With advances in solid organ transplantation, combined heart–kidney and liver–kidney transplantation have evolved as separate entities. Both procedures share the similarities of unmatched kidney grafts with short, cold ischemic time, reduced rejection rates of the kidney, pretransplant exclusion of reversible renal dysfunction due to terminal heart or liver failure, and the operative procedure being performed synchronously with organs from the same donor. Generally, both combinations result in short-and intermediate-term survival rates comparable with those of respective single-organ transplants. Both organs have been shown to be rejected independently from each other and this fact is implemented in surveillance strategies. When accurately evaluated and indicated, heart–kidney and liver–kidney transplants are justified as a routine procedure for a selected group of patients with double organ failure and do not mean wasting of valuable resources.