Transplant centers take months to complete evaluations, burning waitlist time

Before a patient can be placed on the organ transplant waiting list, they must complete a multi-step evaluation at a transplant center involving cardiac testing, cancer screening, psychosocial assessment, financial clearance, and dental exams. While the actual testing takes 1-2 days, scheduling and completing all required tests routinely takes months because of appointment backlogs, insurance pre-authorization delays, and the difficulty of coordinating around a dialysis patient's thrice-weekly treatment schedule. Every month spent in evaluation is a month not accruing waitlist time, and since median kidney wait times are 3-5 years, a 6-month evaluation delay is significant. Worse, some nephrologists delay referral to transplant centers in the first place, wanting patients to 'get used to dialysis' before referring—a practice that directly contradicts evidence showing preemptive transplantation (before dialysis starts) has the best outcomes. The compounding effect is devastating: late referral plus slow evaluation means patients spend more years on dialysis, which causes cardiovascular damage that reduces post-transplant survival and can even make them ineligible for transplant. This persists because transplant center evaluation capacity is not scaled to demand, there are no mandated referral timelines for nephrologists, and dialysis facilities (which profit from keeping patients on dialysis) have no financial incentive to expedite transplant referrals.