The overall number of transplants per million of population has increased to 60.8, which is the highest in Europe. However, the increase in kidney transplants in the new millennium has mainly been due to an increased deceased donation rate. The short waiting list for deceased donor kidney transplantation, less than 50 per million inhabitants, reflects the high transplant rate. In our opinion, renal transplantation is a safe and satisfactory treatment for patients with terminal kidney failure, including patients over the age of 70. The patient must fulfill the medical criteria for acceptance for transplantation. Ideally, the patient should receive a transplant before the commencement of dialysis, or as soon as possible after starting dialysis. Organs from old and suboptimal donors can be transplanted as single grafts with very good outcomes. Furthermore, functional capacity prior to organ retrieval is far more important than evaluation of kidney biopsies at the time of engraftment.