Purely technical considerations play an important role in successful renal homotransplantation. Minimization of homograft ischemia is critical. Additional important factors involve the site of placement of the homograft, provision for unkinked vascular channels, selection of a method of ureteroneocystostomy which permits early removal of the urethral catheter, and use of a one-stage operation incorporating bilateral nephrectomy and splenectomy in addition to homotransplantation. In the present study, the methods used to meet these purely surgical requirements will be described as they have evolved in the course of caring for the first 42 patients treated with renal homografts from living donors. Consideration will not be given to patients receiving cadaveric kidneys1 or two who received homografts from identical twins,2 since the circumstances in such cases are different than those which obtained with our major experience. The prerequisites and techniques of the donor operation have recently been fully documented by Marchioro