Only 28% of patients with end-stage renal disease in Georgia, the state with the lowest kidney transplant rate, are referred for transplant evaluation within a year of starting dialysis. Referral rates vary substantially between dialysis facilities in Georgia, ranging from 0% to 75%. Factors associated with lower referral rates include treating patients from high-poverty neighborhoods, higher patient-to-social worker ratios, and nonprofit facility status. Standardized guidelines may be needed for patient education on treatment options including transplant at the start of dialysis.