Despite ever-improving health care and new advances in medical technology, the number of Americans who develop end-stage renal disease continues to increase. Diabetes remains the leading cause of new cases, followed by hypertension and glomerulonephritis. More than 200,000 patients require dialysis and more than 40,000 are awaiting kidneys for transplantation. Kidney transplantation has been extremely successful with 1-year patient and graft survival rates at 95% and 90%, respectively. The advantages of kidney transplantation are reversal of many of the pathophysiologic changes associated with renal failure as normal kidney function is restored, elimination of dependence on dialysis and the associated dietary restrictions, the opportunity to return to normal life activities, and lower medical costs than dialysis after the first year. The shortage of donor kidneys is the major limiting factor. Because of the supply and demand discrepancy, maximum use of donors from all sources, appropriate recipient selection, and equitable allocation are critical.