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Rates of simultaneous liver kidney (SLK) transplantation have continued to increase despite lack of clear allocation guidelines and outcomes data. The organ procurement and transplantation network (OPTN)/UNOS board approved a new SLK allocation policy to standardize medical eligibility and optimize organ utilization. This review highlights the rationale behind these new selection criteria and posttransplant outcomes in various patient populations.Uniform criteria for SLK transplantation were adopted in August 2017 and state SLK should be reserved for select patients with cirrhosis who have chronic kidney disease for longer than 3 months, sustained acute kidney injury, or particular metabolic diseases. Many patients who previously underwent SLK did not meet these criteria, reducing organ availability for patients awaiting kidney-alone transplantation. The new criteria includes a ‘safety net’ policy allowing for renal transplant priority for liver-alone recipients who do not meet criteria for SLK but fail to have renal recovery within the first year.The new SLK allocation policy was adopted to avoid kidney transplantation in those patients who have a significant chance of recovering renal function post-liver transplant and those with a poor chance of survival in whom SLK is futile.