May 30, 2025

Older adults weigh the risks and benefits of receiving a kidney transplant with shorter longevity

A qualitative study out of Montréal, Québec, highlights how some older adults with advanced kidney disease are open to receiving a kidney transplant from a donor organ that may not last as long—if it means avoiding dialysis.

For eligible patients with advanced kidney disease, kidney transplantation can improve survival and quality of life compared to dialysis. However, many eligible kidney recipients face long wait times until a donated kidney that is a good “match” for their bodies becomes available, and long wait times for a well-matched kidney. These delays can be especially hard on older adults, who face higher risks of frailty and mortality while on dialysis.

Carina Sancho and colleagues at the Université de Montréal interviewed 14 older adults with advanced kidney disease receiving care at a clinic in Québec to understand their views on receiving a preemptive transplant—a kidney transplant before starting dialysis—even if the donated kidney had a shorter expected lifespan.

Most participants supported the idea of using kidneys with lower longevity if it could increase their chances of receiving a transplant, improve their quality of life, and help them avoid dialysis. At the same time, they emphasized the need for clear education and support to help patients make informed decisions about this option.

Some participants raised concerns about fairness—particularly the idea of being offered a lower-longevity kidney based on age. Others worried about the possibility of the kidney failing early and needing another transplant. To address these concerns, participants suggested strategies such as prioritizing them for better-matched kidneys if a transplant fails sooner than expected.