There are more options than ever before for people with advanced kidney disease in need of a transplant.
There have always been more people needing kidney transplants than there are donated kidneys to give them. That’s a discouraging and challenging fact, but a kidney surgeon with the Vanderbilt Kidney Transplant Program explains recent developments that each make it more likely that a person with advanced kidney disease can be matched with a donated kidney.
Nationally, about 90,000 people are on the wait list for a donated kidney, with about 25,000 kidney transplants done in the U.S. per year.
Kidney donation can not only save the life of someone whose kidneys are failing, but it also frees them from dialysis. Dialysis is a mechanical process in which someone’s blood is routed through an external filtration system that removes waste products, then returns the blood to the person’s body.
Healthy kidneys filter wastes out of the blood so they can be flushed from the body. When one or both kidneys can’t keep up with this job, dialysis becomes necessary, and it’s a time-consuming, physically stressful treatment. A kidney transplant ends the need for dialysis and can greatly improve quality of life for someone in kidney (renal) failure.
Advances make more types of kidneys viable for donation
Kidney transplant surgeon Dr. Rachel Forbes, the chief of Vanderbilt Health’s Division of Kidney & Pancreas Transplantation, explains several innovations in living kidney transplantation that should offer hope to those on the kidney transplant waiting list.
Unlike in the past, kidneys from donors with hepatitis C can now be considered viable for transplant. There are now medications — antivirals specific for hepatitis C — that can cure this liver condition if an organ recipient contracts it from a donated kidney.
“Some transplant centers are not offering these types of transplants because it does require a specialized approach to ensuring patients receive the medications in a timely manner,” Forbes said. “So we are fortunate to be able to provide this service.”
Some patients may be able to receive a transplant sooner than they would otherwise by accepting these hepatitis C-positive kidneys.
We have additionally began to offer hepatitis B-positive kidneys to those willing to accept them and show immunity against the virus either naturally or through vaccines; we performed the first of these transplants in 2025. In 2026 we also began to offer HIV-positive kidney transplants to those who are HIV+.
More ‘mismatched’ blood types can be successfully transplanted
Blood type and antibodies have historically been important considerations when “matching” a donated kidney to a kidney recipient. The organ donor and recipient needed to have the same blood type.
Vanderbilt is now one of only a few transplant centers in the country that routinely performs transplants between donors and recipients with blood type A2/A2B and type B.
Furthermore, Forbes said her team can run blood tests on donor-recipient combinations previously thought “mismatched” that help predict whether the recipient’s body will likely reject the new organ. Some patients may need extra treatment to prevent organ rejection. Those therapies may include blood plasma exchange, or certain medications.
Paired kidney exchange enables chains of donors
It can be difficult to find a living kidney donor who is a good match for the patient who needs a new kidney. Forbes’ team works within Vanderbilt and with other transplant centers to find “pairs” or “chains” of kidney donors. This is a logistical challenge, but it can provide much-needed kidneys for multiple patients at about the same time.
“Paired” kidney donation means finding pairs of living donors and recipients who are not a match (due to blood type or antibodies) for each other, but who match up with another pair. In this case, the donor in one pair gives a kidney to the recipient in the other pair, instead of to their own loved one; and the other pair does the same.
Vanderbilt has also been part of kidney “chains” of donors and recipients. Some altruistic donors (those donating an organ to someone they do not know) can start chains, particularly with blood type O, because they are a universal blood donor. Many people in a paired kidney exchange can have a donor that has type A, B or AB blood when they only accept type O blood, Forbes said.
“As we have become more comfortable with paired kidney donation, we have more pairs at our own center enrolled in national programs such as the National Kidney Registry,” Forbes said.
Dual-organ transplants
Some patients need a kidney transplant as well as another donated organ. Vanderbilt Health offers combined kidney and heart, liver or pancreas transplants for eligible patients.
The Vanderbilt Transplant Center is the nation’s largest and most experienced transplant center. In 2025, it set new records for both total solid organ transplants and heart transplants. Because its multidisciplinary teams care for a high volume of patients with complex conditions, they have the experience and expertise required to transplant two organs during the same procedure.
Transplants using two kidneys
In some cases, a patient may receive two kidneys from the same donor. Known as an en bloc or dual kidney transplant, this approach may be recommended because of the kidneys’ size or condition. Transplanting them together can provide the function the recipient needs while allowing more donated kidneys to be used. Vanderbilt Health began offering this option in 2025 and has since performed several of these procedures.
Giving more donated kidneys a second chance
Since June 2025, Vanderbilt Health has partnered with 34 Lives to evaluate and rehabilitate donated kidneys that might otherwise go unused. The company uses specialized technology to preserve the kidneys and help determine whether they are suitable for transplant. Vanderbilt Health has successfully transplanted these kidneys into more than 60 patients.
The Vanderbilt Kidney Transplant Program is one of the largest programs in the country. Its surgeons have performed more than 6,000 pediatric and adult kidney transplants. The team has deep expertise with even the most complex cases. Clinics in Clarksville, Tennessee, and Madison, Alabama; and a telemedicine clinic in Jackson, Tennessee, bring expert kidney care closer to those communities. Vanderbilt surgeons also treat veterans by working with the Nashville VA to provide pre- and post-transplant care.
