Procedure prep
Fasting Before a Kidney Transplant
A kidney transplant is a major step, and a little preparation makes the day go smoothly. Whether you are a planned living-donor recipient or you have just been called in for a deceased-donor kidney, here is exactly how to handle fasting and what to bring.
Fasting for this procedure
→ Get your exact fasting times with the calculator
Medicines to check
- Keep taking your immunosuppressants and transplant medicines exactly as told, including any pre-transplant doses (such as tacrolimus, mycophenolate, or steroids) the team starts you on. Swallow them with a small sip of water even while fasting unless specifically instructed not to.
- Blood thinners need a plan. Drugs like warfarin, apixaban, rivaroxaban, or clopidogrel raise bleeding risk during surgery, so the team will tell you when to pause them. Do not stop on your own. See medications to stop before surgery.
- Diabetes tablets and insulin are adjusted on the day because you will be fasting and kidney function is changing. Read diabetes tablets before surgery and bring your insulin and glucose meter with you.
- Bring all your medicines in their boxes, plus a written list with doses. This includes blood pressure tablets, phosphate binders, and any erythropoietin injections, so the ward can continue them correctly.
- Take blood pressure tablets only as advised with a sip of water; some (like ACE inhibitors or ARBs) may be held on the morning of surgery to protect blood pressure under anaesthetic.
- Mention any recent antibiotics or new symptoms when you arrive, as a fresh infection can affect whether the team starts immunosuppression on schedule.
When this surgery may be delayed
- The donor kidney is found unsuitable. For deceased-donor transplants, final checks on the organ happen right up to the last minute. Occasionally the kidney is not safe to use and the operation is called off after you arrive, which is disappointing but is done to protect you.
- An active infection. Because you will be on strong immunosuppression, even a chest, urine, or dental infection can lead the team to postpone until it is treated, as infection is far more dangerous once your immune system is suppressed.
- You are not fasted properly. If you ate or drank after being told to stop, anaesthesia may be unsafe and surgery is delayed. This is why the timing of the call matters so much.
- You need dialysis or your bloods are off first. High potassium or fluid overload may mean you need a dialysis session or correction before it is safe to proceed.
- A positive crossmatch or last-minute mismatch. Final compatibility testing between you and the donor can occasionally come back unfavourable, and the team will not transplant a kidney that is likely to be rejected immediately.
Reports & documents to carry
- All your current medicines in their original boxes, plus a written list with doses, especially immunosuppressants, blood thinners, and diabetes medicines.
- Your dialysis details: the date and time of your last session, your usual schedule, and your dialysis unit's contact, so the team knows your fluid and potassium status.
- Recent test results and your transplant workup file if you have copies, including blood group, tissue-typing, and any virus screening (CMV, hepatitis) results.
- Your ID, transplant coordinator's number, and insurance or hospital paperwork, kept together so check-in is quick when you are called in.
- An overnight bag for a longer stay: a kidney transplant usually means several days to a week or more in hospital, so pack toiletries, comfortable clothes, phone charger, and glasses or hearing aids.
What to ask your anesthesia team
- From exactly what time should I stop eating and drinking once you call me in for the deceased-donor kidney?
- Which of my immunosuppressants or other tablets should I take this morning, and which should I hold?
- Do I need a dialysis session before the operation, and has my most recent potassium level been checked?
- How is my blood thinner and diabetes medication being managed around the surgery and the fasting period?
- How long should I expect to stay in hospital, and when will I start my anti-rejection medicines after the transplant?
Your prep checklist
Tick things off as you sort them — saved on this device only, nothing is sent anywhere.
A general guide — your hospital's own instructions always come first.
Frequently asked questions
I got the deceased-donor call after dinner. Can I still have the transplant?
Often yes. The team plans for this, which is exactly why they tell you to stop eating and drinking the moment they call. They will note when you last ate and time your anaesthetic safely, sometimes waiting a little or adjusting their approach. Tell the coordinator honestly what and when you last ate or drank, do not eat anything more, and let the experts decide. Guessing or hiding it is what causes real delays.
Should I still take my anti-rejection tablets if I am fasting before surgery?
Usually yes. Immunosuppressants are time-critical, and the transplant team often gives you specific pre-transplant doses to take even while your stomach is otherwise empty. Swallow them with a small sip of water unless you are told otherwise. The fasting rule is about food and large drinks, not your essential medicines. Always confirm the exact tablets and timing with your coordinator, and bring all your medicines with you so nothing is missed.
Do I need dialysis right before my transplant?
Sometimes. If your potassium is high or you are carrying extra fluid, a dialysis session shortly before surgery makes the anaesthetic safer and helps the new kidney settle. Many people do not need it if their bloods are stable. The team will check your latest results when you arrive and decide. This is one reason they ask for the date and time of your last dialysis session, so bring that information with you.
Why might my transplant be cancelled at the last minute?
A few reasons. For a deceased-donor kidney, final checks on the organ or a last-minute compatibility (crossmatch) result can show it is not safe to use. An active infection, abnormal blood tests, or not having fasted properly can also postpone surgery. It feels crushing to be sent home, but every one of these checks exists to protect you and give the new kidney the best chance. Your place on the list is not lost.