Messages in Bottles: Why Pretransplant Care Coordination Remains so Difficult

The contemporary era of kidney transplantation in the United States offers plenty of opportunities for pride. Kidney transplant volume has grown at 3-4% year over year for the last several years (OPTN), while patient and graft survival outcomes remain excellent. While innovations in transplant immunosuppression are taking a long time to be realized, closer attention is finally being paid to patient reported outcomes focused on the long-term consequences and complications of immunosuppression exposure. Despite these achievements, one facet of the transplant process that continues to trouble clinicians, researchers, and policy makers are the durable inefficiencies, disparities, and overall opacity of what is generically termed "access" to kidney transplantation.