*Purpose: Kidney transplantation is the optimal treatment for end-stage kidney disease. However, antibody-mediated rejection can lead to graft loss. The use of Precision Medicine (PM) tools in transplantation, which considers donor-recipient compatibility at the epitope level, can lead to an improved immunologic risk and prevent rejection and premature graft loss. Incorporation of PM tools in decision making of organ allocation, however, must abide by ethical principles of fairness and justice. The objective of this study was to gather patients’, caregivers and transplant professionals (TP) on PM in kidney transplantation.

*Methods: We conducted 27 individual semi-directed interviews with kidney transplant recipients and caregivers from three Canadian provinces and with 17 TPs from eight Canadian transplant centres. The interviews were digitally recorded and transcribed. Thematic and content analyses were conducted.

*Results: TPs, patients and caregivers viewed equity and fairness as the forefront principles in access to transplantation. The majority of participants viewed PM as a promising technology, but expressed ambivalence on the way epitope matching should be incorporated into kidney allocation. They voiced concerns about negative consequences, like decreased access to transplantation, as well as the increased waiting time for a compatible kidney. The operationalization of an epitope compatibility program was also an issue. Patients and caregivers wanted to be informed on the extent of epitope compatibility that can be achieved, implications to graft rejection and risks of graft failure. TP’s suggested the creation of a national epitope compatibility program to ensure a better access to kidneys.

*Conclusions: PM is a promising strategy for decreasing risks of graft failure. Participants viewed PM as an important innovation but were concerned about increased waiting time and decreased access to transplantation when considering PM for allocation. These results will inform the development of future organ allocation algorithms in kidney transplantation that integrate PM in a way that would be deemed acceptable and fair to key stakeholders.

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