Background: With the increasing shortage of donor kidneys a constant review of organ quality and utilisation is required. Getting any positive result from a potential donor is superior to rejecting the organs outright. The major reason for rejection of potential kidney donors is age coupled with a positive past medical history, especially of Diabetes Mellitus (DM) and Hypertension (HTN). The results of graft survival and renal function from marginal donors with these characteristics has been demonstrated to be inferior to Standard Criteria Donors (SCD) in the past. The implantation of both kidneys from a marginal donor into the same recipient is gathering momentum. Methods: A Dual Kidney Transplant (DKT) policy was developed at our centre. Selection criteria included a) DCD donors older than 70 years of age, b) DCD donors older than 65 with DM, HTN or both; and c) DBD donors older than 70 years of age with DM, HTN or both. Recipient exclusion factors were DM, Polycystic kidney disease, severe cardiovascular disease, treatment with Clopidogrel or Warfarin and BMI > 31. Both kidneys were implanted on the same side (ipsilateral). We compared outcomes of consecutive DKT between Feb 2011 and April 2014 with our historic single kidney transplant recipient group with identical donor criteria to the DKT group. Data was collected prospectively in the DKT group and retrospectively in the earlier single transplant group. Results: Twenty Nine recipients received DKTs, of which 85.2% were from DCD donors. There was a higher incidence of HTN (77.8% vs 46.8%) and DM (18.5% vs 8.5%, p=0.02) among donors in the DKT group. Also, mean donor age was higher (76.5% vs 73%) though not significant. In contrast, the incidence of delayed graft function (DGF) was lower in the DKT group (74.1% vs 78.7%); and mean eGFR was superior at six months (58 vs 37), 12 months (66 vs 36) and 36 months (42 vs 36). Conclusion: Results show that DKT delivers superior mid-term function compared to single kidney transplants from similar donors, which are still considered not suitable for transplantation by many centres. Longer term results are awaited and required for a nationwide policy

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