← the access Reviewed as of 15 July 2026
THE ACCESS · WHAT HAPPENS TO A PATIENT?

The Transplant Map

How a person gets from the chair to an organ, and what happens to their coverage after. The gate is in the clinic: the plan of care must carry a transplant referral status—or the documented why-not—every year. And the door swings both ways: ESRD-only Medicare ends thirty-six months after a successful transplant, the immunosuppression outlives it, and a failed graft returns the traveler to the chair with no new waiting period.

TEXT ALTERNATIVE ↓
WIDE DRAWING · SCROLL SIDEWAYS TO READ IT ALL · THE FULL CONTENT IS ALSO IN WORDS BELOW
A station—where the traveler is
The move—how they get there
The bypass, or the way back
Reviewed as of 15 July 2026 Changelog

The drawing in words

  1. The clinic—where the map leaves from. The chair: in-center or home dialysis.
  2. The gate is a decision inside the plan of care: transplant referral status, or the rationale—reviewed annually. [1 · 2]
  3. Referred sends the person to the transplant center. Not a candidate returns them to the chair, with the why documented. [1 · 2]
  4. The bypass: late-stage CKD, not yet on dialysis, can be referred preemptively—straight to the transplant center, never through the chair. [3]
  5. The transplant center: evaluation, a multidisciplinary workup. Listed goes on to the wait. Deferred or declined returns to the chair—re-referral possible. [3]
  6. The wait: the OPTN national waitlist. Time is credited from the day dialysis began—reaching back even if the candidate lists later—or, before dialysis, from the registration date when GFR is 20 mL/min or less. OPTN Policy 8.4.A (the KAS backdating rule, 2014). [3]
  7. The match run: KDPI x EPTS, plus priority. A deceased-donor organ recovered by an OPO enters the match run; an accepted organ goes to transplant. [3]
  8. A living donor—direct or paired exchange—goes straight to transplant. [3]
  9. After the organ: transplant, then a functioning graft—off dialysis.
  10. Immunosuppression for the graft’s life: Part B for the 36 months of ESRD-only entitlement, then lifetime Part B-ID (2023) if there is no other coverage. Someone entitled by age or disability keeps Part B and never needs Part B-ID. [4]
  11. At 36 months: ESRD-only Medicare ends—36 months after a successful transplant. [4 · 5]
  12. If the graft fails: return to dialysis or re-list. Re-entitlement, with no new waiting period—back to the chair. [5]

BRACKETED NUMBERS TRACE EACH LINE TO THE SOURCE LIST BELOW · EVERY SOURCE IS HELD IN THE REFERENCES LEDGER WITH ITS LOCATOR, ITS LAST-CHECKED DATE, AND HOW IT WAS VERIFIED