The most common surgical approach used for cadaveric donor nephrectomy is the en bloc technique through a large abdominal incision. Transplantation using organs from cadaveric donors is always performed with the over-riding need to minimize the cold ischemic time of the organ. There are a number of techniques for anastomosing the ureter to the bladder. These include the Leadbetter-Politano or a direct vesico-ureteric anastomosis. Many patients with renal failure have significant atherosclerosis, with calcification resulting in noncompressible solid arteries that cannot be clamped. Careful preoperative assessment by computed tomography scanning should allow identification of calcified arteries before listing for transplantation. The preferred donor procedure is a laparoscopic nephrectomy, with mobilization of the kidney assisted by the use of a hand port, usually through a small infra-umbilical midline incision through which the kidney is removed. Late vascular complications are usually stenosis of the arterial anastomosis.