Background: Since longer waiting time on dialysis is associated not only with lower post-transplant graft and patient survival but also higher medical care costs, an efficient pre-kidney transplant evaluation (PKTE) process is very important, specially in a resource-constrained setting like the Philippines. We aimed to describe the progress of indigent ESRD patients who were 18 years old and above who underwent PKTE in our institution between January 1, 2003 and September 30, 2003. Methods: The medical records of 117 potential recipients and their 142 potential living donors referred to the NKTI Charity Service were reviewed. Descriptive statistics were applied to the PKTE process. Multiple logistic regression analysis was done to identify predictors of successfull completion to KT. Results: Only 42% of potential recipients received KT within 1 year of starting PKTE. The interval from start of PKTE to KT was less than 2 months in 8%, between 2 to 6 months in 35%, and greater than 6 months in 57% of patients transplanted. The median duration of a recipient work-up was 140 days (range = 36 - 350). Recipient problems contributed to 40% of delays and 79% of failures to proceed to KT. The median duration of a donor work-up was 108 days (range = 36 - 356). Only 52% of potential donors were accepted and only 34% actually became kidney donors. Donor problems contributed to 42% of delays and 57% of failures to proceed to KT. The mean of total charges incurred during a successful work-up was P203,397.00. The cost of PKTE increased with duration and the number of donors evaluated per patient. Financial problems contributed to delay or failure to proceed to KT in 26% of candidates. Multiple logistic regression analysis showed that recipients who were 18 – 29 years old, employed prior to diagnosis of ESRD, with college degree and females were more likely to receive kidney transplantation. Recommendations: Medical as well as financial problems involving both recipients and donors contributed to the low rate of transplantation and the long duration and high cost of the PKTE process. We recommend that improving the process for PKTE should be chosen as a key quality assurance initiative of our institution.