For many patients with advanced chronic kidney disease (CKD) or end-stage kidney disease (ESKD), the treatment that provides the longest and best quality of life is a kidney transplant. Recently, the U.S. transplant system achieved a record milestone, with over 40,000 organ transplants performed in 2021. Despite this achievement, there are still many more people waiting years for a kidney than there are kidneys available. The transplant ecosystem, while functioning well, could be significantly improved with additional reforms.