In Canada, there are large regional disparities in the waiting times for kidney transplantation. Previous studies show that these disparities cannot be explained by differences in the rate of organ donation or the incidence of kidney disease; instead, they may be the result of practice differences in referral or acceptance of patients for transplantation. Unlike waiting lists for most other medical services, increased waiting times for transplantation are clearly associated with loss of life. Currently, there is no formal, national system to ensure that medically eligible patients have equal access to transplantation across Canada. Very little research has been conducted regarding regional disparities in access to transplantation. To gain insight into the cause of these differences, Dr. John Gill is following a group of new dialysis patients in BC and Alberta to determine if there is a difference in referral for kidney transplantation or acceptance for transplantation within one year of starting dialysis. He will investigate the reasons why patients who are medically eligible for transplantation may not be referred for transplant, and document provincial differences in the time required to complete the transplant assessment and to activate a patient onto the transplant waiting list. Ultimately, this research will contribute to enhanced patient and physician education, better implementation of protocols to ensure that patients are appropriately referred, and new strategies to minimize regional disparities between provinces.