Kidney transplantation from living donors is widely performed all over the world. Living nephrectomy for transplantation has no direct advantages for the donor other than an increased self-esteem, but at least remains an extremely safe procedure, with a worldwide overall mortality of 0.03%. This theoretical risk for the donor seems to be justified by the socioeconomic advantages and increased quality of life of the recipient, especially in selected cases, such as pediatric patients, when living donor kidney transplantation can be performed in a pre-uremic phase, avoiding the psychological and physical stress of dialysis, which in children is not well tolerated and cannot prevent the retarded growth. Some forms of psychological conditioning are difficult to be recognised in a family setting, while economic dealings may be on purpose concealed even by the donor. According to the Ethical Council of the Transplantation Society, commercialism must be effectively prevented, not only for ethical but also medical reasons. The risks are too high not only for the donors, but also for the recipients, as a consequence of poor donor screening and evaluation with consequent transmission of HIV or other infective agents, as well also of inappropriate medical and surgical management of donors and also of recipients, who are often discharged too early. Most public or private insurance companies are considering kidney donation a safe procedure without long-term impairment and therefore do not increase the premium, while recipients’ insurances of course should cover hospital fees for the donors. "Rewarded gifting" or other financial incentives to compensate for the inconvenience and loss of income related to the donation are not advisable, at least in our opinion. Our Centre does not perform anonymous living organ donation or “cross-over” transplantation.