Can people on dialysis be placed on the transplant list? 

Yes, people on dialysis can be placed on the national kidney transplant waiting list, provided they are medically fit enough to undergo surgery and manage the long-term aftercare. In the UK, dialysis is often a bridge to transplantation, and many patients are added to the list either shortly before they start dialysis or while they are already receiving regular treatment. Being on dialysis is not a barrier to listing; rather, it is one of the primary reasons a person becomes eligible for a transplant assessment. 

What We’ll Discuss in This Article 

• The eligibility criteria for joining the national transplant list while receiving dialysis 

• How the clinical ‘work-up’ assessment determines your suitability for surgery 

• The role of dialysis time in your overall transplant priority points 

• Common medical reasons why a patient on dialysis might be temporarily suspended from the list 

• The physical and psychological readiness required for a successful transplant 

• How the multi-disciplinary team makes the final decision on your listing status 

How being on dialysis affects your transplant listing 

For most patients in the UK, dialysis and the transplant waiting list go hand in hand. Once you reach stage 5 chronic kidney disease, your medical team will begin a ‘transplant work-up’. This is a series of tests to ensure your heart, lungs, and immune system can handle the surgery. If you pass these tests, you are added to the national database held by NHS Blood and Transplant. 

While you are on the list, you will continue your dialysis treatments as usual. In fact, the time you spend on dialysis is a significant factor in the UK organ allocation system. The points-based system awards more points to those who have been on dialysis or the waiting list for longer periods, helping to ensure that the process remains fair for those who have waited the longest for a compatible organ. 

The criteria for joining the national transplant list 

Joining the list is not automatic; it requires a detailed medical evaluation. The primary criteria include being healthy enough to survive a major operation and having a life expectancy of at least five years. Doctors look closely at your cardiovascular health, as the rapid fluid shifts and surgical stress of a transplant require a strong heart. 

Weight and lifestyle are also key factors. Most UK transplant centres require a Body Mass Index (BMI) below 35 to minimise surgical risks such as poor wound healing or blood clots. Additionally, you must be free from active cancer and serious, untreated infections. Once you are deemed fit, you are ‘activated’ on the list, meaning you could be called for a transplant at any time, day or night. 

Comparing Listing Status: Active vs Suspended 

The following table explains the difference between the two primary statuses on the transplant waiting list: 

Status	What it means	Common reasons for this status
Active	You are waiting and ready to be called for a kidney immediately.	Fit for surgery, reachable by phone, and ready to travel.
Suspended	You are on the list, but you will not be offered a kidney today.	Recent infection, temporary illness, or planned holiday.
Pending	Your assessment is still ongoing.	Tests like heart scans or dental checks are still being reviewed.
Permanent Removal	You are no longer suitable for a transplant.	Significant health decline or choosing to stop treatment.

Causes for needing to be on the list while on dialysis 

The primary cause for needing a transplant referral while on dialysis is end-stage renal disease (ESRD). At this stage, the kidneys are functioning at less than 15 per cent of their normal capacity, and dialysis is the only way to keep the body’s chemistry in balance. Because a transplant offers a better quality of life and improved survival rates compared to long-term dialysis, it is the ‘gold standard’ treatment goal for most eligible patients. 

Some patients are listed ‘pre-emptively’, meaning they are added to the list before they even start dialysis. This is ideal because it allows for a transplant to happen just as the kidneys are reaching total failure, potentially avoiding dialysis altogether. However, due to the shortage of organs, many patients find that their kidney function drops quickly, necessitating the start of dialysis while they wait for a match to be found on the list. 

Triggers for moving from dialysis to the active list 

The move from being a ‘dialysis patient’ to an ‘active transplant candidate’ is triggered by the completion of your clinical assessment. Once all your blood tests, heart scans, and virology checks are clear, your case is presented to a Multi-Disciplinary Team (MDT). The approval by the MDT is the formal trigger that allows the transplant co-ordinator to activate your name on the national database. 

Another important trigger is your commitment to medical compliance. To remain active, you must attend all your dialysis sessions and take your prescribed medications reliably. If a patient frequently misses dialysis, the team may suspend them from the list, as this suggests they may also struggle with the strict anti-rejection pill routine required after a transplant. Maintaining good health and stability on dialysis is the best way to ensure you stay active and ready for a potential offer. 

Differentiation: Dialysis time vs Waiting list time 

In the UK, the way your ‘waiting time’ is calculated changed in recent years to be more inclusive. Previously, points were awarded based only on the time you were active on the list. Now, for many patients, the time spent on dialysis can also count toward your priority points. This differentiation is important because it ensures that someone whose transplant work-up was delayed through no fault of their own is not unfairly penalised. 

This system recognizes that every day spent on dialysis is a day spent waiting for a better quality of life. Whether you are on haemodialysis or peritoneal dialysis, your clinical team will ensure that your records accurately reflect your start dates. This integrated approach helps to balance the ‘queue’ and ensures that those who have been managed with dialysis for several years receive the appropriate level of priority when a compatible kidney becomes available. 

My Final Conclusion 

People on dialysis are frequently placed on the transplant list, as a transplant is the preferred long-term treatment for kidney failure. Eligibility depends on your overall health and surgical fitness rather than the fact that you are on dialysis. By staying healthy, maintaining a stable weight, and attending all medical appointments, you can remain ‘active’ on the list while you wait for a suitable donor match. 

If you experience severe, sudden, or worsening symptoms, such as sudden chest pain, extreme breathlessness, or severe confusion, call 999 immediately. 

Authority Snapshot 

This article was written by Dr. Rebecca Fernandez, a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, and emergency medicine. Dr. Fernandez has extensive experience in patient assessment and treatment planning, ensuring this guide follows established clinical pathways for renal care in the UK. The content is designed to align with current NHS and NICE standards for kidney transplantation.