In the early 1990s live kidney donation regained popularity to meet the demand of kidney transplantation. Significant developments in the field of live kidney donation have established live donation as the potential prime source of kidney transplants in the future. Nowadays management focuses on logistic and immunological innovations, and improvements in care of the live donor. However, a flawless surgical procedure in donors and recipients is a prerequisite for further expansion of live kidney donor transplantation. From a surgical perspective the introduction of the laparoscopic approach has been a major breakthrough. Less invasive techniques to procure live donor kidneys have been held responsible for a steep increase in the number of live donors. In addition, less invasive imaging, improvements in perioperative care, and novel insights in follow-up have all improved the care of the live donor. Live kidney donation may develop as the most promising source of renal organs since artificial kidneys, xenografts and stem cell therapy for restoring intrinsic kidney function will probably not find application on large scale in the near future.