In order to deal with the organ shortage, the use of organs from marginal donors has emerged as an obvious option. The decision to accept a kidney from an expanded criteria donor is left to the transplantation centre. This study was carried out to evaluate whether clinical judgment is a suitable method to decline a kidney from a marginal donor. This was a retrospective study of the outcome of marginal kidneys rejected by our centre between 1st January 2000 and 31st December 2006 but accepted by another centre. The decision to refuse a marginal kidney was based on the clinical judgment of the nephrologists on call. Kidney refusal was retrospectively considered as a "mistaken decision" when the kidney was transplanted in another centre and when the estimated GFR was above 60 mL/min/1.73 m(2) one year after transplantation. The DD score was calculated retrospectively for every rejected kidney. During the study period, 304 kidneys were not accepted for transplantation. Of these 304 kidneys, 55 marginal kidneys were not accepted by the nephrologists on call. Among these 55 marginal kidneys, 44 were accepted and transplanted in another centre. Early graft loss occurred in 2/44 recipients. Death censored allograft survival at one and two years was retrospectively 98 and 93%. Kidney refusal was considered as a "mistaken decision" for 12/44 rejected kidneys. Of these 12 rejected kidneys, only two could have been considered as marginal kidneys by the DD score, as compared with 27/30 of the remaining rejected kidneys. Our study shows that clinical judgment alone is not a suitable method for selecting marginal donors. Proven definitions of "marginal donor", available to physicians when the medical decision has to be made, may help nephrologists in their clinical practice.