Discussions regarding genetic testing for variants in apolipoprotein L1 (APOL1), a gene located on chromosome 22 whose risk variants are strongly associated with end-stage kidney disease (ESKD), in the context of kidney transplantation must address donors (deceased and living) and recipients. In addition, these discussions must occur in the context of known genetic epidemiology regarding APOL1. Specifically, APOL1 risk variants are only found among individuals of African descent, as these variants are derived from exposure to African sleeping sickness that is largely confined to countries along the west coast of Africa.