Restricting Kidney Transplant Wait-Listing for Obese Patients: Let's Stop Defending the Indefensible


  • Csaba P. Kovesdy,

    Corresponding author
    1. University of Tennessee Health Science Center, Memphis, Tennessee
    2. Memphis VA Medical Center, Memphis, Tennessee
    • Address correspondence to: Csaba P. Kovesdy, MD FASN, Division of Nephrology, Memphis VA Medical Center, 1030 Jefferson Ave., Memphis, TN 38104, Tel.: 901 5767 7278, Fax: 901 577 7539, or e-mail:

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  • Miklos Z. Molnar

    1. Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
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The allocation of limited medical resources represents an ethical dilemma that continues to generate lively debates. While the allocation of allografts to wait-listed patients is done in a transparent manner, with its rules open to public debate and prone to continuous improvement, the practice of wait-listing is not centrally regulated, and its rules are often less scrutinized. Denial of kidney transplant wait-listing to obese individuals has been a common practice by most transplant centers. On the face of it, this practice is justified by commonly accepted ethical standards, yet there is now mounting evidence that these justifications do not withstand closer scrutiny. A candid and open debate in the Nephrology and Transplant community is needed to examine the true motivations that underlie the practice of denying wait-listing to obese individuals, and to find a solution that is truly in the best interest of our patients.