Little is known about how nephrologists discuss transplantation as a treatment option with end-stage renal disease patients. The authors sought to describe the content and manner of patient-nephrologist discussions about transplantation. Using a cross-sectional study design, we interviewed 79 chronic hemodialysis patients and 12 nephrologists using a semistructured questionnaire that focused on nephrologist and patient reports of discussions about transplantation. The authors found that nephrologists provided information on treatment options gradually over several weeks to months. They generally presented the option of dialysis first, then transplantation, but avoided discussing mortality data. Nephrologists said they encouraged most patients, but especially young patients, to seek transplantation. Of all patients, 68% reported being encouraged to seek transplantation by nephrologists. Low socioeconomic status patients were less likely to report being encouraged to seek transplantation even after adjustment for transplant suitability. Both nephrologists and patients avoided discussing life expectancy data. In conclusion, patient age and socioeconomic status appear to influence discussions of transplantation as a treatment option. Further work is needed to determine how the content and manner of such discussions affect treatment decisions.