Introduction: Despite a well-established living donor kidney transplant programme, there is still a steep rise in the number of patients awaiting a kidney transplantation. It is well known that kidney transplant from deceased donors have shown improved patient survival compared to those who remained on dialysis. In an attempt to increase the number of donor kidneys, Sri Lanka has introduced a deceased donor programme, incorporating donors that previously would not have been considered optimal, known as expanded criteria donors (ECD). 
Objective: To compare the survival and renal functions of transplant recipients who received kidney as standard criteria donors(SCD) vs ECD.
Method: The study enrolled 74 deceased donor recipients who underwent kidney transplantation between October 2016 and August 2023.  Organs were obtained from 47 (56%) SCDs, and the remaining 36 (44%) were from ECDs. Out of the 36 ECD kidneys 18 were transplanted as single grafts (to 18 different patients), and the remaining 18 kidneys were transplanted as dual grafts to 9 patients. The immunosuppressive protocol for all used Basiliximab for induction, followed by standard triple therapy. The log-rank test was used to compare the difference in survival. The Chi-square test was used to compare the occurrence of postoperative complications and postoperative renal function. 
Result: There were 47 SCD transplants where as 27 ECD transplants. Analysis showed that graft survival at one year were no difference between the two groups; 87% vs 85.1%. (P = 0.13). There were more delayed graft functioning in ECD group 33.3% vs. 23.9% in SCD, (P = 0.4) but this was not statically significant. The 30 day post-operative complications were comparable between the two groups.  The eGFR in the ECD group was lower 66.8±16.9 than that of the SCD group 75.6±13.7 at one month, but no difference at one year post-transplantation. At 33 months post-transplantation follow up the overall graft survival of SCD vs ECD was 78.2 % and 77.7% respectively. The main cause for graft loss was found to be sepsis.  
Conclusion: When carefully selected implantation of ECD-derived kidneys show comparable graft and patient survival when compared to SCD-derived kidneys. However, in selected situations it may be necessary to perform dual implantation of ECD kidneys to obtain a better patient outcome in a resource poor setting like Sri Lanka. Therefore, ECD kidneys should not be excluded as potential donors even during early days of an deceased organ donation programme.