It is current practice to only consider heart-beating donors as suitable for organ donation. Patients who have sustained a permanent cardiac arrest are believed to be unsuitable for kidney retrieval, in the knowledge that the kidneys will have received extensive ischemic damage. In situ kidney preservation (ISP), using the double balloon triple lumen (DBTL) catheter, offers the possibility of harvesting valuable kidneys from these, otherwise unsuitable, donors. With this technique human kidneys can be cooled in situ prior to the donor nephrectomy. During ISP, nephrectomy can be performed under optimal surgical conditions. In this report indications for ISP, insertion technique of the DBTL catheter, legal aspects, and transplantation outcome of kidneys harvested by means of ISP are discussed.