Since the frequency of living-related and unrelated kidney donation has increased in the past decade, the risk of uninephrectomy should not be neglected. Major complications after kidney donation are rare. No serious problems like infection or bleeding are common with an overall perioperative complication rate of 14%. Risk of long-term mortality is lower compared to the expected mortality. Little decrease of glomerular filtration rate immediately after transplantation occurs with no further decline. Risk of end-stage renal failure in living donors is approximately 0.2-0.5%. Only a few patients develop proteinuria. After age adjustment, no increase of blood pressure is noted. The benefit of living kidney transplantation is superceding the potential risks. After careful work-up of the donor short- and long-term risks are minimal.