In the early 1990s, live kidney donation regained popularity to meet the demand of kidney transplantation. Significant developments in the field of live kidney donation have established live donation as the prime source of kidney transplants. Nowadays, management is focused on logistic and immunological innovations, and improvements in care of the live donor. However, a flawless surgical procedure in both donor and recipient is a prerequisite for further expansion of live kidney donor transplantation. From a surgical perspective, the introduction of the laparoscopic approach has been a major breakthrough. Less invasive techniques to procure live donor kidneys have been held responsible for a steep increase in the number of live donors. In addition, less invasive imaging, improvements in perioperative care, and novel insights in the follow-up have all improved the care of the live donor. Live kidney donation is developing as the most promising source of renal organs since artificial kidneys, xenografts and stem cell therapy for restoring intrinsic kidney function will probably not find application on a large scale in the near future.