Renal replacement · UK
Deceased donor kidney transplant, the UK gold standard for ESRD.
When a living donor isn’t available, a deceased donor kidney — allocated through the NHS Blood and Transplant national scheme — remains the treatment that best restores life expectancy and quality of life in end-stage renal disease.
Why patients choose us
- 01
A transplant nephrologist and surgical team
Kidney transplantation is not a single specialty. You are looked after by nephrology, transplant surgery, HLA, pharmacy and clinical psychology together.
- 02
Access to nationally listed programmes
UK deceased donor kidneys are allocated by NHS Blood and Transplant. We help you get listed at a recognised centre and understand where you sit on the scheme.
- 03
Honest talk about wait, risk and alternatives
Two to four years on the list is typical. We cover living donation, home dialysis and conservative care so the choice is genuinely informed.
Key facts
What deceased donor kidney transplant looks like in the UK.
Deceased donor kidney transplantation is delivered through the NHS and allocated by NHS Blood and Transplant. The figures below give a sense of the pathway.
In short
Around 5,000 people are on the UK kidney list; the typical wait is 2–4 years, with median graft survival of 12–15 years.
| Stage | Setting | Typical duration | Turnaround |
|---|---|---|---|
| Pre-transplant nephrology assessment | NHS-funded | 60–90 min | Weeks to months |
| Cardiac workup (stress test, echo) | NHS-funded | Day-case | Same visit |
| HLA typing and DSA screening | NHS-funded | Blood test | 1–2 weeks |
| Deceased donor kidney transplant | NHS-funded | 2–4 hours | 7–10 day stay |
| Post-transplant clinic (first 3 months) | NHS-funded | Weekly | Same visit |
| Lifelong immunosuppression monitoring | NHS-funded | 30 min | Same visit |
Kidney transplantation in the UK is delivered by the NHS at recognised centres; private involvement is limited to workup and shared care. We help patients understand where they are on the pathway and coordinate second opinions.
The problem
The right listing, the right centre, the right conversations.
The kidney list is national, but the experience of getting on it — and being ready when the call comes — varies enormously. We help patients navigate that in a considered, unhurried way.
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Not sure you’re listed?
Listing status and cross-match risk should be transparent. We help you get the answers from your renal team.
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Worried about the wait?
Two to four years is typical. Living donation and paired exchange are always worth exploring alongside the deceased donor list.
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Want a considered plan?
A named nephrologist, an honest look at your comorbidities, and preparation so you’re actually fit when the call comes.
The journey
From referral to lifelong follow-up — what happens, in order.
Referral, listing, the call, surgery, three to six months of intensive follow-up, then lifelong monitoring on immunosuppression.
Phase 1 · Before
Referral, workup and listing
Phase 2 · The call
Hours from phone call to theatre
Phase 3 · After
Intensive then lifelong follow-up
- 01
Before
Referral from your renal team
Usually made when eGFR is around 15–20 ml/min, or earlier if dialysis is imminent. We help you understand what a listing referral involves.
- 02
Before
Transplant workup
Cardiac stress testing, dental and malignancy screening, vaccinations, HLA typing, virology and donor-specific antibody (DSA) screening — the full assessment before listing.
- 03
Before
Listing on the NHSBT scheme
Once fit and consented, your details go onto the national waiting list. Typical wait in the UK is two to four years, depending on blood group and sensitisation.
- 04
The call
The call
A kidney has been offered. You arrive at the transplant centre within hours, are cross-matched, and reviewed by anaesthetics. A back-up recipient is often called in parallel.
- 05
The call
The operation
An extraperitoneal graft into the iliac fossa under general anaesthetic, usually two to four hours. Induction immunosuppression (basiliximab or ATG) is given peri-operatively.
- 06
After
Early recovery
Seven to ten days in hospital. Creatinine, urine output, tacrolimus levels, BK virus and CMV monitored closely. Ureteric stent removed at around six weeks.
- 07
After
Long-term follow-up
Intensive clinic reviews for three to six months, then lifelong monitoring on tacrolimus, mycophenolate and low-dose prednisolone. Median graft survival is 12–15 years.
Typical wait on the UK list: 2–4 years. Intensive follow-up: 3–6 months, then lifelong.
When it helps
When a deceased donor kidney transplant is the right step.
The situations we see most, plus the situations where transplant is not the right answer — at least for now.
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End-stage renal disease (ESRD)
eGFR under 15 ml/min, or already established on haemodialysis or peritoneal dialysis, with no medical contraindication to transplant.
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No suitable living donor
Where family or friends cannot donate, or paired exchange is not possible, the deceased donor list is the route to a transplant.
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Diabetic nephropathy
Type 1 and type 2 diabetes are among the commonest causes of ESRD in the UK; transplantation improves survival compared with dialysis.
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Hypertensive nephrosclerosis
Long-standing poorly controlled hypertension damages the kidneys — transplant is offered when function is lost.
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Polycystic kidney disease
ADPKD is a common inherited cause of ESRD; native kidneys sometimes need removal before or during transplant if very large.
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Glomerulonephritis
IgA nephropathy, FSGS, membranous nephropathy and other GN can lead to ESRD; recurrence in the graft is possible and is discussed before listing.
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Failed previous transplant
Re-listing is possible after a failed graft, though sensitisation from previous exposure to HLA antigens can extend the wait.
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Red flag: active infection or cancer
Untreated malignancy, active sepsis, uncontrolled cardiovascular disease and severe frailty are contraindications — usually temporary, sometimes permanent.
Donor options
Not every deceased donor kidney is the same.
DBD versus DCD, standard versus extended criteria — and why you might sensibly accept a marginal kidney rather than wait years for a perfect one.
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Donation after brain death (DBD)
The traditional deceased donor pathway. Circulation is maintained until organ retrieval, giving generally better early graft function than DCD.
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Donation after circulatory death (DCD)
Kidneys retrieved after cardiac death. Now around 40% of UK deceased donor kidneys; delayed graft function is more common but long-term outcomes are similar.
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Standard criteria donor
Younger donor, no significant comorbidity — the kidney with the best expected long-term function, though wait times are longer.
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Extended criteria donor (ECD)
Older or higher-risk donor. Shorter wait, shorter expected graft life — a reasonable choice for older recipients where the alternative is many more years of dialysis.
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Normothermic machine perfusion
Some kidneys, particularly DCD or marginal grafts, are perfused ex-situ on a device that mimics normal physiology to assess viability and improve outcomes.
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Dual kidney transplant
Occasionally two lower-quality kidneys from a single donor are implanted together in one recipient to give sufficient nephron mass.
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Living donor kidney
Always discussed as an alternative. Better outcomes, shorter wait, but requires a willing and medically suitable donor.
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Conservative kidney management
For frail patients where transplant and dialysis burden outweigh benefit, symptom-focused care is a legitimate and dignified choice.
Our clinical network
Consultant-led transplant care, we know the teams.
Introductions to transplant nephrologists and surgeons at recognised UK centres — for second opinions, listing questions and shared care.
Selection criteria
How we choose every transplant clinician in our network.
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Consultant transplant nephrologists and surgeons at recognised UK centres
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Full multidisciplinary team — pharmacy, dietetics, psychology, HLA laboratory
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Living donation and paired exchange discussed alongside deceased donor listing
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Long-term follow-up and immunosuppression monitoring for the life of the graft
Safety and complications
What can go wrong, and how it’s picked up.
Kidney transplantation is life-changing but not risk-free. The early risks are surgical and immunological; the late risks are infection, cardiovascular disease and drug side-effects.
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Delayed graft function
The transplanted kidney sometimes takes days or weeks to start working, especially with DCD kidneys. Short-term dialysis may be needed while it recovers — long-term outcomes are usually still good.
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Ureteric leak or stenosis
The connection between the transplant ureter and your bladder can leak or narrow. A ureteric stent is placed at surgery and removed at around six weeks.
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Renal artery or vein thrombosis
Uncommon but serious — a clot in the graft blood supply usually presents in the first week and can mean loss of the kidney. Immediate re-exploration is sometimes possible.
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Acute cellular rejection
The commonest form of rejection, typically in the first six months. Diagnosed on biopsy and usually reversible with pulsed steroids or T-cell-depleting antibody.
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Antibody-mediated rejection
Less common but harder to treat. Managed with plasma exchange, IVIG and rituximab — carries a worse long-term prognosis for the graft.
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BK virus nephropathy
A polyomavirus that reactivates on immunosuppression and can damage the graft. Screening urine and blood in the first year lets us reduce immunosuppression before injury sets in.
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CMV disease
Cytomegalovirus reactivation is common in the first three months, especially in mismatched pairs. Valganciclovir prophylaxis and monitoring are standard.
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Post-transplant lymphoproliferative disorder (PTLD)
A rare EBV-driven lymphoma linked to immunosuppression. Rare but taken seriously — a new lump, night sweats or unexplained weight loss needs urgent review.
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Cardiac and metabolic risk
Cardiovascular disease remains the leading cause of death with a functioning graft. Blood pressure, cholesterol, glucose and weight are actively managed lifelong.
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Chronic allograft dysfunction
Gradual decline in graft function over years, from a mix of immunological injury, drug toxicity and recurrent disease. Median graft survival is 12–15 years.
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Non-adherence
Missing tacrolimus doses is the single most modifiable cause of late graft loss. Pharmacy, apps and honest conversation are all part of preventing it.
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Red flags
Fever, reduced urine output, sudden rise in creatinine, graft tenderness or a spreading rash all warrant same-day contact with the transplant team.
Reading your operation and clinic notes
Your transplant summary in four parts. Read the last one first.
Every transplant discharge summary follows a similar shape, whichever centre you are looked after by.
A quiet reminder
Transplant language is precise and can read coldly — we translate it for you.
If you would like us to talk you through your discharge summary before your review, just ask.
- 01 Donor
Donor type and match
Whether the kidney was DBD or DCD, the donor’s age and comorbidities, cold ischaemia time and the HLA mismatch score.
- 02 Operation
Surgical technique and vessels
Which iliac fossa the kidney went into, the artery and vein anastomoses, the ureteric implant and whether a stent was placed.
- 03 Early course
Graft function and complications
Immediate versus delayed function, creatinine trend, any need for dialysis, and any early surgical or vascular issues.
- 04 Plan
Immunosuppression and follow-up plan
Read this first: your induction and maintenance regimen, target tacrolimus levels, when the stent is removed, and how often you will be seen.
Recognised by major UK insurers
Deceased donor kidney transplantation is delivered through the NHS. Private insurance can cover pre-transplant workup, second opinions and some elements of long-term monitoring.
Frequently asked
Everything we get asked about kidney transplant.
Quick answers on wait times, DBD versus DCD, immunosuppression and long-term outcomes.
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How long is the wait for a deceased donor kidney in the UK?
The average wait is roughly two to four years, but it depends on your blood group, HLA sensitisation and age. Blood group B and O typically wait longer; highly sensitised patients wait longer still. The National Kidney Allocation Scheme run by NHSBT balances waiting time, HLA match and equity of access.
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What is the difference between DBD and DCD kidneys?
DBD kidneys come from donors declared dead by neurological criteria, with circulation maintained until retrieval. DCD kidneys come from donors after circulatory death. DCD kidneys have a higher rate of delayed graft function but the long-term outcomes are broadly similar — around 40% of UK deceased donor kidneys are now DCD.
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What immunosuppression will I be on?
Most patients receive induction with basiliximab or anti-thymocyte globulin at the time of transplant, then lifelong maintenance with tacrolimus, mycophenolate mofetil and low-dose prednisolone. Doses are adjusted to blood levels, kidney function and any complications.
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How long does a transplanted kidney last?
Median graft survival for a deceased donor kidney in the UK is around 12 to 15 years. Some grafts fail sooner from rejection or recurrent disease; others last well over twenty years. Living donor kidneys generally last longer.
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Can I still be listed if I have had a previous transplant?
Yes. Re-listing is common once a graft fails. Because of exposure to previous donor HLA antigens you may be more sensitised, which can lengthen the wait for a suitable match.
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When should I contact the transplant team urgently?
Any fever, a sudden fall in urine output, pain or tenderness over the graft, a rapid rise in creatinine, new breathlessness, or a spreading rash while on immunosuppression should trigger same-day contact with your transplant centre or A&E.
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