Surgical technics for the excision and transplantation of paired renal graft from pediatric donors to adult recipients is described. Experience based on literature and on two own transplantations speaks for the adoption of this policy. The operation is technically advantageous. The double transplant provides a greater functioning renal mass as compared with the use of a single pediatric graft. In case of a rejection which can result in loss of some renal capacity, the double transplant is more likely to be able to maintain sufficient fuction even in adult recipients. The importance of a properly performed donor operation is stressed.