The disparity between the supply of cadaveric donors and the demand for organ transplants continues to grow steadily. In the USA, every year 6700 patients (pts) die while waiting for an organ transplant. To increase utilization of cadaveric organs we have recently expanded our acceptable criteria to include very old (VO) or very young (VY) donors. For such donors we transplanted both donor kidneys (Dual Transplant) into a single recipient. The aim of this study is to evaluate the long term outcomes and complications of dual kidney transplants from VO or VY donors. From July 2001 to December 2006, 356 kidney (kd) transplants were performed in our center. 22 pts received a dual ktx. 15 pts (mean age 68, range 60-78) received kds from VO (mean age 72, range 60-79) donors and 7 pts (mean age 47, range 27-72) were transplanted from VY (mean age17 months, range 2-36) donors. 74% of these kds were imported from outside of our region after being deemed unacceptable by their local center due to the quality (extreme age) of the donor. Three and 5 year pt survival rates were 95% and 82% respectively. Three and 5 years graft (gft) survivals (death censored) were in the VO donors 94% and 94% and 85% and 68% in recipients of VY kds respectively. Mean hospital stay was 6 days in both gps. One pt. (8%) in the VY gp and no pt. in the VO gp experienced acute graft rejection. In the VO gp, one patient experience early graft thrombosis of both kds, three pts experienced ureteral stenosis, one pt. develop urinary leak and one pt developed a lymphocele after tx. Three gft losses occurred in the VY gp: 1 due to lymphoma 11 months post tx, 1 due to HUS 7 mos post tx and one due to early thrombosis on POD 2. Four pts experienced UTI’s and 3 pts developed incisional subcutaneous seroma. Mean serum creatinine at 3 and 5 years were 1.23 and 1.38 mg/dl respectively. Mean eGFR at 3 and 5 years were 56.8 and 55.65 ml/min respectively. Our study showed that using dual kidneys from cadaveric donors that fall outside the general acceptance criteria for kidney donation are a valuable source and can maintain a good eGFR and provide acceptable long term outcomes compared to conventional single kidney transplant when properly placed.