Medically reviewed by the Know Your Surgery Editorial Team. Last reviewed: May 2026.
A kidney transplant is a surgical procedure that places a healthy donor kidney into a person whose own kidneys have failed. The new kidney takes over the work of cleaning the blood, removing waste, and balancing fluids. For many patients with end-stage kidney disease, transplant offers the best long-term quality of life and survival compared with ongoing dialysis.
This guide gives you a calm, plain-English overview of what kidney transplant is, the main types of donor pathways used in the United States today, who tends to need a transplant, and what the patient journey looks like at a high level. Detailed information on causes and evaluation, the operating-room steps, and patient questions live in the other articles in this cluster.
Significance and Prevalence of Kidney Transplant in the United States
Kidney disease is one of the most common and serious chronic conditions in the United States. According to the Centers for Disease Control and Prevention (CDC) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), more than 35 million American adults have chronic kidney disease, and several hundred thousand are living with end-stage kidney disease (ESKD), which requires dialysis or transplant.
Each year, more than 25,000 kidney transplants are performed in the United States, according to data from the Organ Procurement and Transplantation Network (OPTN) and the United Network for Organ Sharing (UNOS). Transplant offers patients with ESKD a path to longer life and better quality of life compared with long-term dialysis.
Despite the high volume of transplants performed, demand far exceeds supply. Tens of thousands of patients are on the kidney transplant waiting list. Living-donor transplants help reduce wait times and often have better outcomes. The Centers for Medicare and Medicaid Services (CMS) covers kidney transplant for most patients with ESKD.
Modern immunosuppression medications, surgical techniques, and donor matching have made kidney transplant a well-established procedure with strong long-term outcomes for most recipients.
What Is a Kidney Transplant?
A kidney transplant is the surgical placement of a healthy donor kidney into a recipient with kidney failure. The donor kidney is connected to the recipient’s blood vessels and bladder, where it begins making urine and filtering blood.
The procedure is performed by a transplant surgical team in a specialized transplant center, under general anesthesia in a hospital operating room. The recipient’s own kidneys are usually left in place, unless they are causing problems.
The goals of kidney transplant typically include:
- Restoring normal kidney function
- Freeing the patient from dialysis
- Improving long-term survival
- Improving quality of life
- Allowing the patient to return to many normal activities
The full step-by-step procedure walkthrough lives in our procedure and recovery article.
How the Kidneys Work
The two kidneys sit at the back of the upper abdomen. Each kidney is about the size of a fist and contains roughly a million tiny filtering units called nephrons. The kidneys filter waste and extra fluid from the blood, balance electrolytes, regulate blood pressure, and produce hormones that support red blood cell production and bone health.
When the kidneys lose most of their function (typically below 15 percent of normal), waste and fluid build up in the body. Dialysis can substitute for some kidney function but does not replace all of it. A successful kidney transplant restores most kidney function, allowing the patient to live without dialysis.
Main Types of Kidney Transplant
US transplant centers today perform two main types based on the source of the donor kidney. Each has trade-offs in terms of waiting time, recovery, and matching.
Living-donor kidney transplant. A healthy person (often a family member or close friend) donates one of their kidneys. The donor lives a normal life with one kidney, and the recipient receives a kidney that often functions immediately and lasts longer on average than a deceased-donor kidney. Living-donor transplants can be scheduled in advance, often before the recipient needs to start dialysis.
Deceased-donor kidney transplant. The donor kidney comes from a person who has recently died and donated their organs. Patients on the waiting list are matched based on blood type, tissue type, antibodies, time on the waiting list, and other factors. Wait times vary by region, blood type, and antibody levels.
Paired kidney exchange (kidney swap). When a willing living donor is not a match for their intended recipient, two or more pairs swap donors so each recipient gets a compatible kidney. This expands access to living-donor transplant.
A single sentence on emerging methods: some centers now perform robotic-assisted donor nephrectomies, although this is not yet standard everywhere. We compare techniques in more depth in our procedure and recovery article.
Surgical Techniques at a High Level
Most kidney transplants are performed under general anesthesia. Operating times typically range from 3 to 5 hours for the recipient surgery, and 2 to 4 hours for living-donor surgery. Patients are at the hospital for several days.
The donor kidney is placed in the lower abdomen (the iliac fossa), not in the location of the original kidneys. This location allows the surgeon to connect the new kidney to nearby blood vessels and to the bladder.
Living donors typically undergo a laparoscopic or robotic donor nephrectomy, which uses small incisions and allows quicker recovery than older open techniques.
What Gets Done in a Kidney Transplant?
In the recipient surgery:
- A donor kidney is connected to the recipient’s iliac artery and iliac vein
- The donor ureter is connected to the recipient’s bladder
- The recipient’s own kidneys are typically left in place (unless they are causing problems)
- A drain may be placed temporarily
In the donor surgery (living donor):
- One healthy kidney is removed (usually the left, which has a longer renal vein)
- The donor’s remaining kidney compensates by enlarging modestly and functioning at a higher capacity
Both surgeries are major procedures, but they are well-established and routinely performed at high-volume US transplant centers.
Who Might Need a Kidney Transplant?
Kidney transplant is generally considered when a patient has end-stage kidney disease (ESKD) or is approaching ESKD. Common causes include:
- Diabetes (the leading cause of ESKD in the US)
- High blood pressure
- Glomerulonephritis (inflammation of the kidney’s filters)
- Polycystic kidney disease (an inherited condition)
- Recurrent or severe kidney infections
- Autoimmune diseases affecting the kidneys
- Birth defects of the urinary tract
Patients are usually evaluated for transplant when their kidney function (eGFR) drops below 20 milliliters per minute and dialysis is approaching or has begun. We cover causes and evaluation in detail in our causes and diagnosis article.
Early Warning Signs of Kidney Disease
Kidney disease often progresses silently for years. Common warning signs include:
- Swelling in the legs, ankles, or around the eyes
- Foamy or bubbly urine (a sign of protein in the urine)
- Decreased urine output
- Fatigue and weakness
- Trouble concentrating
- Trouble sleeping
- Persistent itching
- Loss of appetite
- Muscle cramps
- Nausea or vomiting (in advanced disease)
- Anemia
- High blood pressure that is hard to control
These symptoms can have many causes. Anyone with persistent symptoms suggestive of kidney disease, especially patients with diabetes or high blood pressure, should be screened by their primary care clinician with a urine test and a kidney function blood test.
Your Kidney Transplant Journey at a Glance
Although every patient’s path is different, the typical kidney transplant journey in the United States follows a familiar pattern.
It often begins with a referral to a transplant center when kidney function is declining. The transplant evaluation includes blood tests, imaging, heart and lung tests, infection screening, cancer screening, and meetings with a transplant surgeon, transplant nephrologist, social worker, and financial counselor. Patients are placed on the waiting list (or scheduled for living-donor transplant) when they meet criteria.
For patients with a living donor, the donor undergoes a separate evaluation. When both are approved, surgery can be scheduled. For patients on the deceased-donor list, the wait depends on blood type, antibody levels, and region.
When a transplant occurs, the recipient surgery takes 3 to 5 hours. The hospital stay is typically 4 to 7 days. The patient leaves with a complex medication regimen including immunosuppressants. Close follow-up over the first weeks and months is essential.
Living-donor surgery is typically 2 to 4 hours. The donor’s hospital stay is 1 to 3 days, with most donors returning to office work in 2 to 4 weeks.
Long-term, the recipient takes immunosuppressant medications for life and continues regular follow-up with the transplant team. Detailed timelines are covered in our procedure and recovery article.
Frequently Asked Questions
Is kidney transplant major surgery?
Yes. Kidney transplant is major surgery performed under general anesthesia, with several days in the hospital and ongoing close follow-up. Recovery is structured and continues for months as the team monitors for rejection and adjusts medications.
Will I be free of dialysis after a transplant?
Most successful kidney transplant recipients can stop dialysis once the new kidney is functioning. Some patients need temporary dialysis early after surgery if the kidney takes time to start working (called “delayed graft function”).
How long does a transplanted kidney last?
This depends on the donor source, recipient health, medication adherence, and other factors. Living-donor kidneys often last longer on average than deceased-donor kidneys. Specific outcomes vary; the transplant team will discuss expectations.
Continue Reading the Kidney Transplant Cluster
- Kidney Transplant: Causes, Diagnosis, and When to Consider Surgery
- Kidney Transplant: Procedure, Recovery, and Rehabilitation
- Kidney Transplant: FAQs, Statistics, and Patient Stories
Sources
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Kidney transplant. https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/kidney-transplant
- Centers for Disease Control and Prevention (CDC). Chronic kidney disease basics. https://www.cdc.gov/kidney-disease/about/
- Organ Procurement and Transplantation Network (OPTN). Kidney transplant data. https://optn.transplant.hrsa.gov/
- United Network for Organ Sharing (UNOS). Kidney transplant resources. https://unos.org/
- Mayo Clinic. Kidney transplant overview. https://www.mayoclinic.org/tests-procedures/kidney-transplant/about/pac-20384777
- Cleveland Clinic. Kidney transplant. https://my.clevelandclinic.org/health/treatments/17498-kidney-transplant
Medical Disclaimer
The information in this article is for general education and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about kidney disease or kidney transplant.
