The Waiting List Clock

This flow follows the changing status of HCV-infected candidates as waiting-list time exposes hidden liver progression and competing mortality.

increasingBearing stren­gth in each eventdecreasing

Initial Listing

Initial Listing Screening gate Candidates are tested by serology and nucleic acid methods according to local prevalence. Active viremia triggers a deeper liver evaluation rather than automatic exclusion. Suitability The central question is whether the patient can safely receive a kidney alone. Listing therefore becomes an ongoing medical judgment rather than a single administrative event.

Waiting List Progression

Waiting List Progression Time as exposure Long waits create opportunities for fibrosis to worsen, diabetes to emerge, and cardiovascular risk to accumulate. A candidate who was suitable at listing may become unsuitable before an organ appears. Reassessment Repeat biopsy or other surveillance becomes necessary for patients with established fibrosis. The waiting list functions as a slow clinical test in which delay can alter the transplant strategy.

Removal or Escalation

Removal or Escalation A boundary reached Progression to early or established cirrhosis may make kidney-alone transplantation unsafe. The patient is removed from the kidney-only pathway and referred for combined-organ assessment. The cost of delay This change is not simply a medical classification. It represents lost time, increased mortality, and a more complex operation in which liver failure now controls renal access.

at entry to the waiting list

after several years on the waiting list

when cirrhosis becomes established