It is apparent from calculations that for paired kidney donation programs, a national program will provide optimum benefit. To obviate major problems associated with donors traveling long distances, we propose shipping donor kidneys. Evidence is provided from the United Network for Organ Sharing (UNOS) Kidney Transplant Registry, that 14 873 immediate functioning kidneys from deceased head-trauma donors with an average cold ischemia time of 18.3 h had 85.7% three-yr graft survival compared with 87.8% survival of 23 369 transplants from living donors with 2.4 h of ischemia. Grafts from 10 368 deceased donors with 13–24 h cold ischemia time had three-yr graft survival of 82.6% compared with 84.2% for 1153 transplants with up to six h cold ischemia time. After adjusting for major confounding factors, cold ischemia does not significantly influence graft survival. We conclude that shipment of donor kidneys can be performed safely and will significantly increase paired donor transplants.