People with advanced kidney disease or kidney failure may be evaluated for transplantation. Eligibility depends on whether a person is healthy enough to undergo surgery, take lifelong anti-rejection medicines and follow the required follow-up care. Doctors also consider conditions that could affect transplant success, such as serious heart disease, active cancer, severe infection or other significant health problems. Each transplant centre has its own eligibility criteria, so a comprehensive evaluation is needed before determining whether transplantation is appropriate.

Before transplantation, the patient undergoes a comprehensive assessment to determine whether surgery is safe and whether a transplant is likely to be beneficial. Evaluation may include a physical examination, blood tests, imaging scans, cancer screening and assessment of heart and blood vessel health. Psychological and social evaluations may also be performed. The transplant team reviews the findings along with the patient's medical history and ability to follow long-term treatment. The final decision is based on the individual's overall health and transplant suitability.

A living-donor transplant uses a kidney donated by a living person, who may be a relative, friend or another eligible donor. A deceased-donor transplant uses a kidney donated after a person's death. Living-donor transplantation can often be planned in advance and may reduce waiting time. If a compatible living donor is unavailable, a patient may be placed on a waiting list for a deceased-donor kidney. Both options require careful donor and recipient evaluation and compatibility testing.

Compatibility testing commonly includes blood typing, tissue typing and a crossmatch. Blood typing determines whether the donor and recipient have compatible blood groups. Tissue typing, also called HLA typing, compares genetic markers that can influence the likelihood of rejection. A crossmatch tests whether antibodies in the recipient's blood react against the donor's cells. A negative crossmatch generally indicates better compatibility. Other factors, including the donor's kidney size, age and infection exposure, may also be considered when selecting a suitable kidney.

After a kidney transplant, patients need lifelong anti-rejection medicines, also called immunosuppressants, to prevent the immune system from attacking the donated kidney. Other medicines may be prescribed to reduce the risk of infections and other complications. Regular follow-up is essential, particularly during the first few weeks when blood tests may be needed several times a week to monitor kidney function and adjust medicines. Continued medical reviews are important throughout life to monitor the transplanted kidney and manage treatment.

Taking anti-rejection medicines exactly as prescribed is one of the most important ways to protect a transplanted kidney. Missing doses can increase the risk of rejection. Patients should attend scheduled appointments and blood tests, report symptoms such as fever, reduced urine output or pain around the transplanted kidney promptly, and follow their transplant team's advice on medicines, diet and activity. Because immunosuppressants increase infection and certain cancer risks, recommended vaccinations, health screenings and skin checks are also important.