Two distinctly different methods are used for clinical kidney preservation: pulsatile perfusion and static storage. Pulsatile perfusion continuously delivers nutrients including oxygen to the organ at hypothermia (4° to 8°C). Static storage limits nutrient delivery, and the kidneys are stored without oxygen at 0° to 4°C. The superiority of each method has been continuously debated since about 1970. We show in this review that pulsatile perfusion is a better preservation method when judged on the basis of lower delayed graft function (DGF) rate (10 to 15% lower when compared to static storage). The reduction of DGF rates can lower the cost of renal transplantation significantly by reducing the length of hospital stay and eliminating the need for post-transplant dialysis, which is necessary for the transplanted kidney to regain life-supporting function. Furthermore, the trend is for greater late-term loss of the graft (5 to 10 years) in kidneys with DGF. Thus, pulsatile perfusion can contribute to greater long-term graft success and reduce the number of patients waiting for kidney transplantation.