The number of living donations is increasing in Europe and especially in Germany. The reasons seem to be a continuous shortage of cadaveric organs, better results after living related and living unrelated donation, and a high willingness in the population to donate. Various legal prerequisites have to be fulfilled in different countries. In general, careful donor evaluation is necessary to avoid excessive risk in the donor. Nephrectomy for transplantation can be performed via various approaches; microinvasive surgical techniques have been introduced, but are not yet established. Immunosuppression in living related donation is no different from that in cadaveric transplantations. In conclusion, living donation seems to be an adequate alternative to cadaveric donation. Moreover, results are twice as good as cadaveric donation with regard to long-term function.