An article in the New York Times (September 21, 2012) describes a new proposal to allocate kidneys to recipients using an index to estimate the quality of kidneys and directing 20 % of the kidneys at the top of this index to patients expected to survive the longest after the transplant. This new index thus provides some benefits to younger patients while not all. An earlier plan had allocated kidneys based on patient age but was deemed a discrimination based on age and thus rejected. This new plan recoups about 50 % of the benefit of the old plan while enabling more effective allocation. In addition, wasted kidneys i.e., those allocated to patients but rejected because of associated quality, accounted for 2,644 kidneys that were discarded in 2011. A wider pool will now be offered access to the lower quality kidneys to decrease this waste. Given the need to balance access while reducing waste and increasing the life of the kidney, is this an acceptable outcome ? Should patients be allowed to provide preferences for kidneys by index and that data used to create allocations ? How much emphasis should be placed on reducing the wasted kidneys if the decision to refuse to accept them is based on their quality ?