Cadaveric dual kidney transplantation using organs from marginal donors that would otherwise be discarded offers a good option for older individuals who may not withstand a long waiting time. To describe the technique of dual kidney transplantation using an extraperitoneal approach through a lower midline incision. Lower midline incision two fingerbreadths above the umbilicus down to symphysis pubis. Identification of peritoneum and careful blunt dissection of extra-peritoneal space bilaterally. Buckwalter retractor application with the ring positioned over the side to be transplanted. After implanting the kidneys, the ureters can beanastomosed extra or intravesicular. Drains placement bilaterally before closure. We believe that there are advantages to this approach, which are: 1) an extraperitoneal approach and 2) using one incision. The extra-peritoneal approach has the following advantages: 1) Less graft mobility 2) Easier access to the iliac vessels than the trans-abdominal approach 3) Less post-operative bowel ileus and no adhesion complications 4) Easier biopsy access and placement of drains or nephrostomy tubes with reduced risk of bowel injury. The advantages of using a mid-line incision include: 1) Easier conversion to intra-abdominal approach if necessary 2) less potential hernia complications with one incision than with two incisions 3) If a wound infection develops, the wound is far from the grafts 4) Faster operation & less time under anesthesia than with two incisions reducing cold ischemia time 5) Faster patient post-operative recovery with one incision. Extra-peritoneal midline approach is a useful technique in dual kidney transplantation.