Cadaveric kidney allocation, in most countries, is based on human leukocyte antigen matching of the donor kidney with the recipient. Traditional human leukocyte antigen matching is based on defining human leukocyte antigen specificities by antibodies. Newer techniques have emerged from the tissue typing laboratory, which challenge the accuracy of serological typing and crossmatching. Improvements in renal allograft survival, predominantly as a result of newer immunosuppressive drugs, have led to longer survival times even in poorly matched human leukocyte antigen renal allografts. The scarcity of donor organs has focused attention on organ allocation policies, and the exact role of human leukocyte antigen matching in renal transplantation is under scrutiny. In this review, we examine developments in human leukocyte antigen matching as well as attempts to utilize this information to allocate cadaveric kidneys optimally.