In Brazil, the transplant is a right of society, however the shortage of organs from deceased donors has been reflected in increased demand for transplantation. In this context, this paper aims to analyze access to kidney transplantation in the State of Rio de Janeiro from the perspective of fairness. We sought to identify through the charts and analysis from the non-transplanted qualified for kidney transplantation in 2008 the factors that hinder access, from the steps required for the potential recipient to undergo transplantation. Based on the consensus that equity is a constitutional principle and the Health System and the conceptual options influence the choice of distributive criteria, the indicators used to assess the degree of equity and interpretation of results for the effectiveness of interventions. Among the results, we highlight the "serum loser" as the main obstacle is not classified among the transplant, followed by "not informed", "Contact Phone", "Without clinical conditions"; "Contra-indication for transplantation teams"; "without examination" and "Other". It was noted that the current selection criteria for kidney transplantation has many limits to implement fairly, especially concerning the organization of the network and consumption of health services. The national policy on transplantation still presents a disjointed network that is unable to ensure access to the actions and health services, thus not allowing all health needs of the user population of transplant services in the State of Rio de Janeiro.