The organ transplantation system in the United States faces significant challenges, with a severe shortage of donor organs leading to long wait times and even death for those in need. While some advocate for a regulated market for kidneys, the reality of reforming the transplant system is more complex. This article explores the various efforts to improve the transplantation network, including reducing waste and fraud, increasing transparency and accountability, and implementing evidence-based matching algorithms. It also highlights the importance of ongoing system-wide reforms and the need to avoid quick fixes that may not actually improve the system.