Children and adolescents with end-stage renal disease are given priority in most organ allocation systems worldwide, because a prolonged waiting time on dialysis leads to irreversible disturbances of growth and of somatic and mental development, also because school education and professional training are hampered. The current regulations for the allocation of a kidney transplant for children and adolescents within Eurotransplant are problematic because of a relatively long waiting time (approximately 2 years), a fixed age limit of 16 years for the definition of a “pediatric patient,” and no consideration of a certain age match between donor and recipient. In an intense discussion during the last 2 years in the Eurotransplant Kidney Advisory Committee (ETKAC) and in the Commission for Organ Transplantation of the German Board of Physicians important improvements of the allocation rules for pediatric patients could be achieved, such as a higher pediatric bonus to shorten the waiting time on dialysis and granting the pediatric bonus also to those adolescent patients above 16 years of age who still have the potential for growth.