Since the establishment of the 1972 Social Security Amendment to cover permanent kidney failure, the population needing dialysis in the United States has grown from an initial estimate of 10 000 beneficiaries to more than 500 000 prevalent patients receiving hemodialysis.1 Dialysis clinics in the United States, a landscape now dominated by commercial entities, provide life-sustaining therapy that delays mortality by a mean of 5 years. The undeniable medical success coupled with the financial profitability of clinics may have overshadowed the intended purpose of dialysis: a rehabilitative therapy designed as a bridge to kidney transplant. As the preferred form of renal replacement therapy, transplants are both cost-effective2 and have the greatest survival advantage, extending life by 7 to 11 years, depending on the cause of kidney failure.3