Background: Chronic Kidney Disease(CKD) is getting more and more common in society and at the same time availability of donors is very sparse. In a resource limited country like India, where the cadaver donation rate is low and people don’t readily agree for live donation to their own family members, we have to choose between the optimal and only donors available, even though marginal.

Methods: This is a case report of 23 yrs old male patient, a case of IgA nephropathy with CKD on hemodialysis since one month. He was under the transplant workup with mother as donor but unfortunately mother’s glomerular filtration rate in DTPA scan was low despite a creatinine of 0.8mg/dl, so mother was cancelled as donor. Patient was left with one donor only, his father who was hypertensive since five years. On further investigation father had right renal artery stenosis at osteum, but glomerular filtration rate and other reports were within normal limits. We did a right open donor nephrectomy and transplanted right kidney in the recipient. Right renal artery ligation was done distal to the osteal stenosis.

Results: The transplant surgery was uneventful and the recipient attained a creatinine of 0.9mg/dl on 5th postoperative day. Donor was discharged on 3rd day with a creatinine of 0.8mg/dl. Donor had a normal blood pressure post operatively and didn’t require any hypertensive medications till date.

Conclusion: A person with unilateral renal artery stenosis can be taken as donor if other optimal donors are not available. It will have two advantages, not only the recipient is cured of the disease but also the donor is free from hypertension or from any risk of development of hypertension in future.