Introduction: Donation after circulatory determination of death (DCDD) donors are increasingly considered a viable organ supply and are adding to the global donor pool. The current study aims to evaluate the results of Maastricht Category IV DCDD kidneys.
Method: To examine the results of Maastricht Category IV DCDD kidneys, a single-center retrospective study was conducted between February 2011 and April 2025. The patient information was obtained from file records, an electronic database, and outpatient department (OPD) follow-ups.
Results: 42 kidneys were removed from 21 suitable DCDD donors. Seven kidneys (16.6%) were discarded (6 unsuitable and 1 without a recipient), leaving 35 kidneys (83.3%) that were used. A total of 31 individuals—27 single kidney recipients and 4 dual kidney recipients—with a mean age of 41±11.7 years were given kidneys. The average age of donors was 31±15 years, and most of them suffered head traumas (15/19). The mean warm ischemia time was 56±8.9 minutes. The rates of primary non-function (PNF) and delayed graft function (DGF) were 9.67% and 70.9%, respectively. There was a 7.14% early rejection rate. During the study period, there were 8 graft losses (25.8%)—3 PNF and 5 following initial function. The eGFR showed a significant increase (P=0.0039) up to two years following transplant, followed by a decline. 
The percentage of DCDD kidney recipients in the whole donor pool was 7.5% (31/411).
Conclusion: In situations where managing Maastricht category III kidneys proves to be challenging, Maastricht category IV kidneys have demonstrated comparable efficacy to DCDD kidneys retrieved from other parts of the world.