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The transplant evaluation — the weeks of tests that decide candidacy: cardiac, cancer screening, infections, social support, and the listing conversation.
Evidence reviewed & updated: 2026-08 — reflects the latest published trials and guidelines.
Transplant evaluation is a deliberate, weeks-long medical workup that decides whether and when a patient lists for transplant: heart testing (the leading reason patients are turned down), cancer screening, infection and immunization status, psychosocial assessment, and the transplant team's candid conversation about risks. It's also the best education a kidney-failure patient can get.
Heart disease is the biggest gatekeeper: transplant surgery and immunosuppression stress the heart, so patients get cardiac evaluation — EKG, often an echo and stress test, and catheterization when indicated. Finding and fixing heart disease BEFORE transplant is exactly the point; it protects the transplant's outcome.
Patients with significant uncorrected heart disease are deferred for treatment and re-evaluated — the deferral is a plan, not a verdict.
Cancer screening follows age guidelines (colon, breast, cervical, prostate, lung where indicated), and recent cancer typically means a cancer-free waiting period before listing. Infection workup: HIV, hepatitis B/C, TB, CMV, and immunization status — chronic infections are treated or managed first, and vaccines (COVID, flu, hepatitis, pneumococcal) are updated because vaccines work poorly after transplant.
Dental clearance, a pap smear/prostate check, and eye exams round out the set — and the social evaluation reviews support, adherence history, and substance use, not to judge but to plan the post-transplant help structure.
Evaluation ends in one of: listing (with an expected wait-time conversation), a living-donor pathway (the fastest, best route), a deferral with specific tasks (weight, cardiac procedure, cancer-free period), or — rarely — a permanent non-listing with honest reasons. Every outcome comes with a plan and a conversation.
Patients who 'fail' evaluation often don't — they defer, fix the identified problem, and list later. The evaluation is a roadmap either way.
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