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It is also, fundamentally, the objective of organ transplantation. A new kidney is not a cure but a bridge\u2014a way to ease the symptoms of kidney disease and extend life. By definition, kidney transplantation is a form of palliative care. Yet, this alignment has been lost in some aspects of pediatric kidney transplant care. We examine four aspects of transplant care that reveal ongoing disconnection between patients, families, and clinicians across the transplant journey: the transplant lexicon, approaches to adherence, measures of success, and care transition. Applying core palliative care principles, like meaning, agency, connection, and hope, offers a necessary paradigm shift to bridge these clinical divides. 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