The aim is to assess the early respiratory problems in 473 live donor nephrectomies this performed from November 1989 to February 2003. Living donor nephrectomy was performed through a transperitoneal (9, 1.9%) and flank (464, 98.1%) incision during about 15 years. In more than 90% obligated to remove the 11th rib due to better exposure. In about 60% (255 cases) of these donors pleura has ruptured. Length of injury was varied from a small hole up to 10 cm. In one case chest tube inserted during the procedure (0.2%) and in reminders the pleura repaired with 3.0 or 2.0 chromic sutures. In the recovery room and the day after operation the chest X-ray film was obtained to exclude the possibility of pneumothorax. The 473 live donors for respiratory complications analyzed included 370 (78.2%) men and 103 (21.8%) women respectively. There were no respiratory problems among abdominal nephrectomies cases, but some in flank approaches. No significant differences were noted between gender, age and side of nephrectomy (P<0.05). The major respiratory problems were occurred including pneumothorax in 8 (1.6%), focal bronchopneumonia in 9 (1.9%), aspiration pneumonia in 3 (0.6%), hydropneumothorax in 4 (0.8%), and atelectasis in 1 (0.2%) case. In cases of hydropneumothorax and pneumothorax (13, 2.7%) the chest tube was inserted immediately which, others managed medically. It is concluded that live donor nephrectomy is a safe procedure with no mortality and low incidence of respiratory complications, which about 5.2% (P=0.21) recorded in our center. Consequently the pleural injury would be enough to repair and inserting the chest tube is usually not necessary.