Renal transplantation program in Egypt is still waiting for the legislation of cadaveric kidneys. In our locality, we have a unique strong motivation and competence between family members to donate a kidney. However, many patients with end stage renal disease do not have suitable genetically related donors. Spousal renal donation has become an important source of donor kidneys. In this report, we retrospectively analyzed the results of spousal donor renal transplantation and contrasted them with genetically related donor transplants. Among 1583 transplants performed between 1976-2003,116 spousal kidney recipients were performed (group 1); 113 husbands and 13 wives. Their outcome was compared with a matched first graft recipients from living related donors (n=150;group2). The mean age(+SD) of recipients was 34.5+7 and 35.5+5 years for group 1 and 2 and were followed for 60.4+30 and 63+35 months respectively.There was no difference in the incidence of delayed graft function,biopsy proven acute rejection and serum creatinine levels at 1 and 5 years. Graft survival rates were 77% and 75.7% for group 1 and 2 respectively. In conclusion, spousal kidney transplantation shares comparable results with live related donor transplants. However, the ethical and social aspects should be considered to be sure that spousal donation is free of coercion or pressure from either the family or the recipient.