Not kidneys, but I have a kid who graduated from Texas in May and is now a CICU nurse at Children's in Dallas, which is adjacent to Parkland and UTSW (Children's at present doesn't do deliveries, so a lot of their patients come from one of those two places). We haven't talked specifically about the concept of transplants, but she has obviously had patients who are/are not on a list for a new heart. She might have a patient who could use a new heart, but they have way too many other issues to be a candidate. Sometimes that could be a product of bad luck. Other times, as has previously been pointed out, it could be a product of the ability of the family to care for the patient when they are home, etc, which then precipitated the other issues that no longer make a patient viable to be a transplant candidate. She may have a patient where a series of procedures worked...until they didn't (like the teenager she had the other day, who had hypoplastic left heart syndrome, went through all the procedures from birth to 5, everything was fine for a decade, and now it isn't, so a decade of potentially being on a list was lost)
I imagine at some point, when trying to address the problem of "what other issues does this candidate have that could make this heart transplant unsuccessful," that biases creep in. While there are certainly miles of objective criteria in medicine, the uncomfortable part for all of us is that there is a dose of subjectivity and intuition there as well...otherwise medical personnel would DO medicine, not PRACTICE medicine.
And by the way, while this topic is about transplants, the same thing goes on when it comes to curative/palliative procedures.
Not sure how we fix it.