Despite significant accomplishments to date, kidney transplantation is a relatively young field in medicine. The shortage of deceased donor organs available for transplantation has led to the need to identify novel strategies to increase the organ donor pool. Due to the armamentarium of agents available to effectively suppress the immune system, the past decade has seen a shift in focus from prevention of rejection to a focus on extending the life of the allograft, with much focus on developing agents and immunosuppression combinations that are less toxic to the transplanted kidney. These concepts provide the framework for this textbook. For the first time in years, agents with novel mechanisms of action are beginning to come to market for use in kidney transplantation, and novel concepts to increase both deceased and living donor organ availability have been adapted by progressive transplant centers. Within the field of living donation, kidney paired donation and single site laparoendoscopic donor nephrectomy are important methods of increasing access to living donor transplantation. Utilization of expanded criteria, donation after cardiac death, hepatitis C positive, and pediatric donor organs are discussed as methods to increase deceased donor transplant opportunities for the over 90,000 patients currently on the kidney transplant waiting list in the United States alone.