In this study, we compare laparoscopic donor nephrectomy (lap Nx) to open donor nephrectomy (open Nx), with specific emphasis on outcome parameters in the donor and recipient. This is a single-center prospective and sequential analysis recruiting 100 consecutive donor-recipient pairs operated upon from 1997 till 2003 (open Nx performed 1997-200 and lap Nx performed 2000-2003) with recording of operative data, anatomic details of graft, hospital stay and donor recovery. Donor characteristics and renal function were similar for open Nx and lap Nx. Operative parameters were similar except for longer warm ischemia time in lap Nx vs. open Nx (3.14±2.10 vs. 1.5±0.5 min, p<0.001). Donor complications were equivalent but differed in spectrum. Donor recovery, hospital stay, and return to work were improved in lap Nx vs. open Nx (p<0.001). Renal function and graft survival were similar. Lap Nx offers major advantages to the donor compared to open Nx, and yields similarly favorable results in graft outcomes, but is more surgically demanding. Consequently, lap Nx should be adopted as the procedure of choice of live kidney retrieval.