In principle, the use of living donors is unanimously accepted all over the world. There is no conclusive argument that could justify a general exclusion of unrelated donors. Available evidence suggests that decisions about the acceptability of living unrelated donors should be made on a case-by case basis. To illustrate the characteristics of living kidney donors in Syria in order to better understand the circumstances of living related and unrelated donation and whether we need relevant guiding principles or just to apply them, a retrospective analysis of the medical records of 933 kidney donors who underwent kidney donation in all active kidney transplant units of different hospitals in Damascus during the years 2005, 2006, and 2007 was performed. The following characteristics were recorded: blood relation, age, gender, and difference in age between recipient and donor. A total of 933 kidney donors were enrolled in this study, of them 454 donors (49%) had been operated in public hospitals and 479 donors (51%) in private hospitals. There were 666 unrelated donors (71%) and 267 related donors (29%). When we looked at this issue separately between private and public hospitals, we realized that in private hospital, 92% of donors (439 cases) were unrelated compared to 50% (227 cases) in the public hospitals, and only 8% of donors (40 cases) in private sector were blood-related donors compared to 50% (227 cases) in public hospitals. The analysis of donor characteristics has shown male predominance with 65% of the total donors being males and up to 87% of the unrelated donors were also males, however there was no gender predominance when it concerns the related donors who were equally distributed between males and females. With regards to the donor age, more than 90% of the unrelated donors were below the age of 40 years compared to 69% of the related donors. The majority of unrelated group were aged between 30-40 years while the majority of the related group were younger and aged between 18-30 years. 46% of donors were younger than their recipients with a mean difference in age of 14 years. 54% of donors were older than their recipients with a mean difference in age of 12 years. Male to male donation was encountered in 40% of cases (the most frequent) compared to only 11% in female to female donation (the least frequent). Male to female and female to male were each seen in 25% of cases. In conclusion, The vast majority of living kidney donors in private hospitals were unrelated to recipients, one has to keep skepticism about the claimed altruistic nature of the unrelated donation act in these settings, and consequently to urge the health authorities and the transplant professional to create a system that incorporate the cultural and legal resources to provide sufficient controls, checks and balances to keep it from getting on the "slippery slope" towards commercialism which could undermine public trust in the transplant system.