Communicating the current knowledge of medical outcomes after live kidney 
donation necessary to support donor candidates in well informed decision-making 
requires grounding in perspectives of comparison. Baseline risk (without 
donating), risk attributable to donation, and absolute risk (after donating) 
need to be considered. Severe perioperative complications and death are rare, 
but vary by demographic, clinical, and procedure factors. Innovative capture of 
"healthy" controls designed to simulate donor selection processes has identified 
higher risk of ESRD attributable to donation in two studies; importantly, 
however, the absolute 15-year ESRD incidence in donors remains very low (0.3%). 
In the first decade after donation, the risk of all-cause mortality and 
cardiovascular events is no higher than in healthy nondonors. Pregnancies in 
donors may incur attributable risk of gestational hypertension or preeclampsia 
(11% versus 5% incidence in one study). A modest rise in uric acid levels 
beginning early after donation, and a small (1.4%) increase in the 8-year 
incidence of gout, have also been reported in comparisons to healthy nondonors. 
As in the general population, postdonation outcomes vary by race, sex, and age. 
Efforts to improve the counseling and selection of living donors should focus on 
developing tools for tailored risk prediction according to donor 
characteristics, and ideally, compared with similar healthy nondonors.