A nationwide study has revealed that almost half of Americans referred for a kidney transplant never begin the required evaluation process. Only 19 percent ultimately reach the transplant waitlist. The research highlights major disparities tied to social, geographic, and medical factors.
Researchers at NYU Langone Health examined records for 720,348 patients referred for kidney transplantation between 2014 and 2025. They found that 48 percent never started the evaluation, while just 19 percent completed it and were placed on the waitlist.
Patients who were unmarried, lived in rural areas, had severe obesity, or received care at smaller centers in the South were less likely to advance. Older adults, Spanish speakers, and those with lower incomes faced additional obstacles.
"Our findings suggest that a substantial proportion of people who need a new kidney fall out of the process long before they reach the waitlist," said lead author Conor Donnelly, MD. The study was published online June 20 in the Journal of the American Society of Nephrology.
Co-senior author Allan B. Massie, PhD, noted that better education and support could help patients navigate the complex process. The work is the largest to date on dropout rates before waitlisting.
