Early renal transplantation is hampered by a long-standing lack of organ donors, particularly in Germany, which leads to long waiting times for postmortal kidneys. Despite the expansion of donor criteria and the transplantation of marginal organs, the curve for the number of kidney donors has been flattening and is even decreasing. Living donor transplantation may expand the donor pool; however, up to one-third of potential living donors must be excluded because of blood group incompatibility. Recently, new protocols for ABO-incompatible transplantation have made it possible to overcome blood group mismatch in kidney transplantation. Close cooperation between the nephrology and urology departments at the University Clinic of Erlangen has allowed for successful ABO-incompatible transplantation in seven patients, using the Swedish protocol with slight modifications.