To determine the accuracy of Sixteen-row Multidetector Computed Tomography angiography (MDCTA) in assessment of renal vasculature and upper urinary tract in living renal donors and correlate the findings with Magnetic Resonance Angiography (MRA), Digital subtraction angiography (DSA) or surgery. 350 prospective living renal donors were evaluated with MDCTA & MRA from 10th October,2004 till 30th June,2006. The findings were analyzed by two radiologists and compared with DSA or surgical findings. The number of vessels and pattern of early branching arteries was assessed. Interobserver agreement between MDCTA and DSA/surgical findings was quantified by using weighted Kappa statistics. MDCTA findings were compared with MRA taking surgical findings/DSA as the ‘gold standard’. Sensitivity and specificity of MDCTA in identifying accessory vessels and branching pattern was also evaluated. MDCTA showed clear delineation of the main renal arteries and veins in all the donors with detailed vessel morphology. Correlation between MDCTA and MRA findings was excellent for renal arteries (K = 0.821) and good for renal veins (K = 0.637). Agreement between MDCTA and surgical findings/DSA was excellent for renal arteries (K = 1.0) and veins (K = 0.889). The sensitivity and specificity of MDCTA was 100% for early branching arteries and accessory arteries/veins. The accessory renal vessels had an overall incidence of 26.7% with commonest distribution in the parahilar region. At urography, the upper urinary tract was well-opacified in all the patients.MDCTA is superior to MRA in detection of accessory vessels and should be the standard imaging method for living renal donors.