there are more people waiting for a kidney than there are kidneys being donated. This means you must remain on a waiting list, sometimes for several years, until a kidney that matches becomes available.

All patients accepted by a kidney transplant program are registered on the national organ transplant waiting list. The United Network for Organ Sharing (UNOS) maintains a centralized computer network linking all organ procurement centers (OPO) transplant centers.

The kidney transplant center must place you on the national waiting list. You are officially on the list when your kidney transplant nurse coordinator or doctor confirms it. You must follow all prescribed treatment carefully while waiting for a new kidney.

Waiting time factors include how urgent the patient’s need is, and how closely the donor and candidate match in body size and blood type. Some kidney candidates have a “highly-sensitized” immune system because of earlier transplants, pregnancy or multiple blood transfusions. Highly-sensitized patients will be good matches for a limited number of organ offers, so they often wait longer than non-sensitized candidates.

The distance between the donor and transplant hospital is important because the less time the organ must be preserved outside the donor’s body, the better the chance it will function when transplanted.

There is a nationwide shortage of donated organs, which means there are not enough available organs to meet everyone’s needs. Everyone in the transplant community shares the goal of increasing organ donation to save and enhance more lives.

There are three levels considered:  

  • Local. This is usually the area served by the local organ procurement organization where the donation occurs. There are 58 OPOs nationwide. These areas are often statewide but can be smaller (such as a large city or part of a state) or larger (a multi-state area). Your transplant center can tell you what your local area is.
  • Region or zone. If there are no suitable local matches, organs are offered to patients at transplant centers throughout the region. Kidneys, livers, pancreases and intestinal organs are first offered within one of 11 regions of the United States. Heart and lung offers are considered for candidates within 500 miles of the donor site, then 1,000 miles, then 1,500 miles.
  • Nationwide. If there are no matches in the local area or region, organs will be offered to anyone in the United States who is a potential match.

The Matching Process

When a kidney becomes available, the local OPO accesses the UNOS computer system, enters information about the donor organs, runs the match program and coordinates the surgical recovery team.

This program generates a list of patients ranked according to objective medical criteria such as blood type, tissue type, size of the organ and patient's medical urgency. Other factors include time spent on the waiting list and distance between the donor and the kidney transplant center.

The computerized matching process locates the best possible matches between donated organs and the patients who need them, but the final decision to accept an organ rests with the patient's transplant program team. A new list is generated for each time a kidney becomes available.

Availability of an organ is not predictable. Therefore, you must stay in constant contact with your coordinator and your coordinator must be able to connect with you at any time. Call the kidney transplant center immediately if any of the following change:

  • Address
  • Telephone number or cell phone number
  • Emergency contact information
  • Insurance coverage
  • Physical condition
  • Medical condition, such as blood transfusions or start or change dialysis