Terminally ill patients who do not meet brain death criteria and die of cardiac arrest after withdrawal of life support may be considered as potential organ donors: such donors are referred to as controlled donors after cardiac death (dcd). Controlled dcd donors are increasingly being used in northern europe and the united states in an effort to expand the donor pool. Ethical concerns regarding the diagnosis of death based on cardiopulmonary rather than neurological criteria have largely been resolved over the past decade. Follow-up studies of recipients by several transplant centers have shown that functioning controlled dcd kidneys are equivalent to kidneys from conventional brain-dead donors with respect to long-term prognosis. Concerns about long-term repercussions for the higher incidence of delayed graft function with dcd kidneys are not supported by the current evidence. The donor pool may be further expanded by transplanting selected kidneys from older dcd, in particular for the increasing population of older kidney transplant candidates. Successful transplantation of these delicate organs is possible when donors and recipients are carefully managed by well-trained, motivated, and effectively collaborating transplant personnel.