cadaver renal transplantation is fast becoming an important modality in the management of end - stage renal disease ( esrd ) , in india . in the present scenario it is imperative that we improve the donor pool , such that more chronic kidney disease patients are benefited . the existing renal malignancy is a contraindication for renal transplantation , but data regarding graft kidneys with suspicious solid renal masses are not widely available . a 50-year - old man with a history of road traffic accident ( rta ) was admitted to intensive care unit ( icu ) and declared brain dead . formal consent for organ donation was obtained from the relatives and organ harvesting was done . under the organ sharing network , our institution received the left kidney . a 36-year - old , same blood group , routine evaluation of the recipient was done . during bench dissection of the donor kidney , a 1.5  2 c - arm screening was done and no radio opaque lesion was seen . as the cadaver transplantation was done in odd hours , frozen section facilities were not available . as the lesion was found in the mid zone of the graft kidney , partial nephrectomy was not attempted and we proceeded with enucleation of the solid lesion . the nephrotomy wound was closed with absorbable sutures and the kidney was grafted to the recipient [ figure 1 ] . post - operative recovery was uneventful and urine output improved to 150 - 200 ml / day from post operative day two . donor autopsy was done and no evidence of any other malignant lesions or lesions suggestive of metastasis was found . renomedullary interstitial cell tumour , a benign lesion of the renal medulla [ figure 2 ] . renal imaging with a plain ct scan done two months postoperatively , found no lesion in the kidney . although the number of live and cadaver renal transplants have increased in recent years , there continues to be a significant deficit . the increase in the donor pool is not able to match the ever increasing population with esrd and many patients die each year waiting for a suitable graft . the presence of malignancy in a renal graft is considered to be a contraindication to renal transplantation . there are many studies that have studied the use of kidneys with incidental detected renal masses in renal transplantation . our decision in this case to go ahead with the transplantation of the graft after enucleation was due to the small size of the lesion , its grossly benign appearance , and to give the recipient a better chance of survival and quality of life . in july 2009 , reported a series of five cases where < 2.3 cm incidental renal masses were subjected to back table partial nephrectomy and transplanted into the matched recipients . there was no evidence of cancer - specific mortality or recurrence at a 15-month follow - up . mchayleh et al . , in 2008 , reported two cases of metastasis from renal cell carcinoma in a kidney allograft . hence , many articles have been published regarding the use of grafts with renal malignancies . however , data on the management of benign renal masses in donor kidneys are few . renomedullary interstitial cell tumour is a common autopsy finding in patients over 50 years , being found in about 30% of this group . these lesions are usually round to oval , pale gray to yellow with a mean size of 3 mm . clinically symptomatic tumours are rare . the term  renomedullary interstitial cell tumour was coined by lerman et al . , in 1972 . the previous terminology used was  renal medullary fibroma. the finding of a discrete renal mass during bench dissection for a cadaveric renal transplant raises many questions . forty to fifty percent of renal masses less than 2 cm in size are benign . meticulous back table dissection and subsequent histopathological confirmation are necessary when such kidneys are transplanted . hence , such transplant recipients should be diligently followed up to look for recurrence of renal masses and also for occurrence of metastasis . this situation also brings up the case of the need for imaging studies like a contrast - enhanced ct , for the evaluation of potential cadaveric donors . in some cases , it may not be possible to shift the brain dead donor with all supports to the ct room . hence , at least a bedside ultrasound may add to our preoperative assessment of the kidney . incidentalomas like in our case could have been picked up on imaging and the surgical team was better prepared to deal with the situation . therefore , routine imaging studies like the ct or ultrasound may be advocated for all potential cadaveric donors , preoperatively . the increase in the use of imaging studies for a variety of abdominal conditions has increased the rate of detection of small clinically insignificant renal masses .
the number of patients living with end - stage renal disease ( esrd ) is increasing in our country and demand for renal grafts is ever increasing . 
 cadaver renal transplantation is being established as a viable supplement to live transplantation . 
 we present a case where a mass lesion was encountered in the donor kidney from a cadaver . 
 enucleation of the lesion was done and we proceeded with the grafting . 
 histopathological examination showed a 
 renomedullary interstitial cell tumour , a rare benign lesion . 
 post transplant , the renal function recovered well and the patient is asymptomatic . 
 such incidental renal masses present an ethical dilemma to the operating surgeon .