A kidney with triple renal arteries was removed from an HLA identical donor and transplanted to her brother using the donor hypogastric artery as an autogenous graft. The kidney was preserved by hypothermic, hyperkalemic, hyperosmolar washout solution while the three separate renal artery-hypogastric artery autograft anastomoses were being performed in an ex vivo position. Subsequently, the end to side autogenous hypogastric artery patch graft to external iliac artery anastomosis was completed. Prompt renal function occurred and after 18 months the serum creatinine level remained unchanged.