A kidney transplant from a living donor is the preferred treatment for people with end-stage renal failure as it offers better outcomes for patients and is more cost effective than dialysis. The shortage of deceased organ donors means that a transplant from a live donor is the only transplant option for many people. However, there is a growing gap between the number of people needing kidney transplants and the number carried out each year. Māori and Pacific peoples, in particular, have lower rates of renal transplantation than other groups. The international literature suggests there may be options to consider for further enhancing policy and practice relating to live renal transplantation (LRT) in New Zealand; but there is little New Zealand-evidence about factors affecting rates of LRT. This article outlines the current problem of the gap between supply and demand for kidney transplants in New Zealand, framing this as a public policy problem, and suggesting LRT as an important strategy for addressing this issue. New Zealand-based research is required regarding the barriers to LRT and options for increasing current levels in New Zealand.