Purpose of Review <p>This review synthesizes current literature on how patients with end-stage renal disease and their providers approach decisions about marginal kidneys, organs considered higher risk due to donor or graft characteristics (e.g., advanced age, comorbidities, prolonged ischemia time). Specifically, it reviews patients’ attitudes toward marginal organs, providers’ attitudes and knowledge, shared decision-making frameworks, communication preferences and educational needs, and the application of prospect theory to risk communication, with the goal of identifying strategies to improve understanding and acceptance of marginal kidneys.</p> Recent Findings <p>While dialysis carries high morbidity and mortality, many patients and providers hesitate to consider marginal organs, leading to high discard rates. The present literature shows that limited education, poor communication of dialysis risks, and psychological factors such as loss aversion contribute to refusal. Evidence suggests that structured education, theory-based counseling, and shared decision-making frameworks can improve understanding and willingness to accept marginal organs.</p> Summary <p>Marginal kidneys offer a survival benefit over dialysis but remain underutilized. Incorporating better health communication strategies, tailored education, and shared decision making into transplant care may increase acceptance, reduce discard, and improve outcomes for patients awaiting transplant.</p>