Many kidney transplant referrals stall before evaluation, study finds
NYU Langone researchers found that 48% of referred U.S. kidney failure patients did not start transplant evaluation, and 19% reached the waitlist.
By Priya Raghavan · Science Reporter
3 min read
Many U.S. kidney failure patients referred for a transplant fall out of the process before doctors can decide whether to list them for an organ, according to a nationwide study led by NYU Langone Health. The findings point to barriers that arise well before the transplant waitlist, where access to a donor kidney is usually measured.
The study, published online June 20 in the Journal of the American Society of Nephrology, reviewed 720,348 adults referred for kidney transplantation from 2014 through 2025. NYU Grossman School of Medicine researchers found that 48% of referred patients did not begin the required evaluation, while 19% completed it and were placed on the waitlist.
Researchers tracked patients through four steps: referral, evaluation, waitlisting and transplant. NYU Langone said the analysis is the largest and most detailed examination to date of where kidney transplant candidates leave the process before reaching the waitlist.
Barriers before the waitlist
Conor Donnelly, the study’s lead author and a resident and PhD student in NYU Grossman School of Medicine’s Department of Surgery, said the results show that many people who need a kidney leave the system long before surgery becomes possible. He said a patient’s transplant center, place of residence and marital status appeared to affect the chance of advancing to the waitlist.
The study found lower rates of starting or finishing evaluation among patients who were unmarried, had severe obesity or lived in rural areas, according to NYU Langone. Older adults, Spanish-speaking patients and people with lower incomes faced additional obstacles, the researchers reported.
Where patients received care also mattered, according to the research team. Patients referred to smaller transplant programs, and to centers in the Southern United States, were less likely to progress through the pathway.
A long evaluation process
NYU Langone said the transplant evaluation can involve blood testing, chest imaging, cancer screening and other medical checks used to determine whether a patient is healthy enough for transplant. Patients may need repeated appointments over several months while also continuing dialysis.
The researchers said smaller transplant centers may have fewer resources and transplant opportunities, which could affect how they assess candidates. They also said patients with less social support may struggle with transportation and repeated visits, which could help explain why urban patients were more likely to continue through the process.
The study used Epic Cosmos, a database of more than 300 million electronic health records from over 1,850 hospitals, according to NYU Langone. The database included records from more than one-third of U.S. transplant centers.
Researchers used statistical modeling to examine how age, sex, medical history, geography and other factors were linked to movement from one stage to the next. They also assessed social vulnerability, including issues such as poverty, unstable housing and limited transportation access.
Researchers call for more support
Allan B. Massie, a co-senior author and associate professor in NYU Grossman School of Medicine’s Departments of Surgery and Population Health, said reducing barriers to evaluation and waitlisting could broaden access to kidney transplantation. He said patient education and support during the demanding process would be a useful place to begin.
Michal A. Mankowski, a co-senior author and assistant professor in NYU Grossman School of Medicine’s Department of Surgery, said the findings show a need to help patients move from referral to the waitlist. Mankowski said future research will use a similar approach to study other organ transplant pathways.
NYU Langone Health funded the study. The findings are also being presented at the American Transplant Congress, the annual meeting organized by the American Society of Transplantation and the American Society of Transplant Surgeons.
This story draws on original reporting from ScienceDaily.