For a patient with end-stage renal disease, the best option is a living donor transplant. The major concern about living donor transplantation is the risk to the donor. The donor operation is a major procedure that is associated with morbidity, mortality, and the potential for adverse long-term consequences, secondary to living with a single kidney. The surgical risks for laparoscopic and open nephrectomy are similar. The most common causes of death have been pulmonary embolism, bleeding, and infection. Living donors report a similar or better quality of life, as compared with the general population. Risk factors for less positive quality of life after donation have also been identified, including poor donor or recipient physical outcome, a negative personal donor-recipient relationship, and financial hardship. Population studies have shown that smoking, obesity, hypertension, and elevated blood glucose levels are associated with an increased risk of proteinuria and kidney disease.