The practice of live renal donation remains a competition between minimization of the risk to the healthy donor and the ease of reimplantation of the donated kidney. One of the bedrock principles underpinning the practice of live renal donation is leaving the donor with the better kidney, whenever a discrepancy exists between the 2. If both are equal, the left kidney is generally preferred by recipient surgeons owing to the increased length and often thicker wall of the renal vein compared with the right. This facilitates reanastomosis to the iliac vessels, especially in recipients with a deep pelvis or a high body mass index. However, the wide application of laparoscopic donor nephrectomy has created strong incentives to bend these rules. Before laparoscopy, about 30%-40% of donor kidneys were right kidneys. Some even advocated the preferential use of right kidneys in fertile women, to avoid the possibility of physiologic hydronephrosis of pregnancy. With widespread laparoscopic nephrectomy, only 5%-10% of donor kidneys are the right kidney. 1 Wright T.A. Wilt T.A. Holt D.R. et al. Laparoscopic living donor nephrectomy: a look at current trends and practice patterns at major transplant centers across the United States. J Urol. 2008; 179: 1488-1492 Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar In addition to the anatomic reasons mentioned, laparoscopic surgeons are reluctant to remove a cuff of vena cava with the right donor kidney, preferring to divide the right renal vein with a staple line on several millimeters of vein. This makes the right donor kidney less desirable for transplantation. When decisions are made regarding which kidney to remove, the ease of laparoscopy often becomes the primary consideration. Why We Did Not Use Left Side for This DonorUrologyVol. 74Issue 1PreviewWe describe a case of an unusual variation of the double retroaortic left renal vein discovered during routine donor examination of the abdomen by multidetector computed tomography. A 53-year-old man underwent evaluation in our department as a potential renal donor for his brother who had end-stage renal failure. Multidetector computed tomography angiography showed double retroaortic left renal veins. This can increase the potential for serious morbidity and mortality in the donor. We prefer right kidney for potential donation. Full-Text PDF ReplyUrologyVol. 74Issue 1PreviewI would like to thank Stuart M. Flechner, who is one of the eminent researchers of this issue, for his interpretations and comments on our article. Right donor nephrectomy is reserved for instances in which the left kidney is determined to be unacceptable for transplantation. The indications most often cited are multiple left renal arteries or veins, anomalous left anatomy, smaller right kidney, or a cystic mass in the right kidney.1,2 In our case, the diethylenetriamine pentaacetic acid-determined glomerular filtration rate of the left kidney was 68.85 mL/min/1.73 m2 and that of the right kidney was 45.78 mL/min/1.73 m2. Full-Text PDF