*Purpose: With increasing demand for kidneys and a scarce supply, ways to reduce rejection and improve transplant outcomes are needed. One possibility is using epitope compatibility – donor-recipient matching on targeted immune system protein molecules – to guide deceased donor allocation. Greater epitope compatibility is associated with longer-lasting kidneys. Changing the deceased donor kidney allocation must consider trade-offs and ethical principles. Public input is critical as policymakers and health professionals decide how best to allocate kidneys fairly, while balancing transplant outcomes. We sought public input and recommendations for policymakers’ consideration.

*Methods: Postal invitations were sent out to 35,000 randomly-selected households across Canada, with over-sampling of rural/remote locations. Participants were selected to ensure diversity of socio-demographic characteristics within all five Canadian regions. Five two-hour online sessions were held from November-December 2021. In preparation for the deliberation, participants received an information booklet and heard from expert speakers. During small- and large-group facilitated discussions, participants deliberated on how epitope compatibility could be implemented fairly for transplant candidates, and governance issues. Participants generated and voted on a list of recommendations on these topics. In a final policy panel session, participants engaged with kidney donation and allocation policymakers. All sessions were recorded and transcribed.

*Results: Thirty-three participants (18 female) took part and generated nine recommendations. There was consensus on adding epitope compatibility to Canadian kidney allocation criteria. However, participants also called for the addition of safeguards and flexibility around this. They specified that a plan and transition period were needed before implementing epitope compatibility, including an ongoing comprehensive education program for the public. Participants unanimously recommended regular monitoring of outcomes of epitope compatible transplants, and specified that this should be publicly shared.

*Conclusions: The recommendations from the public deliberation can provide guidance to policymakers in consideration of adding epitope compatibility to the deceased donor allocation criteria.

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