To the Editor: In a recent issue of the American Journal of Transplantation, Kayler et al. reported on kidney transplantations from very young donors (1Kayler LK Magliocca J Kim RD et al.Single kidney transplantation from young pediatric donors in the United States.Am J Transplant. 2009; 9: 2745-2751Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar). In general, the elaborated analysis confirms the excellent results after pediatric en bloc kidney transplantation published by our group and others (2Thomusch O Tittelbach‐Helmrich D Meyer S et al.Twenty‐year graft survival and graft function analysis by a matched pair study between pediatric en bloc kidney and deceased adult donors grafts.Transplantation. 2009; 88: 920-925Crossref PubMed Scopus (39) Google Scholar, 3Sureshkumar KK Reddy CS Nghiem DD et al.Superiority of pediatric en bloc renal allografts over living donor kidneys: A long‐term functional study.Transplantation. 2006; 82: 348-353Crossref PubMed Scopus (68) Google Scholar, 4Dharnidharka VR Stevens G Howard RJ En‐bloc kidney transplantation in the United States: An analysis of United Network of Organ Sharing (UNOS) data from 1987–2003.Am J Transplant. 2005; 5: 1513-1517Crossref PubMed Scopus (65) Google Scholar). However, we disagree with the conclusion drawn from Kayler et al. (1Kayler LK Magliocca J Kim RD et al.Single kidney transplantation from young pediatric donors in the United States.Am J Transplant. 2009; 9: 2745-2751Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar) that the cut‐off for split versus en bloc kidney transplantation from very young donors ought to be set at a donor weight of 10 kg. Our first objection is that Kaylers’ analysis excludes the top and bottom percentiles. Especially the removal of very low‐weight donors may skew the results, because these very young donors (<12 months or <10 kg) present most complications and the highest risk for early graft loss. Furthermore, as shown by Kayler et al., early splitting in donors between 10 and 20 kg leads to results comparable with those from marginal adult donors. In contrast to Kaylers’ statement, we do not regard en bloc transplanted kidneys from young donors up to 20 kg as equal to organs from marginal donors, but as excellent organs (GFR approx. 100 mL/min 10 years after transplantation (2Thomusch O Tittelbach‐Helmrich D Meyer S et al.Twenty‐year graft survival and graft function analysis by a matched pair study between pediatric en bloc kidney and deceased adult donors grafts.Transplantation. 2009; 88: 920-925Crossref PubMed Scopus (39) Google Scholar)) with an increased risk of initial graft loss. In addition, Kayler et al. fail to consider the importance of adequate recipient selection criteria. In our experience, a recipient's BMI of less than 25 kg/m2, a recipient to donor body weight ratio between 0.2 and 0.25 as well as the absence of renal hypertension play a key role for transplantation outcome, especially following pediatric single and en bloc kidney transplantation. Moreover, en bloc kidney transplantation from pediatric donors is a surgical and technical challenge. This difficulty becomes even further pronounced after organ splitting. Thus, dividing en bloc kidneys does not always yield two transplantable organs due to an increased rate of discarded grafts. Finally, because of the high mortality rate of patients on the waiting list, the aim of transplantation should not be a high number of transplanted kidneys but primarily a good long‐term organ function, a low number of graft losses during follow‐up, and a good patient quality‐of‐life after kidney transplantation. For the above reasons, we advocate setting the cut‐off for organ splitting at a donor weight of 20 kg.