This chapter discusses about some factors associated with donors or recipients that require variations in implantation technique, where it is up to the transplant team to determine the best approach. External iliac artery and vein interposition technique is useful in instances where there is a short transplant renal vein, such as in right kidney grafts from live donors, right kidney grafts from deceased donors where a reconstruction is not desired or possible, or organs with arterial or venous injuries that cannot be reconstructed. In instances where the renal vein is very short, implantation of the kidney may be facilitated by anastomosing the renal vein onto the recipient inferior vena cava (IVC). In instances where two kidneys are transplanted the surgeon must decide whether to implant them ipsilaterally or contralaterally. A double ureter in the donor can be addressed in a variety of ways, where each ureter can be potentially implanted independently into the bladder.