*Purpose: Living donor (LD) kidney transplantation is the optimum form of renal replacement therapy for suitable patients. Decline of otherwise suitable potential donors on the basis of anatomical complexity may not be justified in terms of graft outcome, and potentially compromises equity of access to transplantation. We aimed to assess whether multiple donor arteries gave rise to greater complications or inferior outcomes in donor and recipient. Northern Ireland has one of the worldwide highest rates of live donation, at 43 live donors per million population per year.

*Methods: The records of all potential LDs evaluated in Northern Ireland in the five year period between 01 Apr. 2012 and 31 Mar. 2017 were reviewed. They were categorized into three groups based on the complexity of donor anatomy, and outcomes evaluated.

*Results: Of the 464 potential LDs evaluated, 117 (25%) exited (43 medically unsuitable, 31 incompatible received an alternative donor, 17 recipient reasons, 26 miscellaneous issues). Of the remaining 347, 46 are yet to donate, 7 pairs had surgery elsewhere, and 21 altruistic donor kidneys were retrieved and exported to other UK recipient centres. The remaining 273 pairs all proceeded with transplantation locally, irrespective of donor laterality or vascular anatomy. No donors were turned down on the basis of complicated anatomy. Results are reported in Table 1.

Backbench reconstructive techniques comprised of bifid and trifid trousering (10), internal iliac artery interposition grafting (2) cadaver donor vessel interposition grafting (2) and end to side anastomosis (1). There were no technical failures in any of the groups. There were no statistically significant differences between mean creatinine values in each category at 12 month follow-up.

*Conclusions: Laterality or complex vascular anatomy, even necessitating back-bench reconstruction, provides recipients with good quality grafts and should not preclude organ donation.

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