The use of kidneys from uncontrolled donors after cardiac death (uDCD) remains disputable due to significant warm ischemia time (WIT) causing ischemia-reperfusion injuries. The aim of study was to use machine perfusion as a tool for preoperative selection and recovery of kidneys obtained from 22 uDCDs from December 2005 until July 2007. The results of transplantation of 21 pump-perfused kidneys (study group) were compared with 17 cold-stored kidneys (control group) from the same donors. The use of pulsatile perfusion allowed kidney transplantation from nine marginal uDCDs with extreme WIT (59 to 65 minutes). At the same time, we discarded five paired kidneys from the control group. The rate of immediate function among the study group was 30% greater than that in the control group. The creatinine level in control group was twice as high on day 21 and at 3 months after transplantation than among the study group. A considerable number of complications and the negative effects correlated with the cold-stored group of kidneys. In conclusion, machine perfusion is an instrument to select kidneys from uDCDs at the preoperative stage, thereby improving postoperative function of these grafts.