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AbstractSince June 1983, 27 kidneys have been shipped to the Kidney Center at the Tokyo Women's Medical College (TWMC) from the United States. These organs were divided into two groups, based on the years of their donation; 13 kidneys were assigned to group 1 and 14 to group 2. The differences between the two groups were as follows: donor age 19.8 ± 10.0 years vs 51.9 ± 14.5 years in group 2 (P <0.0001); total ischemic time 42 h 12 min in group 1 vs 65 h 42 min in group 2 (P= 0.0002); and Euro‐Collins preservation solution in group 1 vs University of Wisconsin (UW) solution in group 2. One hundred percent of the kidneys in group 1 and 85.7 % of those in group 2 recovered their function. The lowest serum creatinine levels averaged 96 + 38.4 µmol/l and 185.8 ± 101.0 umol/l, respectively (P= 0.01). The viability of 9 out of 14 grafts in group 2 were tested using 31P magnetic resonance spectroscopy (31P‐MRS). The results showed that all of the grafts having a monophosphate/inorganic phosphate (MP/Pi) ratio higher than 0.3 recovered their function and those lower than 0.2 did not. The problems associated with international organ sharing are discussed, along with the difficulties encountered at TWMC.