The donor kidney will be brought to the OR and will be prepared to be implanted into the recipient. Fat will be cleaned off, and the vessels will be dissected clean and will be shortened to make the anastomosis easier. An aortic cuff may be used if the kidney came from a deceased patient. The veins need to be reconstructed, and there will be branches that will need to be ligated, but a large renal vein will be kept. The kidney will either be place in the iliac fossa, or in the retroperitoneum. An large incision with a 10 blade will be made, and the external oblique muscle and fascia are dissected. The internal oblique and transverse muscles will be divided to expose the peritoneum. The inferior epigastric will be ligated, and the spermatic cord will be preserved. The renal artery and vein will be anastomosed. The renal vein will be attached to the external iliac vein, usually with a small Prolene suture. The artery will be attached to the external iliac artery. The aortic cuff will be trimmed and fitted to the renal artery, and attached to the arrteriotomy in the external iliac artery. Now the urinary tract will be reconstructed. The bladder will be incised, and the patients' ureter is found. An incision is made in it.the donor ureter will be fed through the incision into the bladder and anastomosed with absorbable suture. The bladder incision sis closed, and the bladder is filled to check for leaks. The tissue will be reapproximated and closed with suture. Notes: booties should be placed on some mosquitos for clamping suture, and ties should always be available on the sterile field.