1. Why choosing kidney transplant 1) Survival Benefit of Transplant vs Remaining on Waiting List 2. When is the right time for kidney transplant? 1) Early referral saves lives 3. What type of kidney transplant? 1) Projected life expectancy after ESRD onset by recipient age and treatment modality. 4. Rules of recipient evaluation The first rule: First Do no harm (to the individual patient) The second rule: First Do no harm (to the list) The third rule: First Do no harm (to the donor) 5. Objective of Recipient evaluation 1) Identify risk factors that: (1) absolutely prohibit transplantation (2) mandate treatment (3) require other special consideration before proceeding to transplantation. 2) recognize medical, surgical, psychosocial, and social risk factors that will require optimization prior to transplantation 3) offer education, guidance, and counseling to patients about several aspects of kidney transplantation. 4) assess immunological risk 5) identify and update recommended screening and health maintenance procedures 6) plan the immunosuppressive protocol, infectious disease prophylaxis and additional monitoring ahead of time 6. There are few absolute contraindications to transplantation: Current Absolute Contraindications to Transplantation • Active sepsis • Current uncontrolled malignancy • Uncontrolled psychosis • Active drug dependence • Any medical condition with a severely shortened life expectancy (<1 to 2 years) • Positive T cell CDC crossmatch Historical Contraindications to Transplantation* • HIV infection • Hepatitis B and C infection • Obesity • Mood disorders • Age older than 60 years • Previous malignancy • Blood group incompatibility 7. Medical evaluation by systems 1) Cardiac 2) Chronic infection 3) Malignancy 4) Renal 5) Hematology 6) Cerebrovascular disease 7) Pulmonary 8) Gastrointestinal 9) Psychiatric evaluation 8. Conclusion 1) Despite an increase risk of mortality immediately post-transplant, there is a clear survival benefit in kidney transplantation compared to remaining on the waiting list. 2) There is a clear survival benefit in preemptive transplantation. 3) Recipient evaluation identifies risk factors that: (1) absolutely prohibit transplantation (2) mandate treatment (3) require other special consideration before proceeding to transplantation.