In this issue of AJKD, Leeaphorn et al1 tackle a critical gap in nephrology by using a target trial emulation (TTE) framework to estimate the causal survival effect of deceased donor kidney transplantation (DDKT) compared with continued dialysis among patients aged 75 years or older. Restricting their cohort to wait-listed individuals, the authors provide an ambitious analysis suggesting that there is a higher mortality risk with DDKT early on after transplantation but a survival benefit after 3 years of follow-up.