Mr. H is a single father of multiple children, who was referred for a kidney transplant evaluation. He was diagnosed with chronic kidney disease (CKD) stage III, attributed to hypertension and ibuprofen use when he presented with flu-like symptoms in the 1990s. He received care for approximately three years before being lost to follow up. Nearly 30 years later, he re-established care after the initiation of dialysis and was referred for transplantation. At that time, the patient had spent more than 20 years in the prison system and had several years remaining on his current sentence.